BackgroundTrials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms.MethodsFirst, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk.ResultsWe found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change.ConclusionsMechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
MULTIFILE
Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.
Risk assessment instruments are widely used to predict risk of adverse outcomes, such as violence or victimization, and to allocate resources for managing these risks among individuals involved in criminal justice and forensic mental health services. For risk assessment instruments to reach their full potential, they must be implemented with fidelity. A lack of information on administration fidelity hinders transparency about the implementation quality, as well as the interpretation of negative or inconclusive findings from predictive validity studies. The present study focuses on adherence, a dimension of fidelity. Adherence denotes the extent to which the risk assessment is completed according to the instrument’s guidelines. We developed an adherence measure, tailored to the ShortTerm Assessment of Risk and Treatability: Adolescent Version (START:AV), an evidence-based risk assessment instrument for adolescents. With the START:AV Adherence Rating Scale, we explored the degree to which 11 key features of the instrument were adhered to in 306 START:AVs forms, completed by 17 different evaluators in a Dutch residential youth care facility over a two-year period. Good to excellent interrater reliability was found for all adherence items. We identified differences in adherence scores on the various START:AV features, as well as significant improvement in adherence for those who attended a START:AV refresher workshop. Outcomes of risk assessment instruments potentially impact decision-making, for example, whether a youth’s secure placement should be extended. Therefore, we recommend fidelity monitoring to ensure the risk assessment practice was delivered as intended.
Veel patiënten gebruiken hun medicijnen nog niet optimaal. Ondanks het groeiende aantal interventies en innovaties om de therapietrouw te bevorderen, lukt het maar mondjesmaat om deze ook grootschalig toe te passen in de dagelijkse praktijk. Het Make-It consortium, wat staat voor Medication Adherence Knowledge, Expertise and Implementation Taskforce, houdt zich sinds 1 juli 2019 bezig met de vraag hoe de therapietrouw in de praktijk verbeterd kan worden. Hiertoe begeleidt het consortium proeftuinen die, met subsidie uit de ZonMw STIP ronde laagdrempelige therapietrouw, interventies in de dagelijkse praktijk willen implementeren.Doel Patiënten die chronisch medicatie gebruiken helpen hun medicijnen optimaal te gebruiken. Resultaten Kennis over de implementatie van interventies en innovaties, succesfactoren en knelpunten hiervan, een verbeterde therapietrouw bij patiënten. Looptijd 01 januari 2019 - 01 juli 2025 Aanpak Tijdens het onderzoeksproject worden verschillende interventies, om de therapietrouw in de praktijk te bevorderen, getest. De interventies die succesvol blijken, zullen geïmplementeerd worden in de zorg die geleverd wordt door de deelnemende proeftuinen. Update: Vier proeftuinen hebben in 2020 subsidie gekregen van ZonMw om hun project uit te voeren. De proeftuinen bestaan uit zorgverbanden uit Amsterdam, Almere, Amersfoort en Utrecht. Alle vier zijn zij voorlopers op het gebied van innovatieve zorgprojecten. Momenteel zijn de vier proeftuinen bezig met de afronding van de implementatie van de door hun gekozen interventies. In 2022 hebben vier nieuwe proeftuinen subsidie gekregen voor de laatste ronde van de STIP Call van ZonMw. Dit zijn zorgverbanden uit de Nederlandse Antillen, Friesland, Vleuten en Limburg. Deze proeftuinen zullen in het najaar van 2022 starten met de implementatie van de interventies die zij gekozen hebben.
