Exploring ambivalence in motivational interviewing with obese African American adolescents and their caregivers: A mixed methods analysis

•We examine statements of ambivalence in motivational interviewing counseling sessions.•Caregivers expressed more ambivalence and were more negative in their ambivalence.•Caregivers were optimistic about targeting nutrition, adolescents about activity.•Clinicians working with families on weight loss interventions should examine both perspectives.

ObjectiveWe conducted an exploratory mixed methods study to describe the ambivalence African-American adolescents and their caregivers expressed during motivational interviewing sessions targeting weight loss.MethodsWe extracted ambivalence statements from 37 previously coded counseling sessions. We used directed content analysis to categorize ambivalence related to the target behaviors of nutrition, activity, or weight. We compared adolescent-caregiver dyads' ambivalence using the paired sample t-test and Wilcoxon signed-rank test. We then used conventional content analysis to compare the specific content of adolescents' and caregivers' ambivalence statements.ResultsAdolescents and caregivers expressed the same number of ambivalence statements overall, related to activity and weight, but caregivers expressed more statements about nutrition. Content analysis revealed convergences and divergences in caregivers' and adolescents' ambivalence about weight loss.ConclusionUnderstanding divergences in adolescent-caregiver ambivalence about the specific behaviors to target may partially explain the limited success of family-based weight loss interventions targeting African American families and provides a unique opportunity for providers to enhance family communication, foster teamwork, and build self-efficacy to promote behavior change.Practice implicationsClinicians working in family contexts should explore how adolescents and caregivers converge and diverge in their ambivalence in order to recommend weight loss strategies that best meet families' needs.