Motivational interviewing is an effective method for reducing risky health behaviors, including negative alcohol and sex-related behaviors. Coding patient language during such counselling is an emerging method for understanding mechanisms responsible for behavior change, a necessary step for improving behavior counselling. The most widely employed system for coding patient language in health behavior counselling is the Motivational Interviewing Skills Code (MISC). The MISC codes patient language as reflecting either support for changing a target behavior (change talk) or for sustaining it (sustain talk) according to the tenets of Motivational Interviewing. A past meta-analysis indicated that the number of patient utterances coded as sustain talk and a composite measure of change and sustain talk are significant predictors of behavior change outcomes.
[Photo: Dr. Chris Kahler]
The purpose of this study, led by Dr. Chris Kahler, professor of behavioral and social sciences, was to examine how topics of discussion in a health behavior intervention relate to patient change language across two target behaviors, alcohol use and sex risk. The researchers extended the Generalized Medical Interaction Analysis System (GMIAS), a conversation coding system of patient-provider interaction across various topics addressed in medical encounters, to include a new category and subcategories of topics that capture content typically covered in a health behavior intervention; the new system was referred to as the Generalized Behavioral Intervention Analysis System (GBIAS). The GBIAS was applied to audio recordings of a brief motivational intervention to reduce risky alcohol use and sexual behaviors with Emergency Department patients for the purposes of coding topics of conversation, while the MISC was applied to code conversation as Change or Sustain talk.
Dr. Kahler and his colleagues found that, for both alcohol and sex, discussions focusing on the benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change was also associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patters and contexts, negotiations of drawbacks, and drawbacks of sexual risk behavior change.
In this study, topic coding provided unique insights into the content of patient change and sustain talk. Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behaviors. Interventions addressing multiple health behaviors, like alcohol and sex, should address the unique motivations for maintaining specific risky behaviors.
This study was published in Patient Education and Counselling, Volume 99, Issue 10.
To read more: https://www.ncbi.nlm.nih.gov/pubmed/27161165