Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients

• Greater discussion of drawbacks of a behavior does not predict more change talk.
• Discussions of benefits of a behavior change often elicit support for change.
• Patient talk supporting behavior change has similar focus for alcohol vs. sex risk.
• Talk supporting sustaining a behavior differs in its focus for alcohol vs. sex risk.

ObjectiveTo elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk).MethodsWe developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk.ResultsFor both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change.ConclusionsTopic coding provided unique insights into the content of patient change and sustain talk.Practice implicationsPatients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors.