Preliminary Findings from Three Models of Motivational Interviewing Training in Jamaica

The Young Adult Centered Healthforce Training (YACHT) Program to Increase HIV Testing and Pre-Exposure Prophylaxis Referrals Among Young Sexual Minority Men in Florida: Protocol for a Type 2 Implementation-Effectiveness Hybrid Trial With a Stepped Wedge Design

BACKGROUND

There is a high incidence of HIV among young sexual minority men in Florida. Many are unaware of their status due to low testing rates. Counseling, testing, and referral (CTR) services are essential for diagnosis and prevention of HIV and are integral to the Ending the HIV Epidemic (EHE) strategic plan. However, efforts to increase CTR among young sexual minority men have not been successful.

OBJECTIVE

The Young Adult Centered Healthforce Training (YACHT) program promotes developmentally sensitive, culturally appropriate, and evidence-based CTR services for young sexual minority men. This study tests whether the YACHT program increases HIV testing among young sexual minority men and fidelity to evidence-based CTR among testing providers.

METHODS

Agencies in Florida EHE counties that tested at least 24 young sexual minority men aged 18 to 29 years in 2021 will be invited to participate. The sites (N=42) will be randomized in blocks of 6 to participate in the YACHT program, following a stepped wedge design. Through YACHT, all sites will receive visits from mystery shoppers (MSs), who are trained to evaluate HIV testing services and complete postvisit quality monitoring assessments. Sites will be offered the opportunity to review their MS feedback and to receive tailored motivational interviewing training and evidence-based technical assistance to address areas of need identified through MS assessments. The study will evaluate whether YACHT leads to increased HIV testing by comparing numbers of young sexual minority men testing for HIV before versus after YACHT's implementation. The Exploration, Preparation, Implementation and Sustainment framework will help understand the barriers to and facilitators of the program's implementation and sustainment.

RESULTS

YACHT was funded in August 2022. Data collection began in June 2023. As of June 2024, 194 MS visits have taken place at 42 sites; 4 (67%) sites from the first block and 1 (33%) site from the second block have engaged with the study. At baseline, sites exhibited the lowest competencies in relationship context, counseling sessions, and safer sex education and the highest competency in privacy and confidentiality. Data collection will continue through May 2027, with results published by the end of 2027.

CONCLUSIONS

To address the high incidence of HIV among young sexual minority men in Florida, YACHT aims to support testing sites with tailored motivational interviewing training and technical assistance to address needs identified by MS assessments. The program seeks to improve delivery of evidence-based CTR services, thereby increasing HIV testing, counseling, and pre-exposure prophylaxis referrals and reducing HIV incidence among this population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06015581; https://classic.clinicaltrials.gov/ct2/show/NCT06015581.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63191.

Influence of provider openness and leadership behaviors on adherence to motivational interviewing training implementation strategies: Considerations for evidence-based practice delivery

Background

Adherence to intervention training implementation strategies is at the foundation of fidelity; however, few studies have linked training adherence to trainee attitudes and leadership behaviors to identify what practically matters for the adoption and dissemination of evidence-based practices. Through the conduct of this hybrid type 3 effectiveness-implementation cluster randomized controlled trial, we collected Exploration, Preparation, Implementation, and Sustainment (EPIS) data and merged it with tailored motivational interviewing training adherence data, to elucidate the relationship between provider attitudes toward evidence-based practices, leadership behaviors, and training implementation strategy (e.g., workshop attendance and participation in one-on-one coaching) adherence.

Method

Our sample included data from providers who completed baseline (pre-intervention) surveys that captured inner and outer contexts affecting implementation and participated in tailored motivational interviewing training, producing a dataset that included training implementation strategies adherence and barriers and facilitators to implementation (N = 77). Leadership was assessed by two scales: the director leadership scale and implementation leadership scale. Attitudes were measured with the evidence-based practice attitude scale (EBPAS-50). Adherence to training implementation strategies was modeled as a continuous outcome with a Gaussian distribution. Analyses were conducted in SPSS.

Results

Of the nine general attitudes toward evidence-based practice, openness was associated with training adherence (estimate [EST] = 0.096, p < .001; 95% CI = [0.040, 0.151]). Provider general (EST = 0.054, 95% CI = [0.007, 0.102]) and motivational interviewing-specific (EST = 0.044, 95% CI = [0.002, 0.086]) leadership behaviors were positively associated with training adherence (p < .05). Of the four motivational interviewing-specific leadership domains, knowledge and perseverant were associated with training adherence (p < .05). As these leadership behaviors increased, knowledge (EST = 0.042, 95% CI = [0.001, 0.083]) and perseverant (EST = 0.039, 95% CI = [0.004, 0.075]), so did provider adherence to training implementation strategies.

Conclusions

As implementation science places more emphasis on assessing readiness prior to delivering evidence-based practices by evaluating organizational climate, funding streams, and change culture, consideration should also be given to metrics of leadership. A potential mechanism to overcome resistance is via the implementation of training strategies focused on addressing leadership prior to conducting training for the evidence-based practice of interest.

Training Providers in Motivational Interviewing to Promote Behavior Change

Motivational Interviewing (MI) is a highly specified behavior change communication approach to improve patient-provider relationships, provider communication, and patient health outcomes. Because MI is built on a foundation of patient autonomy support, a feature known to positively influence behavior change during adolescence and emerging adulthood, MI is an evidence-based framework that can inform interventions targeting improvements in health outcomes among youth. MI can be difficult to implement with adequate fidelity, because learning MI requires time and commitment from busy providers with competing priorities. This review addresses best practices for implementing MI within adolescent serving medical settings (eg, pediatrics, family practices, rural health clinics, community health organizations, and so forth), including an orientation to MI, examples of efficacious interventions that were developed leveraging MI, and consideration for the design of training programs that include ongoing support to maximize the likelihood of sustainment.

Perceived Stigma in Health Care Settings Mediates the Relationships Between Depression, Diabetes, and Hypertension

Stigma is one of the most harmful forces affecting population health. When stigma exists in clinical settings, environments that should be pro-patient and stigma-free, stigma may become internalized and affect patients' well-being. Informed by prior stigma research and the Intergroup Contact Theory, the authors elucidate statistical relationships between patients' perceptions of clinic-based stigma and stigma's impact on health among New York City's diverse residents. The authors hypothesize that perceiving stigma in clinical settings would mediate the relationships between depression, general health, diabetes, and hypertension; they tested this through multiple logistic regressions conducted on pooled data from the New York City Community Health Survey (N = 18,596, 2016-2017). Among women, depression was associated with stigma (α = 4.07, P < 0.01), hypertension (γ = 2.31, P < 0.01), diabetes (γ = 2.18, P < 0.01), and poor general health (γ = 6.34, P < 0.01). Among men, depression was associated with stigma (α = 3.7, P < 0.01), hypertension (γ = 2.35, P < 0.01), diabetes (γ = 1.86, P < 0.01), and poor general health (γ = 5.14, P < 0.01). Overall, perceived stigma in clinics significantly increased adjusted odds of self-reporting poor general health (adjusted ORs [AOR] = 1.87 men; AOR = 2.05 women). Findings contribute to the literature on the Intergroup Contact Theory, which suggests that stigma should be low in diverse communities; findings indicate that stigma may be a mediator, justifying inclusion in epidemiological and health services research. In addition, study outcomes suggest that depression may be associated with clinic-based stigma, and this stigma has deleterious effects on physical health. Thus, clinicians should emphasize stigma reduction in their facilities, potentially through the adoption of trauma-informed approaches or delivery of care using non-stigmatizing communication strategies, such as Motivational Interviewing.

Proof of Concept for the FLEX Intervention: Feasibility of Home Based Coaching to Improve Physical Activity Outcomes and Viral Load Suppression among African American Youth Living with HIV

FLEX is a Motivational Interviewing, home-based coaching program that concurrently targets HIV-related and physical activity goals among African American youth living with HIV in the United States. To create and pilot test FLEX, we leveraged a 2-step exploratory sequential mixed methods design informed by the ORBIT model with initial qualitative work followed by pre-post analysis of quantitative outcomes, concluding with qualitative exit surveys. Data were evaluated pre- and 3-months post-intervention. Recruitment was 90%. Participants reported high program satisfaction and program adherence (76% completion rate). Preliminary findings indicate reductions in participants’ viral loads and improvements across 4 measures of physical activity.