Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: an overview of reviews H Frost, P Campbell, M Maxwell, RE OCarroll, SU Dombrowski, H Cheyne, B Williams, A Pollock Motivational interviewing MI aims to explore and resolve ambivalence that people might have about health behaviour in favour of change. It encourages people to say why and how they might change The five principles include: 1)an empathic non-judgmental stance 2)listening reflectively 3)developing discrepancy 4)rolling with resistance and avoiding argument 5)supporting efficacy to change (Lundahl and Burke 2011) What is already known A rapidly expanding body of research development since 1980s- NICE guidelines (2014) recommend MI approach for wide range of health and social care problems Websites devoted to training practitioners and encouraging use Objectives The overview has three objectives: To identify, appraise and synthesise evidence on the: 1.Effectiveness of MI on adult health behaviour in a range of community, health and social care settings 2.Barriers and facilitators that impact on the implementation of MI 3.Fidelity to effective implementation of MI Methods Rapid systematic review of existing reviews from Nov 2014 Electronic searches: CDSR, DARE, PROSPERO, MEDLINE; CINAHL; AMED PsycINFO Methods- Review criteria Inclusion Structured reviews with clearly defined topic 2000 to November 2014 Europe, North America or Australasia only English language focused on adults delivered in community, social and health care settings Exclusion Letters, commentaries, expert opinion, theoretical and non- systematic reviews children and adolescents under the age of 18 years motivational interviewing intervention to change professional group behaviour Methods data extraction Review characteristics - Template for Intervention Description and Replication (TIDieR) brief name, why, what (materials) what (procedure) who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual) Barriers and Facilitators (SURE checklist) Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014 SURE guides for Preparing and using Evidence-based Policy Brief Data- extraction -Meta-analyses data relating to effectiveness All comparative data for individual and combined outcomes including: Number of trials and participants in the meta- analysis Measure of effect (e.g. effect size, mean difference, standardised mean difference, relative risk) Measure of variability (95% confidence intervals) Measure of heterogeneity (I-squared) Methods Quality assessment ROBIS Reporting bias in systematic reviews The tool is completed in 3 phases: (1)assess relevance (2)identify concerns with the review process (3)judge risk of bias GRADE Grades of Recommendation, Assessment, Development, and Evaluation Assess whether the quality of the evidence was high, moderate, low or very low Whiting P, Savovic J, Higgins JP, et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol Guyatt GH, Oxman AD, Schunemann HJ, et al. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011;64(4):380-2. 1848 records excluded based on titles Full text records assessed for eligibility N=104 Full text records assessed for eligibility N=104 N=38 full text records excluded because of 23 not pre-panned reviews 8 not focused primarily on MI 2 outwith location 5 review focused on theory N=38 full text records excluded because of 23 not pre-panned reviews 8 not focused primarily on MI 2 outwith location 5 review focused on theory Total Studies included in synthesis n= 66 (Review including Meta-analysis data n=23) Total Studies included in synthesis n= 66 (Review including Meta-analysis data n=23) Identification Screening Eligibility Included Abstracts screened n = 171 Abstracts screened n = 171 N= 3 theory N = 5 training Total N= 74 Results- Meta-analysis comparison 96 comparisons 28 comparisons provided moderate quality evidence 51 low quality 17 very low quality Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Key reasons for downgrading the evidence: Risk of bias of the review was unclear (28/68 comparisons); Heterogeneity moderate to high, or confidence intervals very large (43/68 comparisons); Evidence insufficient to support a definitive conclusion (32/68 comparisons) Concerns about the quality of the trials included within the comparison judged by review authors (38/68 comparisons) Guyatt GH, Oxman AD, Schunemann HJ, et al. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011;64(4):380-2. Health behaviour Comparison (population) Outcome Assessment times Number of studies Effect size Confidence intervals Alcohol other treatments (mixed ) Reducing alcohol consumption unclear 18 n =unclear ES 0.43 [0.17,0.70] Binge drinking