JMIR Publications

ABSTRACT

Background:

Motivational interviewing is an effective strategy to mitigate chronic disease risk through promotion of health behavior changes. However, multiple barriers impede its delivery to and uptake by patients. mHealth-based versions of motivational interviewing interventions, or technology-delivered adaptations of motivational interviewing (TAMIs), might increase reach, but their effectiveness is less well-understood.

Objective:

The purpose of this narrative review was to characterize the extent to which TAMIs: (1) affect behavioral outcomes, (2) have included individuals from populations that have been marginalized, and (3) have addressed socio-contextual influences on health.

Methods:

We identified studies indexed in PubMed that described interventions incorporating motivational interviewing techniques into a mobile or electronic health platform. Data were abstracted from eligible studies, including target population characteristics, study design and eligibility criteria, theoretical/conceptual models utilized, mHealth tool details, and effects on behavioral outcomes.

Results:

Thirty-three studies reported the use of TAMIs. Sample sizes ranged from 10 to 2,069 participants ages 13 to 70 years. Most studies (n=24) directed interventions towards individuals engaging in behaviors that increased the risk of chronic disease. Most studies oversampled (n=18) individuals from marginalized socio-demographic groups, but few were designed specifically with marginalized groups in mind (n=3). TAMIs utilized text messaging (n=7), web-based (n=19), app + text messaging (n=1), and web-based + text messaging (n=3) delivery platforms. Twenty-seven (90%) included randomized controlled trials reporting behavioral and health-related outcomes, 21 of which reported statistically significant improvements in targeted behaviors with the use of TAMIs. TAMIs improved targeted health behaviors in the remaining 3 studies. Nine of 30 (30%) assessed TAMI feasibility, acceptability, and/or satisfaction, all of which rated TAMIs highly in this regard. Among 18 studies comprised of a disproportionately high number of racial or ethnic minorities, 15 (83%) reported increased engagement in health behaviors and/or better health outcomes.

Conclusions:

TAMIs can improve health promotion and disease management behaviors for people from a variety of socio-demographic backgrounds. Future studies are needed to determine the contribution of TAMIs on individual health outcomes, and to determine best practices for implementing TAMIs into clinical practice.