Implementation Of Motivational Interviewing Research Articles

Motivational Interviewing Implementation in Primary Care: A "Terrifying Challenge" Becoming a "Professional Revelation".

Motivational interviewing (MI) is an evidence-based counseling approach within primary care. However, MI rarely translates to practice following introductory training programs, and a lack of evidence regarding its implementation persists today. This study describes primary care clinicians' professional transformation in implementing MI through interprofessional communities of practice (ICP-MI). Qualitative data collection involved the research journal, participant observation of four ICP-MIs (76 hours/16 clinicians), and focus groups. A general inductive approach was used for data analysis. Results were conceptualized based on the Consolidated Framework for Implementation Research. Four processes of MI implementation in primary care are presented as a motivational endeavor: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent, taking into consideration the significant challenges involved. After introspecting actual practices, they realized the limits of their previous clinician-centered approaches. The experimentation of MI in the workplace followed and enabled clinicians to witness MI feasibility and its added value. Finally, they were mobilized to ensure MI sustainability in their practices/organization. Intrinsic factors of influence included the clinicians' personal traits and their perception about MI as a clinical priority. Organizational support was also a crucial extrinsic factor in encouraging the clinicians' efforts. As described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented as integrated findings. Incorporating engaging educational activities to provide clinicians with motivational support and collaborating with health care organizations to plan appropriate resources should be considered in the development of MI implementation programs from the onset.

Examining the Impact of Race on Motivational Interviewing Implementation and Outcomes with HIV+ Heavy Drinking Men Who Have Sex with Men.

Motivational interviewing (MI)-based interventions focus on changing behavior through building client motivation. It is unknown how racial mismatch between clients and providers may impact MI implementation and subsequent behavior. We used a mixed methods approach to examine differences in Motivational Interviewing Skill Code (MISC) coded sessions and post-session outcomes between a sample of HIV-positive cisgender men who have sex with men (MSM) participants of an MI-based intervention to reduce heavy drinking who identified as persons of color (POC; n = 19) and a matched sample of White participants (n = 19). We used quantitative methods to analyze how providers implemented the intervention (i.e., MISC codes) and post-session drinking. We used qualitative analyses of session transcripts to examine content not captured by MISC coding. Quantitative analyses showed that providers asked fewer open-ended questions and had a lower ratio of complex reflections to simple reflections when working with POC participants, but no significant differences were observed in drinking post-intervention between participants. Qualitative analyses revealed that participants discussed how racial and sexual orientation discrimination impacted their drinking. Allowing clients to share their experiences and to explore individually meaningful reasons for behavioral change may be more important than strict adherence to MI techniques.

Implementation of motivational interviewing in the general practice setting: a qualitative study

BackgroundGeneral Practitioners (GPs) and Practice Nurses (PNs) collaboratively play an important role in preventing and monitoring chronic diseases. They are trained in Motivational Interviewing (MI), which is a communication style to intrinsically motivate patients to a healthier lifestyle. However, being trained in MI skills does not necessarily mean that it is implemented in daily practice so patients actually benefit. The aim of this study is to identify factors that facilitate or impede the implementation of MI in General Practice.MethodsA total of 152 participants (93 GP-trainees and 59 PN-trainees) who were trained in MI completed a questionnaire regarding the implementation of MI. Semi-structured interviews (N = 17) were conducted with GPs and PNs (ranging from almost graduated to highly experienced) who were selected through the process of maximum variation sampling. The interview guide was based on the five-stage implementation model of Grol and Wensing.ResultsThirteen factors that influence the implementation of MI in General Practice were identified. They can be allocated to three categories: (1) setting factors such as time, (2) GP/PN factors such as self-efficacy, and (3) patient factors such as cultural background.ConclusionsOverall, GPs and PNs considered MI to be useful and part of their professional responsibility. Most difficulties become apparent in stage 4 (change: applying MI skills in practice) and 5 (consolidation: integrating MI into daily routine and embedment in organisation) of Grol and Wensing’s model. Therefore, it is important that training does not only focus on MI skills. It is essential to pay explicit attention to the factors that impact implementation, as well as the appropriate tools to tackle the barriers. These insights can help trainers to effectively support GPs and PNs to apply and maintain their MI skills in daily practice.

The Effect of Motivational Interviewing on Fatigue in Patients with Multiple Sclerosis

Background: Fatigue is taken into account as one of the most important factors affecting quality of life in patients with multiple sclerosis. Such patients can certainly control levels of fatigue, increase their abilities to perform daily activities, and show adaptive behaviors if they are aware of non - pharmacological approaches to reduce fatigue. Thus, the purpose of the present study was to determine the effect of motivational interviewing on fatigue among patients affected by multiple sclerosis in the city of Ilam, Iran. Methods: In the present quasi - experimental study, a total number of 60 patients with multiple sclerosis referring to Shahid Mostafa Khomeini Teaching Hospital in the city of Ilam were randomly allocated to two experimental (intervention) (32 patients) and control (28 patients) groups. To collect the data, the fatigue impact scale (FIS) was used. The experimental (intervention) group also received motivational interviewing based on Miller and Rollnick’s Model. To this end, the given patients were divided to seven groups of five individuals and the motivational interviews were conducted lasting between 45 to 60 minutes during five sessions and on a weekly basis for each group. The questionnaires were also completed prior to the intervention and four weeks after the final training session by patients in the experimental (intervention) and control groups. To analyze the data, descriptive and inferential statistics were employed and significance level of less than 0.05 was considered. Results: The findings of this study showed that there was no difference between fatigue before and after the intervention in the experimental (66.32 (10.87)) and control (63.28 (8.29)) groups. However, after the intervention, the fatigue of the experimental (41.75 (14.35)) patients was reduced compared to that of control (62.13 (7.69)) and pre - intervention patients. Conclusions: The findings of the present study showed that implementation of motivational interviewing could alleviate fatigue among patients with multiple sclerosis; therefore, nurses were recommended to give daily care to these patients using this type of interview and to provide the basis for promoting health status of such patients.

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.

Implementation of motivational interviewing

Implementation of motivational interviewing

Implementation of Motivational Interviewing in a diabetes care management initiative in the Netherlands

ObjectiveMotivational Interviewing (MI) is a counseling approach to support behavioural change. The objective of the present study was to examine the uptake of MI in daily practice by health care professionals in a care management initiative for patients with diabetes in the region of Maastricht, the Netherlands. MethodsMI was implemented by means of a training. Directly and six months after the training, the application of MI was measured objectively (MITI) and subjectively (questionnaire). In focus interviews, MI-trained professionals (n=10) and MI untrained professionals (n=10) were asked about facilitators and barriers for implementation. Additionally, data on patient characteristics (n=141) were collected. ResultsSpirit of MI was present among professionals directly after the training and increased during follow-up. Mostly uncomplicated techniques were applied. Professionals stated the need for training and practice to be able to apply more complicated techniques. ConclusionThe applicability of MI in daily practice was found feasible, with various degrees of uptake. Relevant conditions to further improve the implementation of MI in daily practice were identified. Practice implicationsIn daily practice, a phased training in MI is recommended, with sufficient time and support by colleagues as essential conditions to profit most from the training sessions.

Implementing Motivational Interviewing (MI) in a Non-MI World

Abstract The Oregon Practice Improvement Collaborative (OPIC) facilitated the implementation of motivational interviewing (MI) in two community-based substance abuse treatment agencies. The Change Book: A Blueprint for Technology Transfer was used to structure and support the implementation of motivational interviewing. As part of the implementation process, the agencies' organizational readiness for change was assessed using standardized instruments developed by Simpson and colleagues. Results from the implementation effort suggest that an MI approach may be just as applicable to facilitating organizational change as it is to facilitating individual behavioral change. When integrated with The Change Book framework, MI may provide core strategies for assisting treatment agencies in adopting evidence-based practices and navigating organizational change.

Overview: white norms and psychiatric diagnosis of black patients.

Allegations of psychiatric misdiagnosis of black patients are supported by only a few examples of such errors, but there is a modest body of circumstantial evidence suggesting that black patients run a higher risk of being misdiagnosed than white patients. The author reviews the studies providing such evidence and concludes that greater awareness among clinicians and research into more appropriate diagnostic criteria for black patients are desirable.