Abstract
PurposeThe aim of this study was to design and trial an Adherence Scale to measure fidelity of Motivational Care Planning (MCP) within a clinical trial. This culturally adapted therapy MCP uses a client centered holistic approach that emphasises family and culture to motivate healthy life style changes.MethodsThe Motivational Care Planning-Adherence Scale (MCP-AS) was developed through consultation with Aboriginal and Islander Mental Health Initiative (AIMhi) Indigenous and non-Indigenous trainers, and review of MCP training resources. The resultant ten-item scale incorporates a 9-Point Likert Scale with a supporting protocol manual and uses objective, behaviourally anchored criteria for each scale point. A fidelity assessor piloted the tool through analysis of four audio-recordings of MCP (conducted by Indigenous researchers within a study in remote communities in Northern Australia). File audits of the remote therapy sessions were utilised as an additional source of information. A Gold Standard Motivational Care Planning training video was also assessed using the MCP-AS.ResultsThe Motivational Care Planning-Adherence Scale contains items measuring both process and content of therapy sessions. This scale was used successfully to assess therapy through observation of audio or video-recorded sessions and review of clinical notes. Treatment fidelity measured by the MCP-AS within the pilot study indicated high fidelity ratings. Ratings were high across the three domains of rapport, motivation, and self-management with especially high ratings for positive feedback and engagement, review of stressors and goal setting.ConclusionsThe Motivational Care Planning-Adherence Scale has the potential to provide a measure of quality of delivery of Motivation Care Planning. The pilot findings suggest that despite challenges within the remote Indigenous community setting, Indigenous therapists delivered therapy that was of high fidelity. While developed as a research tool, the scale has the potential to support fidelity of delivery of Motivation Care Planning in clinical, supervision and training settings. Larger studies are needed to establish inter-rater reliability and internal and external validity.
Highlights
The 1989 National Aboriginal Health Strategy helped garner support from the wider community to improve the overall health and well-being of Aboriginal and Torres Strait Islander people
In the Northern Territory, researchers have sought to address these barriers to engagement of Indigenous Australians within the health system [9,10,11]
The Northern Territory Aboriginal and Islander Mental health initiative (AIMhi) aims to promote access of Indigenous Australians to mental health services through development of culturally adapted resources and training tools [13]. These tools include the development of a brief therapy entitled ‘Motivational Care Planning’ (MCP)
Summary
The 1989 National Aboriginal Health Strategy helped garner support from the wider community to improve the overall health and well-being of Aboriginal and Torres Strait Islander people (hereinafter referred to as Indigenous Australians). The Northern Territory Aboriginal and Islander Mental health initiative (AIMhi) aims to promote access of Indigenous Australians to mental health services through development of culturally adapted resources and training tools [13]. These tools include the development of a brief therapy entitled ‘Motivational Care Planning’ (MCP). The therapy incorporates motivational interviewing and problem solving principles It adapts to cross cultural and socially disadvantaged settings by having a central focus on family rather than individual, and by the use of plain English pictorial tools, which guide the strengths based therapeutic approach [14]
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