Motivational Interviewing Fidelity Research Articles

Training peer specialists with mental illness in motivational interviewing: A pilot study.

The objective of this study was to evaluate the effects of providing motivational interviewing (MI) training to peer specialists in the Veterans Affairs (VA) health-care system. Fourteen peer specialists at a local VA medical center received a 2-day workshop on MI and 2 monthly booster sessions afterward. A total of 55 therapy sessions between peer specialists and their peer service recipients were audio-recorded and independently rated on MI fidelity before the workshop and each month after the workshop for 3 months. Sessions were rated on fidelity scales assessing Fundamental MI Adherence and Competence, Advanced MI Adherence and Competence, and MI Inconsistent Adherence scales. One item was created for this study that assessed Sharing Lived Experiences. Repeated measures analysis was conducted to examine change in MI fidelity over time. Peer specialists had a significant decline in MI Inconsistent Adherence scale scores over time. Specifically, they showed reductions in providing unsolicited advice and emphasizing absolute abstinence. Peer specialists also showed a significant decline in the Sharing Lived Experience Adherence item score. There were no significant changes on MI Fundamental and Advance scale scores. Training peer specialists in MI is feasible and may lead to some change in practices, but comprehensive training and ongoing supervision is needed to incur and sustain changes. Guidance and assessment of how peer specialists share their lived experiences with fellow veterans may be needed to capitalize on their unique experiences and skill sets. (PsycINFO Database Record

Is a motivational interviewing based lifestyle intervention for obese pregnant women across Europe implemented as planned? Process evaluation of the DALI study

BackgroundProcess evaluation is an essential part of designing and assessing complex interventions. The vitamin D and lifestyle intervention study (DALI) study is testing different strategies to prevent development of gestational diabetes mellitus among European obese pregnant women with a body mass index ≥29 kg/m2. The intervention includes guidance on physical activity and/or healthy eating by a lifestyle coach trained in motivational interviewing (MI). The aim of this study was to assess the process elements: reach, dose delivered, fidelity and satisfaction and to investigate whether these process elements were associated with changes in gestational weight gain (GWG).MethodsData on reach, dose delivered, fidelity, and satisfaction among 144 participants were collected. Weekly recruitment reports, notes from meetings, coach logs and evaluation questionnaires (n = 110) were consulted. Fidelity of eight (out of twelve) lifestyle coach practitioners was assessed by analysing audio recorded counselling sessions using the MI treatment integrity scale. Furthermore, associations between process elements and GWG were assessed with linear regression analyses.ResultsA total of 20% of the possible study population (reach) was included in this analysis. On average 4.0 (of the intended 5) face-to-face sessions were delivered. Mean MI fidelity almost reached ‘expert opinion’ threshold for the global scores, but was below ‘beginning proficiency’ for the behavioural counts. High variability in quality of MI between practitioners was identified. Participants were highly satisfied with the intervention, the lifestyle coach and the intervention materials. No significant associations were found between process elements and GWG.ConclusionOverall, the intervention was well delivered and received by the study population, but did not comply with all the principles of MI. Ensuring audio recording of lifestyle sessions throughout the study would facilitate provision of individualized feedback to improve MI skills. A larger sample size is needed to confirm the lack of association between process elements and GWG.Trial registrationISRCTN registry: ISRCTN70595832; Registered 12 December 2011.

Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol

BackgroundEvidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate.MethodsThis test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure.DiscussionLOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI.Trial registrationThis study is registered with Clinicaltrials.gov (NCT03042832), 2 February 2017, retrospectively registered.

The relationship between counselors' technical skills, clients' in-session verbal responses, and outcome in smoking cessation treatment

BackgroundThe technical component of Motivational Interviewing (MI) posits that client language mediates the relationship between counselor techniques and subsequent client behavioral outcomes. The purpose of this study was to examine this hypothesized technical component of MI in smoking cessation treatment in more depth. MethodSecondary analysis of 106 first treatment sessions, derived from the Swedish National Tobacco Quitline, and previously rated using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coder's Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. ResultsSequential analyses indicated that clients were significantly more likely than expected by chance to argue for change (change talk) following MI-consistent behaviors and questions and reflections favoring change. Conversely, clients were more likely to argue against change (sustain talk) following questions and reflections favoring status-quo. Parallel mediation analysis revealed that a counselor technique (reflections of client sustain talk) had an indirect effect on smoking outcome at follow-up through client language mediators. ConclusionsThe study makes a significant contribution to our understanding of how MI works in smoking cessation treatment and adds further empirical support for the hypothesized technical component in MI. The results emphasize the importance of counselors avoiding unintentional reinforcement of sustain talk and underline the need for a greater emphasis on the direction of questions and reflections in MI trainings and fidelity measures.

Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis.

Randomized clinical trials (RCTs), mostly conducted among minority populations, have reported that motivational interviewing (MI) can improve medication adherence. To evaluate the impact of MI and of the MI delivery format, fidelity assessment, fidelity-based feedback, counselors' background and MI exposure time on adherence. We searched the MEDLINE database for studies published from 1966 until February 2015. We included RCTs that compared MI to a control group and reported a numerical measure of medication adherence. The main outcome was medication adherence defined as any subjective or objective measure reported as the proportion of subjects with adequate adherence or mean adherence and standard deviation. For categorical variables we calculated the relative risk (RR) of medication adherence, and for continuous variables we calculated the standardized mean difference (SMD) between the MI and control groups. We included 17 RCTs. Ten targeted adherence to HAART. For studies reporting a categorical measure (n = 11), the pooled RR for medication adherence was higher for MI compared with control (1.17; 95% CI 1.05- 1.31; p < 0.01). For studies reporting a continuous measure (n = 11), the pooled SMD for medication adherence was positive (0.70; 95% CI 0.15-1.25; p < 0.01) for MI compared with control. The characteristics that were significantly (p < 0.05) associated with medication adherence were telephonic MI and fidelity-based feedback among studies reporting categorical measures, group MI and fidelity assessment among studies reporting continuous measures and delivery by nurses or research assistants. Effect sizes differed in magnitude, creating high heterogeneity. MI improves medication adherence at different exposure times and counselors' educational level. However, the evaluation of MI characteristics associated with success had inconsistent results. Larger studies targeting diverse populations with a variety of chronic conditions are needed to clarify the effect of different MI delivery modes, fidelity assessment and provision of fidelity based-feedback.

Perceptions of Motivational Interviewing

The practice of motivational interviewing (MI) has gained acceptance as an effective approach to support behavior change in various therapeutic contexts. In recent years, MI has been extended to clients within less traditional therapeutic settings including prisons and probation departments. Despite the known strengths of MI for positively affecting behavioral change in therapeutic contexts, the extent to which probation officers are able to effectively utilize MI remains unknown. The current study utilizes self-report responses from 485 probationers to assess the internal consistency and factor structure of the Client Evaluation of Motivational Interviewing (CEMI) as a tool for gathering feedback on MI fidelity in probation. Confirmatory factor analysis found two distinct MI factors to exist among this client base—technical and relational aspects of MI. Results suggest the CEMI is an effective tool to determine community corrections clients’ self-perceptions of probation officer’s use of MI-consistent techniques.

Fidelity of Motivational Interviewing in an Early Childhood Caries Intervention Involving Indigenous Australian Mothers.

This paper assessed the fidelity of an early childhood caries MI intervention among Aboriginal mothers in South Australia. Four MI-trained staff delivered the intervention and all interviews were recorded. A randomly selected subset (n = 164, 41.2%) were tested for MI fidelity using the Motivational Interviewing Treatment Integrity (MITI) code 3.1.1. A further randomly selected 20 taped sessions were additionally scored by an external expert to assess external reliability. Mean scores for evocation, collaboration, autonomy/support, direction and empathy ranged from 3.5 (95% CI 3.4-3.7) to 4.1 (95% CI 4.0-4.2). The mean global score was 3.8 (95% 3.7-3.9). The Reflection:Question ratio was 0.9 (95% CI 0.8-1.0), % Open-ended Questions was 54.9 (95% CI 50.0-59.8), % Complex Reflections was 54.0 (95% CI 50.5-57.5) and % MI-adherent statements was 95.0 (95% CI 92.0-98.0). Inter-assessor reliability was high. Beginner to expert competency in fidelity to the MI model was observed.

A Comparison of Natural Language Processing Methods for Automated Coding of Motivational Interviewing

Motivational interviewing (MI) is an efficacious treatment for substance use disorders and other problem behaviors. Studies on MI fidelity and mechanisms of change typically use human raters to code therapy sessions, which requires considerable time, training, and financial costs. Natural language processing techniques have recently been utilized for coding MI sessions using machine learning techniques, rather than human coders, and preliminary results have suggested these methods hold promise. The current study extends this previous work by introducing two natural language processing models for automatically coding MI sessions via computer. The two models differ in the way they semantically represent session content, utilizing either 1) simple discrete sentence features (DSF model) and 2) more complex recursive neural networks (RNN model). Utterance- and session-level predictions from these models were compared to ratings provided by human coders using a large sample of MI sessions (N=341 sessions; 78,977 clinician and client talk turns) from 6 MI studies. Results show that the DSF model generally had slightly better performance compared to the RNN model. The DSF model had “good” or higher utterance-level agreement with human coders (Cohen's kappa>0.60) for open and closed questions, affirm, giving information, and follow/neutral (all therapist codes); considerably higher agreement was obtained for session-level indices, and many estimates were competitive with human-to-human agreement. However, there was poor agreement for client change talk, client sustain talk, and therapist MI-inconsistent behaviors. Natural language processing methods provide accurate representations of human derived behavioral codes and could offer substantial improvements to the efficiency and scale in which MI mechanisms of change research and fidelity monitoring are conducted.

Treatment Fidelity of a Nurse-Led Motivational Interviewing-Based Pre-Treatment in Pain Rehabilitation

Treatment fidelity and proficiency of a nurse-led motivational interviewing (MI)-based pre-treatment and control condition was evaluated. A random sample was scored by means of the Motivational Interviewing Treatment Integrity (MITI) scale, and a second rater was in charge. MI fidelity was satisfactory for three out of five ratings. Most mean ratings were higher in the MI-based intervention, but differences were not statistically significant. The threshold for beginning MI proficiency was only exceeded for one score and one additional measure. In general, higher levels of fidelity in the intervention condition confirmed that MI was partially applied there. Although the quality of MI delivery as well as mixed inter-rater reliabilities of the fidelity scores leaves room for improvement, robust findings between the two raters were found. These results suggest the need for rigor selection of MI counselors on beforehand, and continuous supervision. Furthermore, fidelity check in studies using MI is needed.

A Randomized Evaluation of Motivational Interviewing Training for Mandated Implementation of Alcohol Screening and Brief Intervention in Trauma Centers

The American College of Surgeons has mandated that level I and level II trauma centers implement universal alcohol screening and brief intervention (SBI) for injured patients. This study was a secondary analysis of a national, 20-hospital, cluster-randomized implementation trial focusing on practical issues of training and supervising alcohol SBI providers in motivational interviewing (MI). The purpose of this study was to examine whether real-world trauma center providers can be trained to provide higher quality counseling using MI as part of brief interventions for alcohol and whether MI skills can be maintained over time. Sites were randomly assigned to receive a 1day workshop training in MI for alcohol SBI or not, and all providers regardless of training completed up to seven standardized patient assessments of MI fidelity over 27months. Six domains on the Motivational Interviewing Treatment Integrity (MITI) coding system were assessed and compared to proficiency criteria. Providers in the intervention training group showed substantially improved MITI scores over the course of the 27-month time period. Domains that had particularly strong improvement were MI spirit and empathy; however, despite the overall improvement in the intervention group scores, expert-derived proficiency criteria were attained only for the global scores. Routine trauma center providers who receive MI training can deliver higher quality counseling in alcohol brief interventions, but may not, however, attain previously derived proficiency standards. Future implementation efforts in real-world acute care medical settings could further elucidate provider characteristics that predict training response and also strive to demonstrate that higher quality alcohol SBI implementation is associated with improved patient-level outcomes.

How to Measure Motivational Interviewing Fidelity in Randomized Controlled Trials: Practical Recommendations

Many randomized controlled trials in which motivational interviewing (MI) is a key intervention make no provision for the assessment of treatment fidelity. This methodological shortcoming makes it impossible to distinguish between high- and low-quality MI interventions, and, consequently, to know whether MI provision has contributed to any intervention effects. This article makes some practical recommendations for the collection, selection, coding and reporting of MI fidelity data, as measured using the Motivational Interviewing Treatment Integrity Code. We hope that researchers will consider these recommendations and include MI fidelity measures in future studies.

Assessing Treatment Fidelity in a Cultural Adaptation of Motivational Interviewing

The efficacy of motivational interviewing (MI) for addictions is well documented. Grounding MI in social/cultural priorities may enhance treatment response. We evaluate the method of assessing competence using the motivational interviewing treatment integrity system (MITI) for standard MI and culturally adapted MI (CAMI) delivered to Latino heavy drinkers. Twenty audiotapes (MI, n = 10; CAMI, n = 10) were MITI coded by two raters unaware of treatment assignment. Inter-rater reliabilities were excellent (.78–.99) except for CAMI complex reflections, global ratings of empathy, and MI spirit. The MITI reliably evaluates MI and CAMI treatment fidelity. Future research should investigate lower reliabilities for MI global and complex reflections cross-culturally.

Motivational Interviewing support for a behavioral health internet intervention for drivers with type 1 diabetes

While Internet interventions can improve health behaviors, their impact is limited by program adherence. Supporting program adherence through telephone counseling may be useful, but there have been few direct tests of the impact of support. We describe a Telephone Motivational Interviewing (MI) intervention targeting adherence to an Internet intervention for drivers with Type 1 Diabetes, DD.com, and compare completion of intervention benchmarks by those randomized to DD.com plus MI vs. DD.com only. The goal of the pre-intervention MI session was to increase the participant's motivation to complete the Internet intervention and all its assignments, while the goal of the post-treatment MI session was to plan for maintaining changes made during the intervention. Sessions were semi-structured and partially scripted to maximize consistency. MI Fidelity was coded using a standard coding system, the MITI. We examined the effects of MI support vs. no support on number of days from enrollment to program benchmarks. Results show that MI sessions were provided with good fidelity. Users who received MI support completed some program benchmarks such as Core 4 (t176 df=−2.25; p<.03) and 11 of 12 monthly driving diaries significantly sooner, but support did not significantly affect time to intervention completion (t177 df=−1.69; p<.10) or rates of completion. These data suggest that there is little benefit to therapist guidance for Internet interventions including automated email prompts and other automated minimal supports, but that a booster MI session may enhance collection of follow-up data.

Comparing the Motivational Interviewing Integrity in Two Prevalent Models of Brief Intervention Service Delivery for Primary Care Settings

This quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40months post MI training.Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.

Motivational Interviewing at the Intersections of Depression and Intimate Partner Violence among African American Women

This article focuses on design, training, and delivery of a culturally tailored, multi-faceted intervention that used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a community-based participatory research approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program.

Training and maintaining motivational interviewing skills in a clinical trial

Motivational interviewing (MI) is an evidence-based practice that is being implemented in a wide range of settings. Research supports the importance of ongoing coaching and feedback sessions following initial training in MI to implement and sustain MI-adherent competencies. This article describes the development and preliminary testing of a group feedback and consultation process where clinicians code each others’ clinical samples of MI sessions and provide feedback to each other regarding the level of adherence to MI fidelity measures. Preliminary results suggest that group feedback may help clinicians develop and sustain MI skills.

Effectiveness of interventions using Motivational Interviewing for dietary and physical activity modification in adults: a systematic review

Background When healthcare professionals are confronted with ambivalence in their clients, traditional advice-giving can be counter-productive. Motivational Interviewing (MI), an alternative to traditional advice-giving, aims to provide the ambivalent client with a supportive, non-judgmental environment in which to discuss the possibility of change. Objectives This review aimed to synthesize the best available evidence on the effectiveness of dietary and physical activity interventions employing MI to achieve behavior change. Inclusion criteria Types of participants The review included participants aged 18 years or older. Types of intervention(s)/phenomena of interest Studies that defined the intervention as ‘Motivational Interviewing’ and provided detail on how MI was incorporated into the studies were included. The included studies separated subjects into one group receiving the MI intervention and one group receiving a comparison treatment with similar contact but without MI counseling (an attention control). Types of studies The review considered randomized controlled trials (RCT) or systematic reviews published in English between 1980 to January 2012 Types of outcomes Outcomes of interest included diet (energy intake, core food groups, macronutrient composition of the diet, diet quality or diet index) and/or physical activity including exercise or sedentary behaviors (energy expenditure, steps taken, minutes of physical activity or sitting time). Search strategy Nine databases were searched and the reference lists of all included studies were searched for additional studies not previously identified. Methodological quality Two independent reviewers used a standardized appraisal tool to ensure the methodological quality of the studies. Data collection Two reviewers performed data extraction using a standardized tool. Data synthesis A qualitative synthesis was undertaken through a comparative narrative summary. Results The search yielded 1,765 articles of which eight met all inclusion criteria. The review reported on a heterogeneous sample of studies that were of low-to-moderate quality. Five of the studies reported monitoring MI fidelity; however only three studies reported proficiency scores. Two of the five articles reporting on diet found positive effects. One study found a lower saturated fat score in the group that received MI by a dietician (β=0.23, ρ<0.01) compared with counseling by a dietician not trained in MI. The other study reported a significant difference in percent energy from fat (2.6%, ρ<0.001) favoring Motivational Interviewing when comparing Motivational Interviewing from a dietician versus standard care. None of the six articles reporting on physical activity found any difference between MI and the attention control. Conclusions There is not yet sufficient evidence to conclude that MI enhances diet and physical activity behavior change above an attention control, although the findings from two studies are suggestive of a positive effect in decreasing dietary fat intake. Implications for practice When more high quality research evidence is available, the next challenge will be to establish evidence that research-based interventions will translate to the clinical setting. Implications for research More high quality studies that objectively measure diet and physical activity, evaluate and report fidelity scores and compare a MI intervention to an attention control over a period of at least six months are required.

Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial

BackgroundNon-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment.Methods/designStudy design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment.Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program.Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each.Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment.Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs of the pre-treatment intervention, productivity losses, and healthcare utilization. Potential moderators and active ingredients of MI are explored. For the process evaluation, parameters such as MI fidelity, feasibility, and experiences are explored.DiscussionThe results of this study will provide evidence on the effectiveness of this MI-based pre-treatment in pain rehabilitation. Furthermore, a cost-effectiveness analysis and exploration of moderating and working mechanisms of MI and an extensive process evaluation takes place.Trial registrationNederlands trial register NTR3065

Measuring client perceptions of motivational interviewing: factor analysis of the Client Evaluation of Motivational Interviewing scale

Motivational interviewing (MI) is an intervention approach that has solid evidence of efficacy with substance use disorders. Research and training have benefitted from the development of observational measures to assess MI fidelity and competence. However, one untapped area of assessment is the client perception of the clinician use of MI. Client perceptions of MI have been found through qualitative interviews to relate to motivation to change, view of the therapist and safety of therapy. The Client Evaluation of MI (CEMI) scale was developed to assess client perception of clinician MI use. This study further evaluated the CEMI through exploratory and confirmatory factor analysis with a sample of 500 individuals with dual diagnosis pre-discharge from an inpatient unit. Participants completed an MI based session prior to completing CEMIs. A two factor (relational and technical) model explained 51.1% of the cumulative variance and was supported through confirmatory factor analysis. Suggestions for revisions are provided as well as potential uses of the CEMI and future directions for research.

Is the process of delivery of an individually tailored lifestyle intervention associated with improvements in LDL cholesterol and multiple lifestyle behaviours in people with Familial Hypercholesterolemia?

BackgroundMore insight in the association between reach, dose and fidelity of intervention components and effects is needed. In the current study, we aimed to evaluate reach, dose and fidelity of an individually tailored lifestyle intervention in people with Familial Hypercholesterolemia (FH) and the association between intervention dose and changes in LDL-Cholesterol (LDL-C), and multiple lifestyle behaviours at 12-months follow-up.MethodsParticipants (n = 181) randomly allocated to the intervention group received the PRO-FIT intervention consisting of computer-tailored lifestyle advice (PRO-FIT*advice) and counselling (face-to-face and telephone booster calls) using Motivational Interviewing (MI). According to a process evaluation plan, intervention reach, dose delivered and received, and MI fidelity were assessed using the recruitment database, website/counselling logs and the Motivational Interviewing Treatment Integrity (MITI 3.1.1.) code. Regression analyses were conducted to explore differences between participant and non-participant characteristics, and the association between intervention dose and change in LDL-C, and multiple lifestyle behaviours.ResultsA 34% (n = 181) representative proportion of the intended intervention group was reached during the recruitment phase; participants did not differ from non-participants (n = 623) on age, gender and LDL-C levels. Of the participants, 95% received a PRO-FIT*advice log on account, of which 49% actually logged on and completed at least one advice module. Nearly all participants received a face-to-face counselling session and on average, 4.2 telephone booster calls were delivered. None of the face-to-face sessions were implemented according to MI guidelines. Overall, weak non-significant positive associations were found between intervention dose and LDL-C and lifestyle behaviours.ConclusionsImplementation of the PRO-FIT intervention in practice appears feasible, particularly PRO-FIT*advice, since it can be relative easily implemented with a high dose delivered. However, only less than half of the intervention group received the complete intervention-package as intended. Strategies to let participants optimally engage in using web-based computer-tailored interventions like PRO-FIT*advice are needed. Further, more emphasis should be put on more extensive MI training and monitoring/supervision.Trial registrationNTR1899 at ww.trialregister.nl.