# Presentation: 111824

## A CONTENT ANALYSIS OF BRIEF INTERVENTION SESSIONS FOR HEALTH PROMOTION AND REDUCTION OF ALCOHOL CONSUMPTION IN COLLEGE STUDENTS

- Elizabeth M. Rash PhD, ARNP, FNP-C
-  James Schauss M.D., Michael Diechen, M.D., Michael Dunn PhD, Mary Lou Sole PhD, Laura Riddle LFMT, Natalie Mullett, M.Ed.
- University of Central Florida
- Orlando, Florida
- Study funded by grants from Sigma Theta Tau (Theta Epsilon Chapter), Florida Nurses Foundation, and AANP Foundation.  Large study funded by NIAAA (U18 xxx)

## Background

- High rate of negative alcohol behaviors among college students (NIAAA, 2002).
- Brief interventions using Motivational Interviewing (MI) successfully reduce negative behaviors (Miller & Rollnick, 2002).
- Limited analyses of fidelity with MI principles (Miller & Rollnick).

## MI Principles (Miller and Rollnick) 

- Client Centered
- Collaborative
*Dancing vs. wrestling*
*Rolling with Resistance*
- Empathy
- Developing discrepancy
*Values vs. behaviors*

## Background

- NIAAA funded study of college students with evidence of negative alcohol behaviors
- Control Grp. received routine care
- Expt. Grp. Received 2 brief intervention sessions with health care providers trained in MI using NIAAA BASICS (Fleming, Cotter & Talboy, 1997).

## Purpose

- Determine if the brief intervention sessions demonstrated fidelity with motivational interviewing principles

## Methodology

- Content analysis of randomly selected brief intervention session audio-taped transcripts using the Motivational Interviewing Skill Code (MISC) (Miller, 2000) & participant and provider session feedback forms

- The MISC offers good to excellent intra-class correlations and inter-rater reliability
- on global ratings (Moyer, Martin, Catley, Harris, Ahluwalia, 2003).

## MISC

- 1st Pass: global rating
*spirit*
- 2nd Pass: behavior counts
*principles*
- 3rd Pass: computation of talk time* *
*client* *centered*
- Summary scoring
*MI proficiency*
- Not proficient (0-1.9)    Proficient (2-2.9 )    Expert (3+)

## Data Analysis

| Provider (n=sessions) |      Proficiency
         (range) |     Talk Time
          (range) |
| --- | --- | --- |
| W (n=7) | 1.24 (1-1.7) | 60% (35-75%) |
| X  (n=12) | 1.23 (1-1.7) | 67%  (59-80%) |
| Y  (n=2) | 1.05 (1-1.1) | 70% (61-78%) |
| Z  (n=3) | 1.4  (1-1.9) | 46% (28-65%) |
| Total (n1=24)
(n2=10)  | 1.241 (1.26)2 | 62% (28-80%) |

- Rater1  Rater2 *Inter-rater reliability*

## Discussion

- Less talk time correlates with greater proficiency *(albeit still not proficient).*
- Feedback forms reveal positive student perceptions & providers felt they were consistent with MI principles.
- Comparisons (Wilcoxon Signed Ranks Test) of available pre- & 3 mos. post (1-mos. average) BAC (p=0.394) & pre- & 3 mos. post (1-mos. average) peak BAC (p=0.478) demonstrated no significant differences among experimental group. Subset too small to generalize to entire study.
- Design produced artificial setting *(consider blinding providers?)*

## Recommendations & Future Research

- Reassess MI training protocols and needs
- Reassess design
- Determine influence of unintended extraneous variables
- Re-analyze using criteria for a Behavior Change Counseling model

## References

- Moyer, T., Martin, T., Catley, D., Harris, K. J., & Ahluwalia, J. S. (2003). Assessing the integrity of motivational interviewing interventions: Reliability of the motivational interviewing skills code.  *Behavioral and Cognitive Psychotherapy 31, *(2), 177-184.
- National Institute on Alcohol Abuse and Alcoholism. (2002). *A call to action: Challenging the culture of drinking at U.S. Colleges*. NIH Pub. No. 02-5010. Bethesda, M.D.: NIAAA.
- Miller, W. R. (2000). Motivational Interviewing Skill Code (MISC): Coders Manual. University of New Mexico
- Miller, W. R. & Rollnick, S. (2002). *Motivational interviewing (2nd ed.).* New York: The Guilford Press.
- National Institute on Alcohol Abuse and Alcoholism. (2002). *A call to action: Challenging the culture of drinking at U.S. Colleges*. NIH Pub. No. 02-5010. Bethesda, M.D.: NIAAA.
*Thank you to **Rater**2 **Ruchi Gandhi  Shah BSN, FNP resident*