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Motivations, concerns, and expectations of Scandinavian health professionals volunteering for humanitarian assignments.

International nongovernmental organizations (NGOs) involved in humanitarian assistance employ millions of volunteers. One of the major challenges for the organizations is the high turnover rate among their personnel. Another is recruiting the right persons. As part of a series of studies investigating factors that affect the recruitment process and the success of assignment, this qualitative study examined health professionals' motivations for volunteering, their various concerns, and their expectations about themselves and the organizations for which they would work. The findings from focus group interviews with potential humanitarian volunteers were considered within the framework of Hertzberg's theory of motivations and Maslow's hierarchy of needs. The study has significant implications for personnel policy and practice in the humanitarian sector. Recruitment officers should have the self-actualized person, as described by Maslow, in mind when interviewing candidates. This perspective would make it easier for them to understand the candidates' thoughts and concerns and would lead to more effective interventions. Program officers should have satisfiers and dissatisfiers, as identified by Herzberg, in mind when planning programs. The probability that personnel will leave humanitarian work is lower if they perceive working conditions as good.

Adult↗
PubMed2004

An evaluation of workshop training in motivational interviewing for addiction and mental health clinicians.

We evaluated a 2-day training workshop on motivational interviewing (MI) for addiction and mental health clinicians (n = 22). Clinicians completed the helpful responses questionnaire (HRQ) and taped interactions with a standardized patient (SP). Independent, blinded coders rated the tapes using the motivational interviewing skills code (MISC). Post-training assessment showed significant increase on the HRQ and two of four MISC summary scores for SP interviews. At 2-month follow-up, means of the HRQ and two MISC summary scores remained higher than baseline, but declined from post-training. Some MI skills improved to a greater degree than others, and a subset of clinicians (> 40%) showed continued improvement at follow-up. Results were consistent across interviews with different SPs, supporting the use of this assessment method. Findings highlight the need for additional research on the use of standardized patients, alternative assessment techniques, and effective methods of technology transfer for MI skill acquisition and retention.

Adult↗
PubMed2005

Motivationally enhanced group counseling for substance users in a soup kitchen: a randomized clinical trial.

Soup kitchens tend to serve residentially unstable adults characterized by a high prevalence of substance abuse. In this study, 289 soup kitchen guests who reported drug or alcohol problems were randomly assigned to information and referral (I&R) plus peer advocacy (peers encouraging subjects to participate in other services) (N = 139) or to an experimental 12-session motivational group (three sessions per week for 4 weeks) followed by a 36-session cognitive-behavioral group (three sessions per week for 12 weeks), plus I&R and peer advocacy. Mean age was 42; 82% male; 68% African-American; 81% unstable residence; 14% HIV+. Experimentals were significantly more likely than the controls to have increased their participation in some type of substance abuse intervention during the follow-up period. In addition, experimentals were significantly more likely than controls to have reduced both drinking and heavy drinking at follow-up (there was no difference between groups in reduction of cocaine use). Interaction analysis indicated that the experimental intervention was more effective for participants with higher rather than lower substance abuse severity at baseline. These results support the concept that motivationally enhanced group counseling, provided as a low-threshold outreach intervention, can help to increase participation in formal treatment and 12-step groups and to reduce substance abuse, particularly for those starting with high severity of use.

Adult↗
PubMed2005

The Marijuana Ladder: measuring motivation to change marijuana use in incarcerated adolescents.

The purpose of this study was to determine if a modified version of the Contemplation Ladder, a measure of motivation to change marijuana use among incarcerated adolescents (Marijuana Ladder; ML), was related to marijuana use and treatment engagement. Participants (N=122) in this study were all incarcerated at a state juvenile correctional facility in the Northeast. Adolescents were assessed at the beginning of their incarceration, 2 months into their incarceration, and 3 months after their release. There was a significant negative relationship between ML scores and marijuana use and a significant positive relationship between ML scores and treatment engagement. When controlling for prior marijuana use and age, ML scores at baseline significantly added to the prediction of marijuana use and treatment engagement among incarcerated adolescents. Results support the concurrent validity and the predictive validity of the ML. This measure has the potential to provide important information for Juvenile Justice Facilities that might aid in treatment planning and discharge planning for incarcerated adolescents. In addition, researchers may find a quick visual analog measure of motivation to change marijuana use with good psychometric properties useful.

Adolescent↗
PubMed2006

The relationship between disordered eating behavior and drinking motives in college-age women.

Previous research has documented that alcohol use disorders and eating disorders often co-occur. One possible reason for these high rates of co-occurrence is that problematic eating and alcohol use serve similar functions for the persons engaging in them. In particular, both have been hypothesized to serve an avoidant coping function. This study was designed to examine the relationships between drinking motives and disordered eating in a sample of college-age women. A total of 257 women completed the Eating Attitudes Test-26 (EAT-26), Rutgers Alcohol Problems Index (RAPI), and Drinking Motives Measure (DMM). As hypothesized, problematic eating and problematic drinking were positively correlated. Also, regression analyses indicated a strong relationship between problematic eating and the coping scale of the DMM, which measures avoidant coping. This study extends previous research and provides support for the idea that problematic eating and problematic drinking serve similar avoidant coping functions. This line of research may hold important implications for treatment interventions targeting comorbid alcohol use disorders and eating disorders.

Adult↗
PubMed2006

Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption.

OBJECTIVE: This study assessed the effectiveness of a 4-month intervention using stage-based newsletters, computer-based communication, and motivational interviewing to increase fruit and vegetable consumption by college students aged 18 to 24 years. DESIGN: Participants were stratified by stage of change for fruit and vegetable consumption and randomized to an intervention or control group. Participants completed the staging algorithm for fruit and vegetable intake, which included a one-item food frequency question, a 26-item food frequency questionnaire (FFQ), an 18-item decisional balance questionnaire, and a five-item self-efficacy questionnaire at baseline and completion of study. SUBJECTS: A convenience sample of 437 college students enrolled in a rural, land grant university was enrolled in the study. Only nondietetics majors between ages 18 to 24 years were included in the study. A total of 314 students finished the study for a completion rate of 72%. INTERVENTION: After baseline staging and randomization, the intervention group participants received four stage-based newsletters, one motivational interview, and an individually tailored e-mail follow-up over a 4-month period. Control group participants only received assessment at baseline and at completion. MAIN OUTCOME MEASURES: Two fruit and vegetable instruments, a one-item food frequency question, and a 26-item FFQ measured daily consumption of fruits and vegetables at baseline and postintervention. STATISTICAL ANALYSES PERFORMED: The SAS system for Windows, version 8 (1999, SAS Institute, Inc, Cary, NC), was used for analysis, including the following tests: PROC GLM, PROC FREQ, and PROC NPAR1WAY, Kruskal-Wallis, Fisher, Wilcoxon rank sum, and chi(2). RESULTS: Fruit and vegetable consumption increased significantly more for the intervention group than the control group. Consumption increased in the intervention group by one serving a day for both instruments compared with 0.4 servings a day in the control group for a one-item instrument and no change in the control group for a 26-item FFQ. CONCLUSIONS: This intervention is an effective way to increase fruit and vegetable consumption by young adults.

Adolescent↗
PubMed2005

Assessing competence in the use of motivational interviewing.

This report presents reliability, validity and sensitivity indices for the Motivational Interviewing Treatment Integrity (MITI) scale. Factor analysis of MI treatment sessions coded with the Motivational Interviewing Skills Code (MISC) was used to derive 10 elements of MI practice, forming the MITI. Canonical correlation revealed that the MITI captured 59% of the variability in the MISC. Reliability estimates for the MITI were derived using three masked, independent coders. Intra-class coefficients ranged from .5 to .9 and were generally in the good to excellent range. Comparison of MITI scores before and after MI workshops indicate good sensitivity for detecting improvement in clinical practice as result of training. Implications for the use of this instrument in research and supervision are discussed.

Clinical Competence↗
PubMed2006

An examination of the Motivational Interviewing Treatment Integrity code.

This study examines the reliability of the Motivational Interviewing Treatment Integrity (MITI) code, a brief scale designed to evaluate the integrity of the use of motivational interviewing (MI). Interactions between substance abuse counselors with one person role-playing a client were audiotaped and scored by trained teams of graduate and undergraduate students. Segments of 10 minutes and 20 minutes were compared and found to yield the same reliability and integrity results. Interrater reliability showed good-to-excellent results for each MITI item even with undergraduate raters. Correlations between items showed a coherent pattern of interitem correlations. The MITI is a good measure of treatment integrity for MI and seems superior to existing measures when indicators of client behavior are not needed.

Counseling↗
PubMed2004

An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth.

OBJECTIVE: to explore Sudanese midwives' motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. DESIGN: triangulation of methods, using observational techniques and open-ended interviews. SETTING AND PARTICIPANTS: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. FINDINGS: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives' potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.

Adult↗
PubMed2006

Orientation of nurses towards formal and informal learning: motives and perceptions.

The aim of this exploratory study was to gain information on the current orientation of registered nurses towards continuing education and lifelong learning. The population (N=162) consists of 2nd and 1st Level nurses who have or are currently taking part in continuing education. Qualitative empirical data were obtained through semi structured one to one interviews. The research questions sought information related to some of the reasons and motives for the participants' taking part in various categories of learning. Also explored was what factors might influence these participants' learning activities and the views and perceptions of their learning experiences. For many of these nurses, the initial motive for taking part in continuing education was the perception that they were being left behind by the higher educational level of nurses entering the profession. Contrary to some anecdotal views, the participants generally felt that higher education (HE) contributed to enhanced client care, reporting additional personal and professional satisfaction. Alleged poor support from managers for continuing education and the lack of parity, often within the same organisation regarding the selection criteria to take part in a variety of learning activities, was a source of dissatisfaction for some of these participants. Their determination to learn, however, remained strong.

Adult↗
PubMed2006

Motivation, emotion, and their inhibitory control mirrored in brain oscillations.

Recent studies suggest brain oscillations as a mechanism for cerebral integration. Such integration can exist across a number of functional domains, with different frequency rhythms associated with each domain. Here, evidence is summarized which shows that delta oscillations depend on activity of motivational systems and participate in salience detection. Theta oscillations are involved in memory and emotional regulation. Alpha oscillations participate in inhibitory processes which contribute to a variety of cognitive operations such as attention and memory. The importance of inhibitory functions associated with alpha oscillations increases during the course of evolution. In ontogenesis, these functions develop later and may be more sensitive to a variety of detrimental environmental influences. In a number of developmental stages and pathological conditions, a deficient alpha and/or increased slow-wave activity are associated with cognitive deficits and a lack of inhibitory control. It is shown that slow-wave and alpha oscillations are reciprocally related to each other. This reciprocal relationship may reflect an inhibitory control over motivational and emotional drives which is implemented by the prefrontal cortex.

Animals↗
PubMed2006

Reward-motivated learning: mesolimbic activation precedes memory formation.

We examined anticipatory mechanisms of reward-motivated memory formation using event-related FMRI. In a monetary incentive encoding task, cues signaled high- or low-value reward for memorizing an upcoming scene. When tested 24 hr postscan, subjects were significantly more likely to remember scenes that followed cues for high-value rather than low-value reward. A monetary incentive delay task independently localized regions responsive to reward anticipation. In the encoding task, high-reward cues preceding remembered but not forgotten scenes activated the ventral tegmental area, nucleus accumbens, and hippocampus. Across subjects, greater activation in these regions predicted superior memory performance. Within subject, increased correlation between the hippocampus and ventral tegmental area was associated with enhanced long-term memory for the subsequent scene. These findings demonstrate that brain activation preceding stimulus encoding can predict declarative memory formation. The findings are consistent with the hypothesis that reward motivation promotes memory formation via dopamine release in the hippocampus prior to learning.

Adolescent↗
PubMed2004

Individual differences in the effects of serotonergic anxiolytic drugs on the motivation to self-administer cocaine.

Numerous clinical studies have indicated that lifetime anxiety is highly prevalent in drug addicts. In the treatment of drug abuse, dually diagnosed drug addicts may benefit from pharmacological intervention strategies that alleviate the psychiatric symptomatology. We have previously shown that rats with different coping strategies in a stressful environment show strong differences in the motivation to self-administer cocaine. That is, cocaine self-administration under a progressive ratio (PR) schedule of reinforcement was enhanced in high grooming (HG) rats as compared with low grooming (LG) rats. To identify the pharmacological basis of these differences, we tested the acute effects of several anxiolytic drugs on cocaine self-administration in HG and LG rats under a PR schedule of reinforcement. Chlordiazepoxide increased PR responding in both the HG and LG rats, while the selective corticotrophin releasing hormone 1 receptor antagonist R121919 had no effect on cocaine self-administration under the PR schedule. Interestingly, buspirone and fluoxetine decreased PR responding in HG rats only and thereby abolished the individual differences in PR responding between HG and LG rats. In support of the differential effects of the serotonergic drugs on PR responding in HG and LG rats, we found that the in vitro electrically evoked release of [3H]serotonin from mesocorticolimbic brain slices was reduced in the medial prefrontal cortex, substantia nigra and nucleus accumbens core, and increased in the nucleus accumbens shell of HG rats relative to LG rats. These findings show that serotonergic anxiolytics abolish the pre-existing individual differences in cocaine self-administration between HG and LG rats, which show differences in the reactivity of serotonergic neurons. This suggests that the effectiveness of pharmacological interference may depend on the neurochemical and motivational state of the individual.

Animals↗
PubMed2006

Amygdala GABA-A receptor involvement in mediating sensory-discriminative and affective-motivational pain responses in a rat model of peripheral nerve injury.

The contribution of the amygdala to neuropathic pain processing in animals has not been clearly acknowledged. To assess the relative contribution of amygdala GABA-A receptors in mediating sensory-discriminative and affective-motivational pain components, the GABA-A receptor agonist muscimol and the antagonist bicuculline (both 10-25 ng/microl) were administered by acute bilateral injection directly into the central amygdala in rats with a chronic constriction injury (CCI). Escape/avoidance behaviour reflecting the affective-motivational dimension of pain was measured using a light/dark chamber in combination with suprathreshold nociceptive stimulation, and was defined as a shift from the 'non-aversive' dark area of the chamber to the 'aversive' light area. Hindpaw mechanical allodynia and mechanical hyperalgesia thresholds reflecting the sensory-discriminative dimension of pain were determined prior to and following escape/avoidance testing. Muscimol administration into the amygdala attenuated escape/avoidance behaviour and reversed hindpaw mechanical hypersensitivity in CCI rats; the magnitude of reduction in escape/avoidance behaviour was 2- to 3-fold greater than mechanical allodynia. Surprisingly, administration of bicuculline also attenuated escape/avoidance behaviour but had no effect on nociceptive behaviours. The muscimol-induced reversal of hindpaw mechanical hypersensitivity was completely blocked by co-administration of bicuculline, in contrast to escape/avoidance behaviour. Motility behaviour was unaffected by injection of either drug as determined in the open field test. Thus, amygdala GABA-A receptors appear to play an important role in sensory and especially affective pain processing in neuropathic rats. Furthermore, after nerve injury reflex nociceptive behaviours appear to be under tonic control by descending inputs, which originate from or are modulated within the amygdala.

Affect↗
PubMed2006

Genetic susceptibility testing for Alzheimer disease: motivation to obtain information and control as precursors to coping with increased risk.

OBJECTIVE: This study investigated appraisals, including motivation, and coping preferences for undergoing Apolipoprotein E (APOE) susceptibility testing for Alzheimer disease (AD). METHODS: Participants were 60 adult children of individuals affected with AD enrolled in a trial investigating use and impact of APOE susceptibility testing. An exploratory qualitative study was undertaken in which participants were interviewed about their testing experience. RESULTS: Most participants viewed genetic testing as providing valuable information that could help direct future health care decisions and meet their emotional concerns about living at increased risk. Participants related their motivation for genetic testing to their worries about developing AD, preference to seek information about health threats, and need to feel in control of their health. CONCLUSION: Even without prevention or treatment options, genetic testing may be a useful coping strategy for some at-risk individuals. PRACTICE IMPLICATIONS: Once testing becomes clinically available, practitioners need to address the value and limitations of testing as well as appraisals and efforts to cope.

Adaptation, Psychological↗
PubMed2006

Food motivated behavior of melanocortin-4 receptor knockout mice under a progressive ratio schedule.

Melanocortin-4 receptor knockout (MC4RKO) mice are hyperphagic and develop obesity under free feeding conditions. We reported previously that MC4RKO mice did not maintain hyperphagia and as a result lost weight when required to press a lever to obtain food on a fixed ratio procurement schedule. To assess the generality of this result, we tested MC4RKO mice and their heterozygous and wild type littermates using progressive ratio (PR) schedules that are believed to be sensitive indicators of motivation. Mice lived in operant chambers and obtained all of their food (20mg pellets) via lever press responding. Food was available according to a PR schedule so that within a meal, food became progressively more costly, and we expected this would provide a stringent test of mechanisms controlling meal size. The schedule reset after either 3 or 20min of no responding, so defining meals, and the highest ratio completed before the reset was defined as the breakpoint. The average daily number of meals was lower and mean size of meals was higher at the 20 compared with the 3min reset condition. Mean daily food intake did not differ between the two reset criteria but did differ as a function of genotype, with MC4RKO mice eating about 25% more than heterozygous or wild type mice. Hyperphagia in the MC4RKO mice was characterized primarily by larger meals (higher breakpoints) and they emitted about twice as many responses as wild type mice. Thus, using a PR schedule, MC4RKO mice exhibit hyperphagia, and show a high level of motivation to support large meal sizes.

Animals↗
PubMed2006

Transient hypolocomotion in rats repeatedly exposed to phencyclidine: an appraisal of motor function and motivation.

Spontaneous locomotion in rats is reduced about 20 h following phencyclidine (PCP) exposure. Our primary purpose was to test if locomotor irregularities would outlast drug withdrawal and be modulated by a periodic auditory stimulation during or after repeated injections. To circumscribe plausible interpretations, motor coordination and motivation were assessed as well. 10 mg/kg of PCP decreased spontaneous locomotion during the injection period whether or not a sound was presented. Those effects did not persist after a 7-day washout. Motor coordination and motivation to perform a variety of goal-driven conducts in the presence or absence of reinforcement were all unaffected by PCP treatment. The generalized hypolocomotor effects induced by PCP likely resulted from an inability to self-generate behaviors. These deficiencies were apparent in contexts where response production was not clearly specified nor supported, regardless of reward contingency.

Acoustic Stimulation↗
PubMed2005

Trials and tribulations: understanding motivations for clinical research participation amongst adults with cystic fibrosis.

In the context of understanding motivations for clinical research participation, many authors consider issues such as informed consent and how patients perceive the research method and process. However, many investigations focus only on one method of research, most commonly the randomised controlled trial. Understanding how chronically ill members of one specific patient group respond to all requests for research participation are rare. Cystic fibrosis (CF), a genetic condition whereby those affected are used to taking a wide array of treatments and attending a specialist care centre over many years, and are generally knowledgeable about their condition, represents an ideal case for investigating how staff requests for clinical research participation are accepted or declined. Using Bloor's systems of relevance framework for risk behaviour and risk reduction, specialist CF centre patients' motivations for participation or non-participation in clinical research can be understood. The framework takes into account two sets of conceptual oppositions: habituation and calculation, constraint and volition. These oppositions represent a range along a continuum of risk behaviour rather than being absolute distinctions. Decisions to participate are influenced mainly by the patient's state of health at the time of request, the nature of the trial and the social context within which sufferers are placed. Understanding why chronically ill patients refuse some requests and yet accept others may assist researchers in designing protocols that take these factors into account and achieve the desired numbers of participants whilst protecting those in vulnerable positions.

Adolescent↗