Abstract
This article advances the view that motivational strategies can augment the effectiveness of skills-based HIV risk reduction interventions. We articulate the empirical and theoretical rationale for a motivational approach and describe how we developed a motivationally based HIV risk reduction intervention. We also describe the strategic exercises and the therapeutic style that constitutes this approach, and then present detailed reviews of three clinical trials that have evaluated HIV-preventive motivational interventions. Results of these trials provide promising evidence for the integration of motivational approaches with traditional skills-based approaches. We recognize the limitations of existing research and provide suggestions for future investigations.
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REFERENCES
Bandura, A. (1994). Social cognitive theory and exercise of control over HIV infection. In R. J. DiClemente and J. L. Peterson (Eds.), Preventing AIDS: Theories and methods of behavioral interventions. New York: Plenum Press.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.
Belcher, L., Kalichman, S., Topping, M., Smith, S., Emshoff, J., Norris, F., and Nurss, J. (1998). A randomized trial of a brief HIV risk reduction counseling intervention for women. Journal of Consulting and Clinical Psychology, 66, 531–541.
Carey, M. P., Maisto, S. A., Kalichman, S. C., Forsyth, A. D., Wright, E. M., and Johnson, B. T. (1997). Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. Journal of Consulting and Clinical Psychology, 65, 531–541.
Carey, M. P., Braaten, L. S., Maisto, S. A., Gleason, J. R., Forsyth, A. D., Jaworski, B. C., and Durant, L. D. (in press). Enhancing motivation to reduce the risk of HIV infection for low income urban women: A second randomized clinical trial. Health Psychology.
Carron, A. V. (1980). Social psychology of sport. Ithaca, NY: Mouvement Publications.
Choi, K.-H., and Coates, T. J. (1994). Prevention of HIV infection. AIDS, 8, 1371–1389.
Cohen, S., and Edwards, J. R. (1989). Personality characteristics as moderators of the relationship between stress and disorder. In R. W. J. Neufeld (Ed.), Advances in the investigation of psychological stress. New York: John Wiley & Sons.
DiClemente, R. J., and Peterson, J. L. (Eds.). (1994). Preventing AIDS: Theories and methods of behavioral interventions. New York: Plenum.
DiClemente, R. J., and Wingood, G. M. (1995). A randomized controlled trial of an HIV sexual risk-reduction intervention for young African-American women. Journal of the American Medical Association, 274, 1271–1276.
Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46, 931–946.
Exner, T. M., Seal, D. W., and Ehrhardt, A. A. (1997). A review of HIV interventions for at-risk women. AIDS and Behavior, 1, 93–124.
Fishbein, M., and Ajzen I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
Fisher, J. D., and Fisher, W. A. (1992). Changing AIDS-risk behavior. Psychological Bulletin, 111, 455–474.
Fodero, J. M. (1980). An analysis of achievement motivation and motivational tendencies among men and women collegiate gymnasts. International Journal of Sport Psychology, 11, 100–112.
Forsyth, A. D., and Carey, M. P. (1998). Measuring self-efficacy in the context of HIV risk reduction: Research challenges and recommendations. Health Psychology, 17, 559–568.
Gerrard, M., Gibbons, F. X., and Bushman, B. J. (1996). Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychological Bulletin, 119, 390–409.
Healey, T. R., and Landers, D. M. (1973). The effect of need achievement and task difficulty on competitive and non-competitive motor performance. Journal of Motor Behavior, 5, 121–128.
Hobfoll, S. E., Jackson, A. P., Lavin, J., Britton, P. J., and Shepherd, J. B. (1994). Reducing inner-city women's AIDS risk activities: A study of single, pregnant women. Health Psychology, 13, 397–403.
Hobfoll, S. E., Jackson, A. P., Lavin, J., Britton, P. J., and Shepherd, J. B. (1993). Safer sex knowledge, behavior, and attitudes of inner-city women. Health Psychology, 12, 481–488.
Jemmott, J. B., Jemmott, L. S., and Fong, G. T. (1992). Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health, 82, 372–377.
Kalichman, S. C. (1998). Preventing AIDS: A sourcebook for behavioral interventions. Mahwah, NJ: Erlbaum.
Kalichman, S. C., Carey, M. P., and Johnson, B. T. (1996a). Prevention of sexually transmitted HIV infection: A meta-analytic review of the behavioral outcome literature. Annals of Behavioral Medicine, 18, 6–15.
Kalichman, S. C., and Hospers, H. J. (1997). Efficacy of behavioralskills enhancement HIV risk-reduction interventions in community settings. AIDS, 11, S191-S199.
Kalichman, S. C., Kelly, J. A., and Stevenson, L. Y. (1997). Priming effects of HIV risk assessments on related perceptions and behavior: An experimental field study. AIDS and Behavior, 1, 3–8.
Kalichman, S. C, Nachimson, D., Cherry, C., and Williams, E. (1998). AIDS treatment advances and behavioral prevention setbacks: Preliminary assessment of reduced perceived threat of HIV-AIDS. Health Psychology, 17, 546–550.
Kalichman, S. C., Rompa, D., and Coley, B. (1996b). Experimental component analysis of a behavioral HIV-AIDS prevention intervention for inner-city women. Journal of Consulting and Clinical Psychology, 64, 687–693.
Kalichman, S. C., Sikkema, K. J., Kelly, J. A., and Bulto, M. (1995). Use of a brief behavioral skills intervention to prevent HIV infection among chronic mentally ill adults. Psychiatric Services, 46, 275–280.
Kelly, J. A. (1995). Changing HIV risk behavior: Practical strategies. New York: Guilford Press.
Kelly, J. A., McAuliff, T. L. Sikkema, K. J. Murphy, D. A., Somlai, A. M., Mulry, G., Miller, J. G., Stevenson, L. Y., and Fernandez, M. I. (1997). Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention. Psychiatric Services, 48, 1283–1288.
Kelly, J. A., Murphy, D. A., Sikkema, K. J., and Kalichman, S. C. (1993). Psychological interventions to prevent HIV infection are urgently needed: New priorities for behavioral research in the second decade of AIDS. American Psychologist, 48, 1023–1034.
Kelly, J. A., Murphy, D. A., Washington, C. D., Wilson, T. S., Koob, J. J., Davis, D. R., Ledezma, G., and Davantes, B. (1994). The effects of HIV/AIDS intervention groups for high-risk women in urban clinics. American Journal of Public Health, 84, 1918–1922.
Kelly, J. A., St. Lawrence, J. S., Hood, H. V., and Brasfield, T. L. (1989). Behavioral intervention to reduce AIDS risk activities. Journal of Consulting and Clinical Psychology, 57, 60–67.
McClelland, D. C. (1961). The achieving society. New York: Free Press.
McClelland, D. C., Atkinson, J. W., Clark, R. W., and Lowell, E. L. (1953). The achievement motive. New York: Appleton-Century-Crofts.
Miller, W. R. (1996). Motivational interviewing: Research, practice, and puzzles. Addictive Behaviors, 21, 835–842.
Miller, W. R., and Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.
NIMH Multisite HIV Prevention Trial Group. (1998). The NIMH Multisite HIV prevention trial: Reducing HIV sexual risk behavior. Science, 280, 1889–1894.
Prochaska, J. O. (1994). Strong and weak principles for progressing from precontemplation to action on the basis of twelve problem behaviors. Helath Psychology, 13, 47–51.
Prochaska, J. O., DiClemente, C. C., and Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47, 1102–1114.
Project MATCH Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH posttreatment drinking outcomes. Journal of Studies on Alcohol, 58, 7–29.
Reiss, D. (1997). NIH Consensus Statement: Interventions to prevent HIV risk behaviors. Washington, DC: National Institutes of Health.
Rotheram-Borus, M. J., Koopman, C., Haignere, C., and Davies, M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 266, 1237–1241.
Scheier, M. F., Weintraub, J. K. and Carver, C. S. (1986). Coping with stress: Divergent strategies of optimists and pessimists. Journal of Personality and Social Psychology, 51, 1257–1264.
Sikkema, K. J., Koob, J. J., Cargill, V. C., Kelly, J. A., Desiderato, L. L., Roffman, R. A., Norman, A. D., Shabazz, M., Copeland, C., Winett, R. A., Steiner, S., and Lemke, A. L. (1995). Levels and predictors of HIV risk behavior among women in low-income public housing developments. Public Health Reports, 110, 707–713.
St. Lawrence, J. S., Brasfield, T. L., Jefferson, K. W., Alleyne, E., O'Bannon, R. E., and Shirley, A. (1995a). Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection. Journal of Consulting and Clinical Psychology, 63, 221–237.
St. Lawrence, J. S., Jefferson, K. W., Alleyne, E., and Brasfield, T. L. (1995b). Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents. Journal of Consulting and Clinical Psychology, 63, 154–157.
Susser, E., Valencia, E., Berkman, A., Sohler, N., Conover, S., Torres, J., Betne, P., Felix, A., and Miller, S. (1998). Human immunodeficiency virus sexual risk reduction in homeless men with mental illness. Archives of General Psychiatry, 55, 266–272.
Weinhardt, L. S., Carey, M. P., Carey, K. B., and Verdecias, R. N. (1998). Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness. Journal of Consulting and Clinical Psychology, 66, 680–684.
Weinstein, N.D. (1987). Unrealistic optimism about susceptibility to health problems: conclusions from a community-wide sample. Journal of Behavioral Medicine, 10, 481–500.
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Carey, M.P., Lewis, B.P. Motivational Strategies Can Enhance HIV Risk Reduction Programs. AIDS Behav 3, 269–276 (1999). https://doi.org/10.1023/A:1025429216459
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DOI: https://doi.org/10.1023/A:1025429216459