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Evidence summaries

Motivational Interviewing in the Treatment of Behavioural Problems and Risk Factors

Motivational interviewing appears to be effective in the treatment of a broad range of behavioural problems and risk factors. Level of evidence: "B"

A Cochrane review [Abstract] 2 included 83 studies with 29 563 smokers. Studies were pooled to compare more versus less support. When all studies of additional behavioural therapy were pooled, there was a statistically significant benefit from additional support (RR 1.15, 95% CI 1.08 to 1.22; 65 trials, n=23 331, I²=8%) for abstinence at longest follow-up, and this effect was not different when we compared subgroups by type of pharmacotherapy or intensity of contact. Increasing the amount of behavioural support increased the chance of success by about 10% to 20%. This effect was similar in the subgroup of 8 studies in which the control group received no behavioural support (RR 1.20, 95% CI 1.02 to 1.43; n=4018, I²=20%).

A systematic review 5 included 54 RCTs. The MI interventions were delivered alone or in combination with other interventions, and varied in mode of delivery (e.g. face-to-face, phone), exposure level (duration, number of sessions), and provider characteristics (profession, training). Medication adherence showed significant improvement in 23 RCTs, and other clinical outcomes were improved in 19 RCTs (e.g. risky behaviors, disease symptoms).

A systematic review and meta-analysis 3 investigated whether integrated motivational interviewing and cognitive behaviour therapy leads to changes in lifestyle mediators of overweight and obesity in community-dwelling adults. 10 RCTs involving 1949 participants were included. Integrated motivational interviewing and cognitive behaviour therapy had a significant effect in increasing physical activity levels in community-dwelling adults (SMD 0.18, 95% CI 0.06 to 0.31, p < 0.05). The combined intervention resulted in a small, non-significant effect in body composition changes (SMD -0.12, 95% CI -0.24 to 0.01, p=0.07).

Another meta-analysis 4 assessing motivational interviewing for increased physical activity, cardiorespiratory fitness or functional exercise capacity in people with chronic health conditions included 10 RCTs. There was a small effect in increasing physical activity levels relative to comparison groups (standardized mean differences 0.19, 95% CI 0.06 to 0.32, p=0.004). Sensitivity analysis based on trials that confirmed treatment fidelity produced a larger effect. No conclusive evidence was observed for cardiorespiratory fitness or functional exercise capacity.

Comment: The quality of evidence is downgraded by study limitations.

    References

    • Hartmann-Boyce J, Hong B, Livingstone-Banks J et al. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database Syst Rev 2019;(6):CD009670. [PubMed]
    • Barrett S, Begg S, O'Halloran P et al. Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses. BMCPublic Health 2018;18(1):1160. [PubMed]
    • O'Halloran PD, Blackstock F, Shields N et al. Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil 2014;28(12):1159-71. [PubMed]
    • Papus M, Dima AL, Viprey M et al. Motivational interviewing to support medication adherence in adults with chronic conditions: Systematic review of randomized controlled trials. Patient Educ Couns 2022;105(11):3186-3203. [PubMed]

Primary/Secondary Keywords