Background

A brief (<6 contact hours) 16-session motivational interviewing (MI) and cognitive behavioral therapy (CBT) intervention (ACTION PAC; NCT02502383) for adolescents with overweight or obesity (N = 186) implemented by School-based Health Center (SBHC) providers had no significant effects on BMI z-score or insulin resistance. To clarify these results and generate hypotheses regarding potential enhancements, we conducted process evaluation surveys and interviews with some participants.

Methods

All adolescent participants were invited to complete a process evaluation survey at the end of the study. Additionally, we interviewed 9 female and 7 male adolescent participants who had varying levels of pre- to post-treatment change in BMI z-score. Data were managed with NVivo. Themes were identified using a constant comparative method within a constructivist grounded theory framework.

Results

Out of 119 survey respondents, about 62% said that their relationship with the SBHC provider motivated their participation in the study, and 90% rated sessions with the SBHC provider as good or excellent. During the interviews, adolescents uniformly reported experiencing SBHC providers as supportive, respectful, and caring. Some teens expressed difficulty sustaining momentum after intervention termination.

Conclusions

A brief MI/CBT intervention produced high levels of engagement and satisfaction among adolescent participants based on process evaluation surveys and interviews. It seems unlikely that engagement or alliance problems impacted the results. Although SBHC providers were effective in implementing basic aspects of MI, such as conveying empathy, respect, and collaboration, it is possible that other more nuanced components of MI, such as developing discrepancy and eliciting change talk, may have been lacking. This hypothesis is consistent with MI fidelity analyses conducted as part of the trial. It also appears that higher amounts of the intervention may be necessary to solidify progress and sustain motivation.