Application of motivational interviewing strategies with the extended parallel process model to improve risk communication for parents of children with familial hypercholesterolemia

Bridget Winchester, Deborah Cragun, Krista Redlinger-Grosse, Scott T. Walters, Erin Ash, Emma Baldry, Heather Zierhut

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Current genetic counseling practice has not been found to significantly increase risk communication between family members. A more diverse set of genetic counseling approaches may be needed. A genetic counseling intervention based on motivational interviewing principles and the extended parallel process model was utilized to increase cascade outcomes within families with familial hypercholesterolemia, a common, underdiagnosed, and treatable condition. Parents of children with familial hypercholesterolemia were invited to participate in an online pre-survey, single-session genetic counseling intervention, and post-intervention surveys as a part of the CHEERS (Cholesterol Evaluation to Explore Risk Screening) intervention. This study investigated the efficacy of a genetic counselor delivered motivational interviewing intervention and how parents of children with familial hypercholesterolemia react by assessing family member cholesterol screening and risk communication to at-risk relatives. Transcripts were audio-recorded, transcribed, and analyzed for change talk using the Motivational Interviewing Skill Code version 2.1. Participant surveys were analyzed for self-reported extended parallel process constructs and motivations. Coincidence analysis was conducted to explore differences between those with and without positive cascade outcomes within 12 months after the intervention. On average, change talk increased during the session in order of the extended parallel process constructs (perceived severity, susceptibility, response efficacy, self-efficacy). Coincidence analysis revealed that 6 of the 7 cases with positive cascade outcomes were explained by either the presence of high change talk during the intervention or presence of positive motivations shortly after, while 5 of the 5 cases without a positive outcome lacked both of these key factors that were associated with cascade outcomes. Results of this study suggest that incorporating motivational interviewing and the extended parallel process model increases change talk and that the presence of either high levels of change talk or positive motivations is associated with positive cascade outcomes.

Original languageEnglish (US)
Pages (from-to)847-859
Number of pages13
JournalJournal of Genetic Counseling
Issue number4
StatePublished - Aug 2022

Bibliographical note

Funding Information:
This work has been supported by the 2018 Jane Engelberg Memorial Fellowship, an annual grant from the Engelberg Foundation to the National Society of Genetic Counselors, Inc. The research presented in the paper was conducted while the first author was fulfilling a master's degree at the University of Minnesota. Jehannine Austin served as Action Editor on this manuscript.

Publisher Copyright:
© 2022 National Society of Genetic Counselors.


  • cascade testing
  • communication
  • counseling techniques
  • extended parallel process model
  • familial hypercholesterolemia
  • genetic counseling
  • motivational interviewing
  • risk communication

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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