J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Short Communication

Volume 11, Number 11, November 2019, pages 764-768

Pragmatic Quality Assessment of Brief Health Behavior Change Interventions: Evidence for Criterion-Related Validity of the Behavior Change Counseling Index

**Table 1.** Provider Characteristics (N = 64)
Characteristic	N (%)/M, SD
^aCategories do not add up to 100% due to missing data for 12 participants. ^bBased on n = 51 due to missing data. M: mean; SD: standard deviation.
Gender
Male	8 (12.5)
Female	56 (87.5)
Race/ethnicity^a
White	41 (64.1)
Multiracial/ethnic	6 (9.4)
Black	4 (6.3)
Asian	1 (1.6)
Age^b	38.3, 10.3
Professional role
Chemical dependency/mental health counselor	4 (6.2)
Psychologist/psychology trainee	6 (9.4)
Physician/physician trainee	5 (7.8)
Physician assistant	6 (9.4)
Nurse (RN)	8 (11.7)
Nurse practitioner	10 (15.6)
Social worker/social work trainee	21 (32.8)
Research coordinator	4 (6.2)
Education
Bachelors	11 (17.2)
Masters	39 (60.9)
Doctorate	13 (20.3)
Years since receipt of professional degreea	9.0, 9.7

Table 1. Provider Characteristics (N = 64)

Characteristic

N (%)/M, SD

^aCategories do not add up to 100% due to missing data for 12 participants. ^bBased on n = 51 due to missing data. M: mean; SD: standard deviation.

Gender

Male

8 (12.5)

Female

56 (87.5)

Race/ethnicity^a

White

41 (64.1)

Multiracial/ethnic

6 (9.4)

Black

4 (6.3)

Asian

1 (1.6)

Age^b

38.3, 10.3

Professional role

Chemical dependency/mental health counselor

4 (6.2)

Psychologist/psychology trainee

6 (9.4)

Physician/physician trainee

5 (7.8)

Physician assistant

6 (9.4)

Nurse (RN)

8 (11.7)

Nurse practitioner

10 (15.6)

Social worker/social work trainee

21 (32.8)

Research coordinator

4 (6.2)

Education

Bachelors

11 (17.2)

Masters

39 (60.9)

Doctorate

13 (20.3)

Years since receipt of professional degreea

9.0, 9.7

**Table 2.** Simulated Patient Role-Play Scenario Provider Instructions and Additional Details
^aThe simulated patient actor is trained to provide these extra details when asked relevant questions during the role-play by the provider.
Scenario instructions
We will be doing a brief 20-min intervention role-play. I am going to give you a warning when we have a few minutes left for each role play and if you feel comfortable giving a summary at that point to close out the session, you may do so.
I am a 21-year-old college woman named Angela. I was in a motor vehicle crash while driving home from a party. There was no blood alcohol test available but I told the nurse I had been drinking. I have a left ankle fracture and a forehead laceration.
You will pretend you are at bedside with me at a trauma center; your goal is to counsel me about alcohol. That is all the information about the patient I will give you to start, any other questions regarding the patient can occur during the role play.
Additional scenario details^a
Patient engages in periodic binge episodes on weekends at parties; does not drink during the week.
Patient is committed to not driving after drinking and is willing to try counting her drinks at parties and/or consider other means of socializing or relaxing that do not include alcohol.

Table 2. Simulated Patient Role-Play Scenario Provider Instructions and Additional Details

^aThe simulated patient actor is trained to provide these extra details when asked relevant questions during the role-play by the provider.

Scenario instructions

We will be doing a brief 20-min intervention role-play. I am going to give you a warning when we have a few minutes left for each role play and if you feel comfortable giving a summary at that point to close out the session, you may do so.

I am a 21-year-old college woman named Angela. I was in a motor vehicle crash while driving home from a party. There was no blood alcohol test available but I told the nurse I had been drinking. I have a left ankle fracture and a forehead laceration.

You will pretend you are at bedside with me at a trauma center; your goal is to counsel me about alcohol. That is all the information about the patient I will give you to start, any other questions regarding the patient can occur during the role play.

Additional scenario details^a

Patient engages in periodic binge episodes on weekends at parties; does not drink during the week.

Patient is committed to not driving after drinking and is willing to try counting her drinks at parties and/or consider other means of socializing or relaxing that do not include alcohol.

**Table 3.** Descriptive Statistics for Overall BECCI and MITI Empathy and Summary Scores
	M	SD
Overall BECCI score	2.3	1.2
MITI scores
MI spirit	2.3	0.9
Empathy	2.3	1.1
% MI adherent	36.3	39.7
BECCI: behavior change counseling index; MITI: Motivational interviewing treatment integrity; MI: motivational interviewing; M: mean; Mdn: median; SD: standard deviation; IQR: interquartile range. Overall BECCI score ranges from 0 (not at all) to 4 (a great extent). MI spirit and empathy scores range from 1 (low) to 5 (high).
% Open questions	16.2	25.4
% Complex reflections	0.0	17.5
Reflection to question ratio	0.1	0.2

Table 3. Descriptive Statistics for Overall BECCI and MITI Empathy and Summary Scores

Overall BECCI score

2.3

1.2

MITI scores

MI spirit

2.3

0.9

Empathy

2.3

1.1

% MI adherent

36.3

39.7

Mdn

IQR

BECCI: behavior change counseling index; MITI: Motivational interviewing treatment integrity; MI: motivational interviewing; M: mean; Mdn: median; SD: standard deviation; IQR: interquartile range. Overall BECCI score ranges from 0 (not at all) to 4 (a great extent). MI spirit and empathy scores range from 1 (low) to 5 (high).

% Open questions

16.2

25.4

% Complex reflections

0.0

17.5

Reflection to question ratio

0.1

0.2

**Table 4.** Correlations Between Overall BECCI and MITI Scores Based on Simulated Patient Performance
	MITI scores^a
MITI: motivational interviewing treatment integrity; BECCI: behavior change counseling index; MI: motivational interviewing; Adh: adherent; OQ: open questions: CR: complex reflections: R:Q: reflection-to-question ratio. Spearman’s rho (r_s) was used to assess the correlation between BECCI and skewed MITI scores. ^aRated by an expert MITI coder using audio recording of the session. ^bRated by the simulated patient immediately following the role-play. *P < 0.05.
Overall BECCI score^b	0.74*	0.70*	0.51*	0.56*	0.33*	0.60*

Table 4. Correlations Between Overall BECCI and MITI Scores Based on Simulated Patient Performance

MITI scores^a

MI spirit

Empathy

% MI Adh

% OQ

% CR

R:Q

r_s

MITI: motivational interviewing treatment integrity; BECCI: behavior change counseling index; MI: motivational interviewing; Adh: adherent; OQ: open questions: CR: complex reflections: R:Q: reflection-to-question ratio. Spearman’s rho (r_s) was used to assess the correlation between BECCI and skewed MITI scores. ^aRated by an expert MITI coder using audio recording of the session. ^bRated by the simulated patient immediately following the role-play. *P < 0.05.

Overall BECCI score^b

0.74*

0.70*

0.51*

0.56*

0.33*

0.60*