A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol

Abstract

Background The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult. Objective The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI. Methods and Design CAMI2, a large, 12 month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition. Summary The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs.

“…Participants were unaware of condition assignments. The study protocol was not published until after enrollment was completed (Lee, Colby, et al, 2016).…”

“…Feedback on consequences specific to heavy drinking for Latinxs, that is, higher rates of cirrhosis mortality and of motor vehicle crashes, was also provided. The CAMI also introduced a new treatment module that emphasized unique social risk factors for heavy drinking, such as isolation, marginalization, discrimination, acculturation stress, economic disadvantage, and lack of access to job opportunities (Lee, Colby, et al, 2016).…”

“…It was presumed that doing so in a collaborative atmosphere would help disrupt the association of stress with drinking to cope with stress. This was a hypothesized mechanism underlying the adaptation (Lee, Colby, et al, 2016).…”

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers

“…Study Interventions: Both MI and CAMI were delivered in a single face‐to‐face session designed to last between 60 and 75 min. Other publications offer additional detail on the interventions (Lee, Colby, et al, 2016; Lee et al, 2019). Both conditions were manualized treatments delivered by bilingual therapists.…”

“…MI is also presumed to have a strong impact with marginalized individuals because it prioritizes autonomy and unique self‐worth (T. B. Moyers & Martin, 2006), thus augmenting collaboration and engagement (Lee et al, 2019; Miller & Rose, 2009; Parsons, Lelutiu‐Weinberger, Botsko, & Golub, 2014). Prior research has extended this idea by investigating whether a MI discussion that addressed sensitive topics/stressful experiences (i.e., experiences of discrimination) would encourage individuals to consider changes in their responses to the stressor (i.e., decrease drinking; Lee, Colby, et al, 2016). A meta‐analysis of MI for various health outcomes revealed stronger effect sizes with different health outcomes for racial/ethnic minorities than nonminorities (Hettema, Steele, & Miller, 2005).…”