Motivational Interviewing as Evidence-Based Practice? An Example from Sexual Risk Reduction Interventions Targeting Adolescents and Young Adults

This paper critically examines sexual risk reduction interventions, more specifically how they are evaluated and the implications that this has for sexual health policy. The focus is on motivational interviewing (MI) interventions which aim to promote protective behaviors related to sexual risk on the part of young people. MI has become increasingly popular, largely due to it being a highly flexible counseling approach that may, with adequate staff training, and fidelity in implementation, be tailored to many different settings (e.g., health care, schools and in community work). Following a scoping review that comprised 34 papers, of which 29 were unique studies, the range and type of existing research were examined. The results show a wide range of study designs and evaluation procedures, MI conceptualizations, modes of MI delivery, and the particular sub-populations of youth and sexual risk behaviors targeted. While this makes it difficult to draw any generalized conclusions about “what works” in prevention, it provides important insights about the complexity of sexual risk behavior as well as complex behavioral treatment approaches like MI. We therefore problematize the political drive to implement evidence-based methods without adequate resource allocation and contextual adaptation

Preconceptional motivational interviewing interventions to reduce alcohol-exposed pregnancy risk

Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care

The Effectiveness of Substance Abuse Prevention Videotapes with Mexican American Adolescents

The effectiveness of three substance abuse prevention videotapes derived from contrasting theoretical frameworks was experimentally evaluated on common prevention outcomes and measures of theoretical relevance. Seventh and eighth graders were stratified on gender and classroom before being randomly assigned to experimental and control conditions. In a modified replication, ninth graders were assessed and treated in a concentrated time span. Participants were 312 students. A series of 2 2 4 (Replication Gender Treatment) ANCOVAs permitted an inspection of the construct validity of emerging effects. Although the assertion-training video produced significantly higher levels of assertiveness among ninth graders, the other two videos (derived from information-programming and help-seeking rationales) did not register effects on specific measures of high theoretical relevance. A lack of posttest differences on the common outcomes may be due to low intended consumption levels displayed by participants and/or floor and ceiling effects encountered on outcome measures