Motivational Interviewing Via the Internet

Teaming motivational interviewing with the Internet may improve the results of online weight-loss groups, according to a team of nutritionists at the University of Kentucky, Lexington, the University of North Carolina, Chapel Hill, and Boston’s Dana Farber Institute (JADA 2008; 108:1029).

Motivational interviewing is a counseling technique that helps resolve ambivalence and increase motivation for change by eliciting self-motivational statements, or “change talk,” from clients. Examples of change talk might include reasons for change, discontent with the current situation, optimism about change, and intention to change. Motivational interviewing has been effective when used in a variety of in-person or telephone-delivered health behavior interventions, including interventions related to diet and exercise. Using the Internet seemed a natural next step.

A pilot study

Kelly H. Webber, PhD, MPH, and her colleagues designed a pilot study to test the effectiveness of motivational interviewing in online weight-loss treatment groups. Twenty women recruited through a listserv at the University of North Carolina were included in the 8-week, minimal-contact intervention. The women received weekly e-mailed lessons, and were randomized to one of two online groups using motivational interviewing, one that included a discussion of values and one that did not.

The women were randomized to receive either two online group sessions with a basic motivational interviewing-led discussion or two online group sessions with motivational interviewing plus values discussion. The online sessions lasted 1 hour and were led by a graduate student trained in motivational interviewing. Questions about personal values, definitions of those values, and the relationship of those values to starting a weight-loss program were e-mailed before the online sessions. At each session, women in both groups were encouraged to discuss the pros and cons of change and readiness, importance, and confidence for change. The group sessions were conducted over a secure Internet server and the transcripts were analyzed by three independent persons. Typical questions asked during the motivational interviewing plus values group were: “On a scale of 1 to 10, with 10 being very ready, where would you rank your readiness for changing your eating behaviors?” and “What are some of the cons of staying at your current weight?”

Immediately after the second online session, both groups were e-mailed a questionnaire assessing group cohesion and acceptability of the group format.

Results

Self-reported weight losses at 8 weeks were 1.5 kg (3.3 lb) in the motivational interviewing plus values group (n=9) and 2.7 kg (5.6 lb) in the motivational interviewing group without values discussion group (n=9). Adding a discussion of values did not appear to affect the number of self-motivational statements made, motivation, weight loss, or group cohesion. Eighty-four percent of the participants reported willingness to participate again and were comfortable with the discussion topics. Also, higher autonomous motivation at follow-up was associated with greater weight loss.

The authors feel that motivational interviewing techniques may be useful for targeting and maintaining motivation among online weight-loss groups.