Purpose Motivational interviewing (MI) is a client-centred counselling approach which supports an individual’s motivation to change behaviour. It has a substantial evidence base across various disciplines. This review synthesises existing evidence of the barriers and facilitators to MI implementation within service delivery. Design/methodology/approach A systematic search of four databases retrieved ten international studies, which were critically appraised and synthesised following the preferred reporting items for systematic reviews and meta analyses (PRISMA) guidelines. Framework synthesis was used to map findings onto existing MI implementation factors, with a descriptive commentary provided on barriers and facilitators. Findings The review evidences the complexities of MI implementation within service delivery and outlines nine dimensions (leadership and management; workplace context; resources; therapist context; training; client context; documentation and outcomes gathering; and treatment fidelity) for consideration at all stages, if implementation is to be effective. Originality/value As an outcome of this review, the empirically-derived framework may aid the planning and execution of MI implementation.

The effect of motivational interviewing on ethical decision making and moral distress levels in intensive care nurses: Randomized controlled trial.

Erratum to “MEntA Program Based on Motivational Interview to Improve Adherence to Treatment of Obstructive Sleep Apnea With Continuous Positive Airway Pressure (CPAP): A Randomized Controlled Trial” [Open Respiratory Archives. 2021;3(2):100088

Coding of session transcripts is a key strategy in assessing counselors’ and social workers’ fidelity to the motivational interviewing (MI) approach. Artificial intelligence (AI) shows promise in identifying patterns in session transcripts associated with MI proficiency. This study utilizes a multiple instrumental case study approach to compare and contrast intercoder reliability for Atlas.ti, versus human researchers, for six session transcripts using the Motivational Interviewing Competency Assessment (MICA). Atlas.ti’s scores and qualitative feedback were compared to human researchers, and interrater reliability calculated using the Intraclass Correlation Coefficient. Results indicate significant agreement between researchers and AI scoring of intention and strategy, as well as the composite score. The difference in reflection-to-question ratio scoring highlights a difference in AI’s ability to attend to the nuanced nature of utilizing MI skills and strategies to enhance client/patient motivation.

Following a severe burn injury, individuals embark on a lifelong process of managing and integrating the physical, psychological, and social consequences, including functional limitations, fatigue, altered body image, and psychological trauma. To aid in this process, healthcare professionals can provide self-management support. To date, however, no self-management support intervention has been developed to meet the unique needs and preferences of burn survivors within the context of burn aftercare. In this article, we describe the process of developing a self-management support intervention for burn aftercare and present the resulting intervention. A structured, multi-stage process was followed from May 2021 to December 2023 to develop the intervention, guided by established frameworks for the development and adaptation of complex interventions. The process included evidence review, stakeholder consultation, and participatory observations to identify needs, inform design decisions, and ensure contextual fit. A hybrid approach to intervention development was adopted, combining adaptation of an existing intervention with augmentation through five co-creative workshops involving burn survivors, healthcare professionals, researchers, and burn care decision-makers. The final prototype was refined through expert reviews and real-world pilot-testing to assess its feasibility and acceptability. The structured, multistage process resulted in a self-management support intervention addressing the physical, psychological, and social needs of burn survivors. The intervention was named BreeZe (Brandwonden en Zelfmanagement/Burns and self-management). Intervention Core components of the intervention include a holistic care approach, goal setting and action planning, solution-focused brief therapy, motivational interviewing, case management, and the acknowledgment and involvement of informal caregivers. BreeZe is supported by materials like the Self-Management Web, a patient booklet, training for healthcare professonials, and a comprehensive manual. BreeZe is delivered by trained healthcare professionals and is structured into five phases, focusing on holistic needs assessment, goal setting, progress monitoring, and ongoing motivational support. The structured, multi-stage development process was thorough and carefully considered, balancing diverse stakeholder perspectives with scientific evidence and theory. BreeZe offers an evidence-based model tailored to the Dutch context that can be integrated into routine practice that shows the potential to enhance the effectiveness of care and support a more collaborative, patient-centred approach. Not applicable.

Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, efficiency, and quality of delivery, as well as client outcomes. This study is a randomized controlled trial designed to evaluate the impact of an AI-assisted service delivery model on therapist implementation of Supporting Teens' Autonomy Daily (STAND), a CBT blended with Motivational Interviewing (MI) for adolescents with ADHD. Adolescents with ADHD (N = 51), who were clients at three community mental health agencies, received treatment from 23 therapists. There was randomization of adolescents and therapists to AI-assisted or standard implementation supports. In addition to standard supports (i.e., training, standard facilitation resources, technical assistance, case supervision), AI-assisted support package included digitized facilitation resources housed in a clinical dashboard (Care4), feedback on content fidelity, and AI-generated feedback on MI implementation quality. The AI-assisted group was associated with more efficient treatment delivery and lower number of appointments attended by the adolescent. There was also a significant decrement in MI quality over time in the AI-assisted group compared to the standard support group. Feedback in focus groups indicated that therapists perceived a task-oriented mindset to be associated with receipt of the AI-assisted support package, leading therapists to prioritize efficiency over relational aspects of therapy. Following the results of this trial, a future, larger RCT should examine the impact of the AI-assisted implementation model on mental health outcomes and cost savings to organizations, third party payers, and clients. Trial registration number: NCT05135065; https://www.clinicaltrials.gov ; Registered September 2021.

Although organization development (OD) is grounded in behavioral science, there remains a persistent gap between abstract behavioral concepts and applied, psychologically precise tools for navigating change at individual, relational, and systemic levels. This paper introduces Behaviorally Informed Organization Development (BIOD), a conceptual framework that integrates three evidence-based counseling models: Motivational Interviewing (MI), Solution-Focused Therapy (SFT), and Family Systems Therapy (FST); each contributes distinct mechanisms: MI deepens readiness for change and values alignment, SFT accelerates strengths-based goal pursuit and forward momentum, and FST reveals insights into group dynamics and legacy patterns that sustain behaviors over time. Together, these approaches enrich core OD processes such as action research, appreciative inquiry, team development, and culture transformation by providing psychologically grounded interventions that foster trust, reduce resistance, and support sustainable human-centered change. The article offers theoretical justification and practical implications for applying BIOD across diverse organizational contexts.

Chronic musculoskeletal pain (CMP) is the most common and disabling of all pain conditions. Combination treatment that includes duloxetine and web-based cognitive behavioral therapy (CBT) has not been rigorously evaluated. We investigated the effectiveness of the combination treatment against duloxetine monotherapy and also examined the effects of adding motivational interviewing (MI) to enhance participant's motivation to engage in web-based CBT. Participants with CMP (n = 281) were randomized to 1 of 3 treatment arms: (1) duloxetine monotherapy, (2) combination treatment (duloxetine + web-based CBT) without phone-based MI, and (3) combination treatment with 6 sessions of phone-based MI. The primary outcome was the Brief Pain Inventory total pain score (BPI TPS) at week 24. Overall, mean (SD) baseline BPI TPS in arms 1, 2 and 3 were 5.8 (1.8), 5.7 (2.1), and 6.1 (1.6), respectively. Compared with baseline, participants in all 3 arms had significant improvement in their BPI TPS during the 24-week trial. However, BPI TPS were not significantly different among the 3 arms, neither were the BPI pain interference and severity, and global ratings of change. The proportion of participants who completed ≥ 6 web-based modules were about the same in arms 2 and 3: 46.3% vs 45.8%, respectively. Web-based CBT did not demonstrate additional benefits beyond those observed with duloxetine monotherapy, which may, in part, be due to low participant completion of the web-based modules. Unexpectedly, the addition of phone-based MI did not significantly improve module completion rates. These findings support the utility of duloxetine over the 24-week study period.

Virtual Agent for Real-Time Motivational Interviewing by Integrating Adaptive Nonverbal Behavior and Language Models

Healthcare professionals working in primary care are well positioned to provide initial physical activity counseling owing to their frequent patient contact and their role as a trusted source of health information. Unfortunately, despite health benefits and recommendations, physical activity assessment and promotion in primary care settings is not a routine practice. Because there are currently no standardized practices, it is essential to know what practices are currently employed and explore the barriers to their use. The aim of this study is twofold: first, to describe and compare the practices used by primary care healthcare professionals regarding physical activity assessment and promotion among chronic disease patients and second, to explore the barriers to their use. A cross-sectional survey was conducted among primary care healthcare professionals. The questionnaire designed for this project on physical activity assessment and promotion practices was sent electronically to all 619 primary care healthcare professionals in the Mauricie and Centre-du-Quebec regions. Each item was evaluated with a 5-point Likert scale. Descriptive statistics were used to describe sociodemographic characteristics as well as physical activity assessment and promotion practices. Group comparisons were performed according to professionals' roles. Sixty-eight (11%) of the healthcare professionals responded to the questionnaire. Both physical activity assessment and promotion practices were reported at similar levels, with mean scores of 3.79 ± 1.05 and 3.69 ± 0.78, respectively, on a 5-point Likert scale. A few specific tools and methods are used by healthcare professionals to assess and promote physical activity. The main barriers to physical activity assessment and promotion during clinical consultation were patients' perceived lack of interest in physical activity and professionals' lack of knowledge regarding PA guidelines, tools and methods, and contraindications. Overall, primary care healthcare professionals are convinced of the benefits of physical activity in preventing and treating chronic diseases and recognize they have an important role to play. Although committed to promoting physical activity among chronic disease patients, they require continuous training on guidelines, validated tools, and motivational interviews together with clear advice to properly implement physical activity assessment and promotion practices.

ABSTRACT Community coalitions often form as vehicles to support inclusive community change. Yet, community coalition work is complex, and intensive technical assistance (TA) is potentially cost- prohibitive to sustain. A comprehensive review suggests a data-informed approach with “just-enough” contact between coalition partners and technical assistance providers that integrates Motivational Interviewing into interactions may be effective. As a result, we developed and tested the Coalition Check-Up (CoCU), a cyclical 4-step TA model to support all kinds of community coalitions. The current study examines implementation fidelity of the CoCU TA model, including its dosage, adherence to utilizing the data-informed tools, and quality by investigating the degree to which Motivational Interviewing skills were integrated into TA provider – coalition leader interactions. Thirty-two coalitions participated in this study. All coalitions received CoCU TA. Data from meeting recordings was coded with the MITI and data reported by TA providers that described TA provider interactions with coalition leaders and coalitions were used in this study. We found that coalitions received a high dosage of the CoCU TA model. The data tools were used with a high level of adherence, and MI behaviors were integrated at a modest to strong level. This novel study suggests applicability of MI in additional non-therapeutic contexts.

The use of illicit substances is a major public health problem. While individuals with substance use problems primarily seek treatment in specialized treatment programs, the role, exposure, and response of private practice psychiatrists to requests for substance use-related problems remain unclear. This study aims to assess private practice psychiatrists' exposure to and response to treatment requests for substance use-related problems, along with examining the requests' characteristics. A cross-sectional online anonymous survey was administered involving private practice psychiatrists in Greece between January and February 2024. A total of 100 private practice psychiatrists responded to the survey (response rate ~10%; 53.0% male, aged 49.5 (SD=9.3) years, with 13.7 (SD=9.9) years of professional experience, and 59.0% with a private office in the Attica/Athens region. Most participants (84.0%) reported exposure to requests for substance use treatment during the last 12 months, with 69.0% of them (58% of the total) accepting to offer of treatment. The most frequently reported categories of substances included cannabis and cocaine/crack. High rates of comorbidity with problematic alcohol use, multiple substance use, and other mental disorders were also reported. Pharmacotherapy and cognitive behavioral therapy were the treatments most commonly used. Factors associated with accepting to offer treatment included past specialized training in addiction (p<0.001), past or current employment in treatment facilities (p=0.002), self-reported expertise in addictions (p=0.017), previous training during specialty in substance use departments (p=0.001), and use of motivational interviewing (p=0.011). Around 70% of participants who did not accept cases believed patients would be better treated in specialized substance use treatment programs. Among all participants, 63.6% were willing to accept future treatment requests⎯significantly higher percentage (93.1%) among those who had accepted similar requests before, compared to those who had not (19.2%, p<0.001). In conclusion, apart from specialized addiction services, a substantial number of private practice psychiatrists in Greece were also exposed to and accepted treatment requests for illicit substance use-related problems, with most frequently encountering requests related to cannabis and cocaine use. Future research should investigate the characteristics of patients treated for illicit substance use-related issues in private settings and the services provided to them.

Abstract Good communication skills are essential for effective social work practice, yet evidence-based communication approaches are rarely applied in child and family social work. Motivational interviewing (MI) has shown promise in enhancing practitioners’ skills and outcomes in child and family social work, but its use outside the UK remains understudied. This study evaluates improvements in social workers’ communication skills following MI training tailored to child and family social work in Finland. The training included coaching sessions and a self-practice programme informed by behaviour change science. Thirty-three Finnish social workers participated. Recordings of simulated and real service user meetings were analysed using the Social Work and Interviewing Motivationally (SWIM) coding tool. Of the seven measured communication skills, only empathy showed statistically significant improvement at the group level. Due to the small sample size, statistical power was limited. Notably, person-based analyses identified three subgroups: nine participants improved, four declined, and the rest showed mixed changes. Exploratory survey analyses suggested that differences in practice, self-efficacy, and intentions influenced outcomes. These findings underscore the need to move beyond group averages to examine individual responses to training. Such detailed analyses can help optimize interventions and improve the effectiveness of communication skill development in social work.

Motivational interviewing is missing In action.

BACKGROUNDThe coexistence of rheumatological and immunological diseases with nephropathy presents considerable clinical challenges. These challenges often result in heightened anxiety and depression, which detrimentally affect patient outcomes. Motivational psychological nursing, which incorporates motivational interview and cognitive-behavioral therapy, may offer a promising approach to address these psychological concerns.AIMTo evaluate the effectiveness of motivational psychological nursing in the reduction of anxiety and depression and improvement of the quality of life of patients with rheumatological and immunological diseases complicated by nephropathy.METHODSWe conducted a retrospective cohort study involving 206 patients with rheumatological and immunological diseases complicated by nephropathy and who were treated between January 2021 and January 2025. The inclusion criteria were as follows: Aged 18-75 years, met the diagnostic criteria for rheumatological and immunological diseases with a renal biopsy classification above type II, hospitalized in our facility, received consistent basic nursing care, and had complete clinical data available. Participants allotted to the observation group (n = 102) receiving motivational psychological nursing, and those in the control group (n = 104) received standard care. Psychological status was assessed using Self-Rating Anxiety Scale (SAS), Beck Anxiety Inventory, Hamilton Anxiety Rating Scale, Self-Rating Depression Scale (SDS), Patient Health Questionnaire-9, and other standardized measures. Intervention lasted throughout hospitalization, with follow-up assessments conducted before discharge.RESULTSPre-intervention, anxiety, and depression scores were similar across groups. Postintervention, the observation group showed significant reductions in anxiety (SAS: 44.53 ± 6.72 vs 46.79 ± 6.94; P = 0.018) and depression (SDS: 45.20 ± 5.07 vs 46.97 ± 5.25; P = 0.014) compared with the control group. General self-efficacy (P = 0.044), health-related quality of life (P = 0.044), and World Health Organization Quality of Life (P = 0.040) scores also revealed significant improvement.CONCLUSIONMotivational psychological nursing considerably reduces anxiety and depression in patients with rheumatological and immunological diseases complicated by nephropathy, which enhances the overall quality of life.

Generative artificial intelligence (AI), particularly large language models (LLMs), is rapidly evolving and holds significant potential for addressing the multifaceted challenges of obesity management. This systematic review synthesizes current research on LLM applications within the obesity field, critically evaluating their performance, limitations, and key future research directions. Electronic databases, including MEDLINE, OVID, and SCOPUS, were systematically searched from inception to August 2025 to identify eligible studies. Eligible studies investigated the potential role of LLMs in obesity medical and surgical care. Key findings were extracted and synthesized narratively. The ROBINS-I tool was used to assess the risk of bias across each study. Thirty-three studies met the inclusion criteria. The analysis reveals that LLMs are being applied across a diverse range of obesity-related topics, including personalized nutrition, educational interventions, guideline-directed medical therapy, weight loss strategies, anti-obesity medication information, and motivational interviewing. While some LLMs demonstrated promising accuracy and utility, substantial variability was observed. Numerous studies highlighted limitations, including inconsistent recommendations, inaccuracies, difficulties in handling complex scenarios, and a potential for biased outputs. Generative AI and LLMs show considerable promise for enhancing various aspects of obesity management, from personalized interventions to clinical decision support. However, the current state of the technology exhibits crucial limitations regarding accuracy, consistency, and the ability to handle nuanced clinical situations, mandating a continued critical role for clinician oversight and validation. Further research is imperative to address these shortcomings, focusing on improving model training, validating performance in real-world settings, and addressing ethical considerations before widespread clinical implementation.

BackgroundIn South Africa, pregnant and lactating women (PLW) face a dual burden of high alcohol use and HIV prevalence, both of which adversely affect maternal and infant health. However, few interventions address alcohol use and HIV risk concurrently in this population.ObjectiveThis study seeks to adapt and pilot-test in a randomized controlled trial (RCT) the peer-led multisession intervention Mentor Mothers Plus (MM+) to integrate alcohol reduction strategies with HIV prevention and care support (in a seroneutral intervention) among PLW in Saldanha Bay, Western Cape, South Africa.MethodsUsing the ADAPT-ITT (assessment, decision, adaptation, production, topical experts, integration, training, testing) framework, we adapted the evidence-based Mentor Mother (MM) model, originally aimed at reducing vertical HIV transmission among mothers with HIV. Our mixed methods design includes (1) qualitative research, including in-depth interviews (IDIs) and focus group discussions (FGDs), to assess drivers of perinatal alcohol use and HIV risk; (2) intervention adaptation through community-based participatory workshops with stakeholders to refine the MM+ intervention in order to include culturally and contextually strategies; and (3) a pilot RCT with 100 pregnant women (≥16 years old, reporting recent alcohol use) randomized in a 1:1 ratio to the MM+ intervention (motivational interviewing [MI], including HIV and alcohol reduction messaging) or enhanced standard of care (SOC). Primary RCT outcomes include reduced alcohol use, via phosphatidylethanol (PEth) blood levels at 6-month follow-up. Secondary outcomes include uptake and adherence to pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among women with HIV, as well as intervention fidelity, feasibility, and acceptability.ResultsCommunity research included 2 FGDs with health workers (n=6) and community leaders (n=7) and 31 interviews with partners and peers of PLW. Data showed that women are motivated to reduce alcohol use for child health but face barriers (eg, misconceptions about safety of alcohol use, poverty, trauma, and intimate partner violence [IPV]). Alcohol use is with friends/family members/partners and tied to financial stress, unplanned pregnancy, and poor mental health. MM+ support preferences emphasize nonjudgmental, peer-based mentorship, family involvement, and faith/community engagement. Gaps include stigma around HIV and contraceptive services. Communities recommend mentor mothers with lived experience, providing culturally relevant, empathetic support, and linking to social and clinical services. In August 2025, a community workshop refined the intervention, emphasizing the need for trustworthy mentor mothers with lived experience. Priorities included culturally relevant information on alcohol use, HIV prevention, family planning, trauma and interpersonal violence support, and flexible delivery. Next steps involve finalizing materials, training mentor mothers, and launching the RCT.ConclusionsOur community-based, participatory study, MM+, offers a promising approach to address co-occurring alcohol use and HIV among PLW. Stakeholder engagement enhances contextual relevance and supports future scalability. The RCT will evaluate efficacy of the model in reducing alcohol and improving HIV outcomes.Trial RegistrationClinicaltrials.gov NCT06962592; https://clinicaltrials.gov/study/NCT06962592International Registered Report Identifier (IRRID)DERR1-10.2196/78856

Limited empirical evidence exists on the effectiveness of a hybrid approach to heart-healthy lifestyle interventions that integrates mHealth technology with face-to-face counseling. Moreover, its superiority over exclusive mHealth use in promoting heart-healthy behavioral outcomes within a community setting remains unclear. This study aims to evaluate the effectiveness of a hybrid community-based approach to heart-healthy lifestyle intervention incorporating a mobile application and motivational interviewing among community-dwelling adults without a history of cardiovascular disease. We conducted a three-arm, parallel-group, randomized controlled trial with assessments at baseline and after 12 weeks. A total of 75 participants, each presenting at least one component of metabolic syndrome and no history of cardiovascular disease, were randomly assigned to one of three groups: hybrid (n=25), mobile (n=25), or control (n=25). Participants were recruited through online platform. The hybrid group underwent a 12-week hybrid intervention combining a mobile application (i.e., "My HeartHELP") and face-to-face motivational interviewing led by a nursing researcher. The mobile group used only the mobile application, while the control group received written material on general heart health. The intervention was facilitated by three trained nursing researchers. The primary outcome was a composite score of 'heart-healthy behaviors', while secondary outcomes included scores for heart-healthy 'information', 'self-efficacy', 'motivation', and cardiovascular parameters. The trial was conducted in two rounds from October 2022 to May 2023. An intention-to-treat analysis was performed. Of the 75 participants, 72 (96%) completed the study. Compared with the control group, both the hybrid and mobile intervention groups demonstrated significantly greater improvements in behavioral outcomes, including composite heart-healthy behavior (F=7.25, P=.001), its theoretical predictors-heart-healthy motivation (F=8.54, P< .001) and self-efficacy for diet (F=4.87, P=.011) and exercise (F=5.48, P=.006)-as well as fasting glucose levels (F=3.90, P=.025) following the 12-week intervention. Particularly, the hybrid group-unlike the mobile group-showed significantly greater improvement in dietary behavior, a subscale of heart-healthy behavior, compared with the control group, and demonstrated significantly greater improvements in Interest/Enjoyment, a core subscale of intrinsic motivation than the mobile and control groups. The hybrid community-based heart-healthy lifestyle intervention-integrating a mobile application and motivational interviewing-demonstrated overall effectiveness comparable to the mobile application alone, while yielding greater improvements in dietary behavior and core intrinsic motivation. These findings highlight the potential of mHealth applications as practical, standalone tools to promote cardiovascular health, particularly in community settings with limited access to in-person professional support. However, incorporating motivational interviewing may further enhance internalized motivation and complex behavior changes over time. Health professionals can therefore adopt mHealth either independently or in combination with motivational interviewing. Future studies should optimize integration strategies to enhance effectiveness and evaluate the long-term sustainability of such hybrid approaches. The trial was registered on the ISRCTN (no.83643383). RR2-10.1161/circ.147.suppl_1.P147.

Harmful alcohol use remains a significant concern, particularly in the Global South. This scoping review synthesises the literature on Alcohol Harm Reduction Interventions (AHRIs) among countries in the Global South. Following Arksey and O’Malley’s framework, 38 articles published between January 2013 and June 2023 are analysed. Data extraction focused on intervention types, target populations, effectiveness, and barriers. Thematic analysis was conducted to generate five themes. The findings indicate that healthcare workers predominantly implement AHRIs, often through Motivational Interviewing. AHRIs demonstrate positive impacts; however, their effectiveness is hindered by limited professional training and weak policy directives. The need for enhanced professional training, stronger policy frameworks, and region-specific intervention strategies are highlighted.

Practitioners working in a variety of healthcare settings increasingly face a dilemma when speaking with patients about weight health. On one hand, prescriptive weight-related health advice can exacerbate stigma, while on the other, ignoring insufficient health behavior engagement limits health and increases the risk of other adverse weight-related health conditions. Research has demonstrated that higher-than-optimal body weight is a correlate of morbidit and mortality, but has also demonstrated that weight stigma is pervasive, negatively impacting health, health behavior, and well-being. This article introduces a novel conceptual model to help practitioners initiate conversations about weight health by striving to support health behavior change in a way that deactivates and disempowers weight stigma. By advancing the acceptance principle from motivational interviewing and adapting its scope, the model focuses on destigmatizing attitudes and assumptions related to weight health to prevent or reduce generalized and internalized weight stigma. The model also focuses on limiting interpersonal stigma and its disruptive role in practitioner-patient communication by supporting personal autonomy for a lifestyle of health behavior. This article reports results from a rapid review and calls for research efforts to examine the potential causal role of active acceptance for reducing weight stigma. Overall, the conceptual model simultaneously promotes health behavior and reduces weight stigma for weight health.