Abstract
Motivational interviewing (MI) is a method for building motivation for behaviour change that has potential for use in respiratory contexts. There is a paucity of published research exploring the feasibility of this intervention from the clinicians’ perspective. This study aimed to explore respiratory clinicians' views of MI: Is it perceived as useful? Could it be integrated into practice? What training would be required to make it part of routine care? Nine respiratory clinicians attended a one-day MI workshop and a semi-structured face-to-face interview two weeks later. All interviews were audio-recorded, transcribed verbatim and analysed with thematic analysis. Four main themes are presented—1) MI’s suitability for use in respiratory contexts: participants saw potential in using MI to motivate their patients to engage with prescribed respiratory interventions, such as increased physical activity. Those who experimented with new skills post-workshop were encouraged by patient responsiveness and outcomes. 2) MI’s relationship with routine clinical practice: some believed they already used elements of MI, but most participants felt MI was fundamentally 'different' to their normal style of working. 3) Implementation issues: additional time would need to be made available to enable an appropriate depth of conversation. 4) Training issues: Participants sensed the complexity of MI could make it difficult to learn and that it would take them time to become competent. On-going supervision was perceived as necessary. One key challenge identified was how to suppress behaviours that are antithetical to MI. These findings lend support to the feasibility of using MI in respiratory contexts such as pulmonary rehabilitation programmes, but highlight implementation and training issues that would need to be overcome. The insights have informed the development of another study, testing the effect of a tailored training package on MI skill, specifically for respiratory clinicians delivering pulmonary rehabilitation programmes.
Highlights
The success of therapy for many conditions is influenced by the extent to which patients engage with their treatment and adhere to the activities and lifestyle changes that are recommended to them
Most participants talked favourably about the use of Motivational interviewing (MI) within the respiratory setting. They believed that MI improved the relationship that they had with patients and had the potential to be an effective method to motivate patients to change behaviour
Participants described it as a pragmatic approach that might be used in several situations in their clinical practice: smoking cessation, mobilising, exercise, reducing alcohol consumption and modifying diet
Summary
The success of therapy for many conditions is influenced by the extent to which patients engage with their treatment and adhere to the activities and lifestyle changes that are recommended to them. This paper provides insight into clinicians’ views of an approach to changing health behaviour (motivational interviewing) adapted for respiratory patients. Patients with respiratory conditions may be motivated to change their behaviour (mobilise, exercise more, stop smoking) to improve their health, but simultaneously lack confidence in their ability to succeed, or may perceive that the personal costs, such as the time and effort it takes, to be insurmountable. MI seeks to create a supportive, empathic atmosphere whilst gently encouraging patients towards thinking about and verbalising their own motivations for change, as well as considering how their current behaviour is influencing their ability to lead the life they want [5]. The aim is to help patients to explore and resolve their ambivalence
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