Barriers and Facilitators for Implementing Motivational Interviewing as a Return to Work Intervention in a Norwegian Social Insurance Setting: A Mixed Methods Process Evaluation

Vegard Stolsmo Foldal,Roar Johnsen,Ida Løchting,Marit Solbjør,Hedda Eik,Margreth Grotle,Lene Aasdahl,Egil Andreas Fors,Martin Inge Standal,Gunnhild Bagøien,Roger Hagen,Heidi Fossen,Karen Walseth Hara

doi:10.1007/s10926-021-09964-9

Abstract

Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for “beginning proficiency” whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.Trial registration ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).

Highlights

Long-term sickness absence is a challenge for industrialized countries [1]
In a recent study we found that sick-listed workers receiving motivational interviewing (MI) as an return to work (RTW) intervention, given by caseworkers at NAV, experienced increased RTW self-efficacy [35]
This mixed-methods process evaluation was conducted alongside a randomized controlled trials (RCT) [20] and was guided by the reach and effectiveness (RE)-AIM framework [15, 19]

Summary

Introduction

Long-term sickness absence is a challenge for industrialized countries [1]. For the individual, prolonged sick leave is associated with adverse health outcomes, multimorbidity, increased risk of disability pension and a risk for exclusion from the labour market and economic instability [2,3,4,5]. A frequently used framework for process evaluations is the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework [15, 16]. RE-AIM is comprised of five parts to evaluate interventions by individual factors, such as reach and effectiveness (RE), and multilevel organizational factors, such as adoption, implementation, and maintenance (AIM) of the intervention [15]. Previous studies using the RE-AIM framework to evaluate RTW interventions have emphasized the importance of evaluating potential barriers and facilitators of implementation for practice and policymakers [17, 18]. It is recommended to use qualitative methods within the RE-AIM framework to increase the transferability of research findings to practice [20]

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Methods

Results

Discussion

Conclusion