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Coding Client Language in Motivational Interviewing for HIV Medication Adherence Using Self-Determination Theory.

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Autonomous motivation speech in motivational interviewing (MI) sessions more strongly predicts HIV medication adherence than controlled motivation speech or general change talk. This highlights the importance of autonomy-supportive communication for treatment success.

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Area of Science:

  • Psychology
  • Health Behavior
  • Clinical Intervention

Background:

  • Motivational interviewing (MI) and self-determination theory (SDT) highlight client autonomy's role in behavior change.
  • SDT posits motivation exists on a continuum, with autonomous motivation (AM) representing self-determined engagement.
  • Current MI research often categorizes autonomous motivation speech under the broader 'change talk' (CT) umbrella, limiting nuanced analysis.

Purpose of the Study:

  • To develop and validate a coding tool (SDT coding system: SDTCS) to differentiate between autonomous motivation (AM) and controlled motivation (CM) speech in MI sessions.
  • To examine the relationship between AM/CM speech and antiretroviral (ART) adherence among adults living with HIV.
  • To compare the predictive power of AM/CM speech and general change talk (CT) on ART adherence.

Main Methods:

  • Developed the SDTCS using a combined inductive and deductive approach to code naturalistic AM and CM speech during MI sessions.
  • Applied the SDTCS to sessions with 62 adults living with HIV undergoing MI for ART adherence.
  • Coded the same sessions using the Motivational Interviewing Skills Code (MISC) 2.5 and analyzed relationships with on-time ART adherence data.

Main Results:

  • The SDTCS demonstrated adequate reliability and good content validity.
  • Naturally occurring AM speech showed a stronger association with ART adherence in the subsequent week compared to CM speech.
  • Evidence suggested AM speech was more strongly related to adherence than general CT.

Conclusions:

  • The SDTCS offers a more nuanced understanding of client motivational speech than existing tools.
  • Refining and expanding the SDTCS can enhance the analysis of client motivation in MI interventions.
  • This approach can improve the effectiveness of MI for improving adherence to HIV medication.