Development and Results of a Motivational Interviewing Program for Health Education to Facilitate Osteoporosis Self-Management

Abstract

Introduction: Medication adherence is poor for many chronic conditions, including osteoporosis. Few proven interventions exist to improve Osteoporosis (OP) medication adherence. We report on methods to develop a telephonic motivational interviewing-based counseling program for health educators to promote osteoporosis medication adherence in elderly. Methods: Five health educators participated in an initial day and a half education training session. Motivational Interviewing techniques were reinforced by a behavioral scientist via semi-monthly calls over one year. At trial midpoint, two 20-30 minute client conversations were recorded. A certified Motivational Interview trainer evaluated performance using the Motivational Interviewing Treatment Integrity code (MITI) and provided feedback (scale: 0=poor to 5=excellent) to determine the extent of motivational interviewing “spirit” incorporated by the health educators during interactions with clients. Results: All health educators were female, mean age of 42 years. The range of health counseling experience was 7 to 15 years in varied healthcare areas. Scores across the five MITI domains suggest performance was strongest in providing direction and empathy. Domains needing improvement included evocation, collaboration, and autonomy/ support. On average, the total reflection to question ratio was 1.3, suggesting the need for more client reflections. Conclusion: Among health educators without substantial prior motivational interviewing experience, a year-long, multi-faceted motivational interviewing training program resulted in suboptimal competence in use of motivational interviewing counseling behaviors. This program serves as a novel, instructive model to inform the development and maintenance of MI intervention integrity among health educators using telephonic counseling.