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PubMed2003

Motivational techniques for improving compliance with an exercise program: skills for primary care clinicians.

Motivating patients to adopt a healthful treatment plan during brief office visits is a major challenge facing health care providers. Therefore, effective communication strategies that can be successfully employed during time-pressured consultations are worthy of consideration. Traditional approaches to patient care often rely on advice-giving and direct persuasion. Motivational interviewing is an alternate style of communication that has demonstrated success with very resistant clients, such as those recovering from drug and alcohol addiction. More recent adaptations of this approach to medical settings have been effective in improving a wide range of problem behaviors, including physical inactivity. This motivational approach is well suited to the daily practice of a busy primary care clinic, where improved patient compliance is a priority. Skillful application by a clinician provides the platform for patients to talk about change instead of exhibiting resistance. Consequently, clinical consultations are not only more effective, but also less frustrating for the provider.

Counseling↗
PubMed1999

Simultaneous evaluation of spatial working memory and motivation by the allocentric place discrimination task in the water maze in rats.

In order to evaluate learning and memory deficits separately from and simultaneously with motivational, motor and sensory impairments in identical animals, we developed the allocentric place discrimination task test using a water maze in rats. For this assessment task, two similar, visible platforms, one was fixed and the other was floating, were simultaneously present in a pool, and the working memory of the allocentric place discrimination task was evaluated. After training, the task accuracy was high about 85% correct and animals were used repeatedly. The accuracy decreased significantly when the pool was surrounded with a black curtain. Muscarinic receptor antagonist scopolamine 0.5 mg/kg selectively impaired the accuracy. Muscle relaxant dantrolene 10 mg/kg selectively decreased swimming speed. Under low motivational condition (warm water), still time increased and swimming speed decreased, but the accuracy was not affected. Similar to warm water, opioid receptor agonist morphine 15 mg/kg increased still time and decreased swimming speed. These results suggest that the allocentric place discrimination task is useful in evaluating spatial working memory ability independently of and concurrently with also visual, motor ability and motivation in identical animals.

Analgesics, Opioid↗
PubMed1998

The effect of a restricted smoking policy on motivation to quit smoking in psychiatric patients.

UNLABELLED: As dissatisfaction with unrestricted smoking in institutional settings has grown, a number of psychiatric facilities have banned smoking. A compromise, restricted smoking, was recently introduced on an inpatient psychiatric unit at a University of Michigan Hospital. The subsequent rescission of the restricted smoking policy enabled us to compare the effects of restricted smoking vs. ad lib smoking on motivation to quit smoking. METHOD: Current smokers admitted to an inpatient psychiatry unit were asked to participate in this study. As soon as possible after intake, the patient completed a smoking history questionnaire, depression and anxiety scales, and a stage of change measure. The stage of change measure was readministered upon discharge from the unit. RESULTS: Repeated measures ANOVA revealed an interaction for Condition (Restricted vs. Ad Lib) by Time (Admission vs. Discharge) for the Action scale, which assesses current level of activity in smoking cessation efforts. Restricted smokers decreased while ad lib smokers increased in motivation over time. CONCLUSIONS: Results suggest that the restricted smoking policy does not have beneficial motivational effects. Alternative strategies for controlling smoking on an inpatient psychiatric unit are suggested.

Adult↗
PubMed1991

Eight myths on motivating social services workers: theory-based perspectives.

A combination of factors has made formal motivational and reward systems rare in human service organizations generally and virtually non-existent in social service agencies. The author reviews eight of these myths by reference to eight motivational theories which refute them: need theory, expectancy theory, feedback theory, equity theory, reinforcement theory, cognitive evaluation theory, goal setting theory, and social influence theory. Although most of these theories have been developed and applied in the private sector, relevant research has also been conducted in social service agencies. The author concludes with a summary of guidelines suggested by the eight theories for motivating human service workers.

Feedback↗
PubMed1994

Job satisfaction and retention of social workers in public agencies, non-profit agencies, and private practice: the impact of workplace conditions and motivators.

The authors examine a selected array of agency-influenced work and employment conditions and assess their impact upon social workers' job satisfaction, motivation, and intention to seek new employment. The study makes correlations with past empirical studies on job satisfaction and retention, with staff development concerns as stated in social work administration textbooks, and with conditions subject to administrators' influence. Some specified motivational issues included are salary, fringe benefits, job security, physical surroundings, and safety. The analysis demonstrates the contribution of certain contextual and motivational factors to a prediction of job satisfaction or of intent to leave the organization.

Adult↗
PubMed2006

Risk perceptions, barriers, and motivators to tractor ROPS retrofitting in the New York state farm community.

The prevalence of tractor rollovers among agricultural workers has made the retrofitting of tractors with rollover protective structures (ROPS) and seat belts a public health priority for agricultural health and safety specialists. To address this concern, the New York Center for Agricultural Medicine and Health (NYCAMH) developed a seven-question survey, designed to assess perceptions of risk as well as potential motivators and barriers to retrofitting. Data from 465 phone surveys were gathered from New York State farmers representing various commodities and farm sizes. Analysis of responses to three qualitative questions contained in the survey indicated that most farmers in New York understand the importance of ROPS but lack the proper motivation to consider retrofitting. It appears that more convenient safety strategies, cost, and age of the tractor compete with a farmer's initiative to retrofit. In addition, survey responses illustrate that although many farmers believe ROPS are important in a general sense, many believe that this safety measure is not necessary for them in particular. Frequent motivators to retrofitting are concerns about safety, although the authors conclude that a more thorough analysis of these "general safety concerns" in qualitative interviews is important.

Accident Prevention↗
PubMed2006

The role of knowledge and motivation in symptom identification accuracy among schizophrenic patients: application of signal detection theory.

OBJECTIVE: Many people with schizophrenia have poor awareness of their symptoms, a problem that may result from lack of knowledge about their illness and/or unwillingness to acknowledge it. The present study assessed the joint influence of lack of knowledge and motivated denial in schizophrenic patients' low symptom awareness. METHOD: Schizophrenic patients (N = 85) and normal control participants (N = 35) identified psychotic symptoms and general stress symptoms in a symptom checklist. The signal detection theory was applied to assess levels of sensitivity (which would be knowledge-mediated) and judgment biases (which would probably be motivated). RESULTS: Compared with normal control participants, schizophrenic patients had lower sensitivity and greater aversion to classify a symptom as a psychotic symptom. CONCLUSIONS: These findings suggest that both lack of knowledge and motivated denial are involved in schizophrenic patients' low symptom awareness.

Adult↗
PubMed2004

Stages of motivational readiness for physical activity: a comparison of different algorithms of classification.

OBJECTIVE: The aim of this study was to compare two approaches to classify individuals into stages of motivational readiness for physical activity and test which one was better explained by attitude and perceived behavioural control, as defined by Ajzen (1991). DESIGN: A survey of 20,430 respondents from a population-based sample. METHODS: The relevant variables were assessed in a self-administered questionnaire. The cluster approach consisted of combining both intention and behaviour in order to determine clusters of individuals; such clusters correspond to different stages of motivational readiness. The stage of change (SC) approach consisted of grouping the same individuals by using the SC variable of the Transtheoretical Model (TTM). RESULTS: The SC and cluster-solution approaches were replicated across four subsamples of the total number of respondents. Attitude and perceived behavioural control were more strongly associated with stage membership derived from four-cluster solution than with stage membership in the five categories assessed by the SC method. CONCLUSION: Stage of motivational readiness for physical activity, and possibly for other health-related behaviours, may usefully be characterized when both recent past behaviour and intention in the near future are simultaneously and explicitly taken into consideration.

Adolescent↗
PubMed2006

A systematic review of motivational interviewing in physical health care settings.

PURPOSE: Motivational interviewing (MI), a method of augmenting an individual's motivation to change problematic behaviours, is a patient-centred counselling style that seeks to help patients resolve ambivalence about behaviour change. MI has successfully been used in the field of addictions and has recently received increased interest as a means of promoting treatment adherence in physical health care settings. This systematic review is aimed to evaluate the effectiveness of MI interventions in physical health care settings. METHODS: Electronic databases were searched for articles specifying the use of 'motivational interviewing' in physical health care settings between 1966 and April 2004. Fifty-one relevant abstracts were yielded and data was extracted from eight relevant selected studies. RESULTS: Eight studies were identified in the fields of diabetes, asthma, hypertension, hyperlipidaemia, and heart disease. The majority of studies found positive results for effects of MI on psychological, physiological, and life-style change outcomes. Problems with research in this area include: small sample sizes, lack of power, use of disparate multiple outcomes, inadequate validation of questionnaires, poorly-defined therapy and training. CONCLUSIONS: While MI has high face validity across a number of domains in physical health care settings, the general quality of trials in this area is inadequate and therefore recommendations for its dissemination in this area cannot yet be made. More research into MI applied to health behaviour change is urgently required.

Behavior Therapy↗
PubMed1999

Refining behavioral phenotypes: personality-motivation in Williams and Prader-Willi syndromes.

Despite behavioral differences, individuals with Williams or Prader-Willi syndrome share a proneness to certain personality characteristics. We hypothesized that there are qualitative differences in these shared personality features. Personality-motivation (measured using the Reiss Profiles) was compared for equal numbers of age- and gender-matched individuals with Williams or Prader-Willi syndrome or mental retardation due to nonspecific causes. Each syndrome featured aberrant motivational profiles, and similarities were found across groups in various domains. Significant differences emerged in the specific stimuli that motivated behavior in several Reiss Profile domains. Implications are discussed for the "classic" sociable personality in Williams syndrome and for compulsivity in Prader-Willi syndrome. Recommendations are made for treatment and more refined phenotypic research.

Adolescent↗
PubMed2001

Motivating factors in futile clinical interventions.

With modern medical technology, it is now possible to sustain life for prolonged periods in critically ill patients, even when there is no reasonable hope of improvement or achieving the goals of therapy. Such futile and medically inappropriate interventions may violate both the ethical and medical precepts generally accepted by patients, families, and physicians. In this study, we sought to determine who was primarily responsible for such interventions, the nature of their motivation, and the role of a timely bioethical consultation. In a retrospective review, we identified 100 patients of 331 bioethical consultations who had futile or medically inappropriate therapy. The average age of patients was 73.5 +/- 32 years (mean +/- 2 SD) with 57% being male. Fifty-seven percent of the patients were admitted to the hospital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treatment in 62% of cases, the physician in 37% of cases, and a conservator in one case. Unreasonable expectation for improvement was the most common underlying factor. Family dissent was involved in 7 of 62 cases motivated by family, but never when physicians were primarily responsible. Liability issues motivated physicians in 12 of 37 cases where they were responsible but in only 1 of 62 cases when the family was (chi(2) 5 degrees of freedom = 26.7, p < 0.001). When the bioethics consultation resulted in cessation of the therapy, patients died in a median of 2 days as opposed to 16 days if therapy continued (p < 0.001).

Aged↗
PubMed2005

The motivational component of withdrawal in opiate addiction: role of associative learning and aversive memory in opiate addiction from a behavioral, anatomical and functional perspective.

A major challenge in current drug addiction research is not only to understand the immediate effects of drugs of abuse on brain operations, but also to define at the behavioral and neural levels how cognitive, emotional and motivational processes interact with drug use in order to lead to this psychopathological state which defines addiction. It is now clear that factors other than the direct effects of drugs of abuse are able to powerfully affect drug-seeking and drug-taking behaviors. In former opiate addicts, re-exposure to environmental situations previously paired with withdrawal is able to induce strong craving episodes. It has been proposed that these conditioned stimuli could be strongly involved in precipitating relapse in drug-taking behavior by re-activating the neurobiological circuits which are engaged in an unconditioned way by the withdrawal state itself, leading to a powerful aversive state relieved by drug consumption renewal. In the present review, we provide evidence from a neuropsychopharmacological viewpoint that environmental situations previously paired with the opiate withdrawal syndrome might be able to maintain drug-seeking motivation. Using behavioral models which allow assessment of the aversive and motivational properties of opiate withdrawal both in the unconditioned and conditioned situations, we have recently investigated using extensive mapping the neurobiological correlates which underlie acute withdrawal and the trace of its memory in the brain in terms of localization and neuronal population involved, with an anatomical and functional approach. Thus, on the basis of our results, and together with a number of data in the literature, we provide a functional model for the formation and retrieval of opiate withdrawal memories.

Animals↗
PubMed2001

Identifying the motivations of African American volunteers working to prevent HIV/AIDS.

Community-based organizations that are engaged in HIV/AIDS prevention and support services often rely on volunteers. This article describes the development of a 22-item inventory that measures the motivations of volunteers who deliver HIV prevention education in the African American community. In a statewide survey of volunteers (N = 102), the two strongest motivations for volunteer activity were concern for the African American community and a desire to understand the causes and consequences of the epidemic. These motives predicted the frequency that volunteers held discussions about HIV/AIDS with members of their community. Discussion focuses on the relevance of the results for the recruitment, training, and retention of volunteers.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Healthy choices: motivational enhancement therapy for health risk behaviors in HIV-positive youth.

This study piloted a brief individual motivational intervention targeting multiple health risk behaviors in HIV-positive youth aged 16-25. Interviews about sexual behavior and substance use and viral load testing were obtained from 51 HIV-positive youth at baseline and post intervention. Youth were randomized to receive a four-session motivational enhancement intervention (N = 25) or to a wait-list control (N = 26). Of the eligible youth approached, 88% agreed to participate, and 80% percent of participants completed at least three of four sessions. The treatment group showed significantly greater reductions in unprotected sex acts and in viral load compared with controls. Although change scores for substance use were not significantly different between the two groups, paired t tests demonstrated that reductions in alcohol use and marijuana use were significant for the treatment group at the trend level. There were no significant differences in substance use from baseline to posttest for the control group. Findings demonstrate the potential of a brief motivational enhancement intervention to improve health risk behaviors in HIV-positive youth. Larger randomized clinical trials are warranted. Resources required for retention should not be underestimated.

Adolescent↗
PubMed2004

Tonically active neurons in the primate caudate nucleus and putamen differentially encode instructed motivational outcomes of action.

To achieve a goal, animals procure immediately available rewards, escape from aversive events, or endure the absence of rewards. The neuronal substrates for these goal-directed actions include the limbic system and the basal ganglia. In the striatum, tonically active neurons (TANs), presumed cholinergic interneurons, were originally shown to respond to reward-associated stimuli and to evolve their activity through learning. Subsequent studies revealed that they also respond to aversive event-associated stimuli such as an airpuff on the face and that they are less selective to whether the stimuli instruct reward or no reward. To address this paradox, we designed a set of experiments in which macaque monkeys performed a set of visual reaction time tasks while expecting a reward, during escape from an aversive event, and in the absence of a reward. We found that TANs respond to instruction stimuli associated with motivational outcomes (312 of 390; 80%) but not to unassociated ones (51 of 390; 13%), and that they mostly differentiate associated instructions (217 of 312; 70%). We also found that a higher percentage of TANs in the caudate nucleus respond to stimuli associated with motivational outcomes (118 of 128; 92%) than in the putamen (194 of 262; 74%), whereas a higher percentage of TANs in the putamen respond to go signals for the lever release (112 of 262; 43%) than in the caudate nucleus (27 of 128; 21%), especially for an action expecting a reward. These findings suggest a distinct, pivotal role of TANs in the caudate nucleus and putamen in encoding instructed motivational contexts for goal-directed action planning and learning.

Acoustic Stimulation↗
PubMed2005

Coping motives as a moderator of daily mood-drinking covariation.

OBJECTIVE: The current study examines the extent to which college students' reports of drinking to cope (DTC) with negative affect moderate the daily covariation between specific types of negative mood (sadness, fear, hostility, shyness and boredom) and alcohol use. METHOD: Participants were full-time college students, aged 18-20, attending a large Southeastern university (N = 72; 50% male). These individuals completed an experience-sampling protocol over a 1-month interval, to assess daily mood and alcohol use. RESULTS: A series of Hierarchical General Linear Models found that individuals who reported low motives to cope through drinking showed an expected absence of daily mood and drinking covariation. For those reporting high coping motives, a complex and somewhat counterintuitive series of findings were found; students high in DTC drank less on days in which they experienced greater sadness. Analyses on the quadratic effects of mood revealed that when experiencing moderate to high levels of fear and shyness, individuals high in DTC were more likely to drink. For those low in coping motivations, fear and shyness did not predict daily drinking. CONCLUSIONS: Findings highlight the need to better our understanding of the exact meaning of DTC measures. In addition, there is a need to study how the context of college drinking influences self-medication and students' self-reports of DTC.

Adaptation, Psychological↗
PubMed2007

Do protective behavioral strategies mediate the relationship between drinking motives and alcohol use in college students?

OBJECTIVE: Heavy alcohol use among college students represents a public health problem on American college campuses. Use of protective behavioral strategies (PBS) has been shown to be related to reduced alcohol use and fewer alcohol-related problems, but the relationship of PBS to other alcohol-related constructs is unclear. The purpose of this study was to determine whether the use of PBS mediated the relationship between positively and negatively reinforcing drinking motives and both alcohol use and alcohol-related problems. METHOD: Data were collected on 254 undergraduate students at a large, public university in the northeast region of the United States. Approximately one third (n = 90) of the participants were volunteers, whereas the remaining individuals enrolled in the study as an option for satisfying an alcohol-related campus judicial sanction. RESULTS: Structural equation modeling analyses indicated that use of PBS partially mediated the relationships between positively reinforcing (i.e., social and enhancement) drinking motives and both alcohol use and alcohol-related problems. Use of PBS did not mediate the relationship between negatively reinforcing (i.e., coping) drinking motives and alcohol use or alcohol-related problems. The theoretical models accounted for 26% of the variance in alcohol use and 24% of the variance in alcohol-related problems. CONCLUSIONS: This study suggests that PBS should be incorporated into theoretical models devoted to understanding college student drinking.

Adaptation, Psychological↗
PubMedDate not supplied

[Satisfaction and motivation in nursing].

Something which affects the internal balance of a hospital system is its workers satisfaction/motivation rate. According to observed and discussed facts regarding our professional environment and also according to some authors assessments (Alcântara and Ribas Gomes), it seems that there is an insatisfaction among those people in relation to their chores. Therefore, based on Herzberg et all. two factors theory and more specifically on Maximiano interpretation of that theory, we made a research aiming at verifying the satisfaction and motivation in nurse work; on how satisfied/insatisfied nurses feel in their work, and if there is a relationship between job conditions (hygienic factors) with satisfaction, and between job features (motivation factors) with motivation.

Factor Analysis, Statistical↗