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American Journal of Critical Care. 2008;17: 205-216
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Evidence-Based Review and Discussion Points

By Kimberly Horn, EdD, Geri Dino, PhD, Candice Hamilton, MPH, N. Noerachmanto, MA, MSc, MAPS and Jianjun Zhang, MS. All authors are affiliated with the Department of Community Medicine as well as work with the Translational Tobacco Reduction Research program in the Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia. Kimberly Horn is the Robert C. Byrd Associate Professor of Community Medicine, associate director of the Mary Babb Randolph Cancer Center, and director of the Translational Tobacco Reduction Research program. Geri Dino is an associate professor and director of the West Virginia University Prevention Research Center. Candice Hamilton is a research instructor, N. Noerachmanto is a research assistant, and Jianjun Zhang is a data analyst.

Corresponding author: Dr Kimberly Horn, PO Box 9190, Morgantown, WV 26506 (e-mail: khorn{at}hsc.wvu.edu).

Background Traditional efficacy research alone is insufficient to move interventions from research to practice. Motivational interviewing has been adapted for brief encounters in a variety of health care settings for numerous problem behaviors among adolescents and adults. Some experts suggest that motivational interviewing can support a population health approach to reach large numbers of teen smokers without the resource demands of multisession interventions.

Objectives To determine the reach, implementation fidelity, and acceptability of a brief motivational tobacco intervention for teens who had treatment in a hospital emergency department.

Methods Among 74 teens 14 to 19 years old, 40 received a brief motivational tobacco intervention and 34 received brief advice/care as usual at baseline. Follow-up data were collected from the interventional group at 1, 3, and 6 months and from the control group at 6 months. For the interventional group, data also were collected from the teens’ parents, the health care personnel who provided the intervention, and emergency department personnel.

Results Findings indicated low levels of reach, high levels of implementation fidelity, and high levels of acceptability for teen patients, their parents, and emergency department personnel. Data suggest that practitioners can operationalize motivational interventions as planned in a clinical setting and that patients and others with an interest in the outcomes may find the interventions acceptable. However, issues of reach may hinder use of the intervention among teens in clinical settings.

Conclusions Further investigation is needed on mechanisms to reduce barriers to participation, especially barriers related to patient acuity.




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Am. J. Crit. Care., May 1, 2008; 17(3): 218 - 220.
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