Spirit Of Motivational Interviewing Research Articles

Can the spirit of motivational interviewing be taught online? A comparative study in general practitioners.

ObjectiveMotivational Interviewing (MI) is an evidence-based approach to enhance patients' motivation and is increasingly in demand in medical practice. Online teaching methods offer advantages to train health care professionals, but only very few studies examined whether MI-specific interviewing skills (""MI-skills""), and especially MIspecific attitudes (the "MI-spirit"), can be taught online and whether learning gains differ from those in face-to-face courses. This study compared the effects of 7 h of basic training for experienced general practitioners (GP) in either an online or a traditional face-to-face format with a non-trained control group. Methods"MI-skills" and "MI-spirit" were measured in a prospective analysis in 49 experienced GPs before and one week after training ResultsAn ANOVA on gain-scores demonstrated significant differences between groups in both MI-specific skills (VASE-R, p = 0.006) and "MIspirit" (MIKAT, p = 0.029; HRQ, p < 0.001) from pre- to posttest. Post-hoc comparisons revealed significant improvement only in the training groups (VASE-R, p < 0.001; MIKAT, p = 0.014 for online, p = 0.003 for face-to-face; HRQ, p < 0.001). ConclusionThe results suggest similar effects of both online and face-to-face training of "MI-skills" and "MI-spirit" to GPs. Practice Implication: Online learning opportunities should be integrated in MIT programs for general practitioners where appropriate.

The Williams and McCoy model of motivational spirited cognitive behavioral change communication

PurposeThe Williams and McCoy Motivational Spirited Cognitive Behavioral Change Communication (MIS-CBC) is an innovative model combining the spirit of motivational interviewing (MI) communication, and cognitive behavioral therapy (CBT) as a patient-centered care model to improve continuity of care while enabling patients to progress during therapy. ConclusionsIncorporating this model into Psychiatric Mental Health Advance Practice Nurse practice allows for provision of best practice with populations experiencing low motivation and subject to dropout. The model aims to improve patient motivation and engagement of CBT to achievement “full dose” CBT with more flexibility to significantly improve patient outcomes, particularly with patient populations subject to interruptions in psychotherapy. Practice implicationsThe Williams and McCoy MIS-CBC model has implications in areas of both practice and academia addressing episodic psychotherapy in populations where interruptions and dropout frequently occur.

Creation of a motivational interviewing-based pharmacy communications course: From dissemination to assessment

Background and purposePharmacists are frequently faced with evocative patient care conversations surrounding medication taking behaviors and overall health and wellness. Teaching communication is a core focus within pharmacy education; however, there is often less emphasis placed on learning motivational interviewing (MI). We will share challenges and successes associated with the creation and dissemination of a MI-based communications course with pharmacy student learners. Educational activity and settingA fast-paced, five-week, active learning course was created for first-year pharmacy students. Learning activities focused on exploration of ambivalence in clinical practice, roadblocks to active listening, resisting the righting reflex, the spirit of MI, and the core skills of MI. The Motivational Interviewing Competency Assessment was utilized to assess student MI competency at the completion of the course. FindingsThis MI-based course has been well-received by pharmacy student learners. It serves as a foundation for communication skills development, as students continue the practice and grow these skills throughout the curriculum. Communication skills assessment and feedback are an integral aspect of MI learning; however, this process does increase the workload of course instructors. A limitation to the global creation of a MI-based course is the reduced number of pharmacy educators who are proficient in training MI. SummaryAs the practice of pharmacy and patient care continues to evolve, effective communication skills that include MI, are essential to the provision of person-centered, empathic patient care.

Motivational interviewing in child sexual abuse investigations: Approaches shown to increase suspect engagement and information gathering during police interviews

On average, more than 200 child sex offences were recorded by UK police every day in 2020, and investigations for offences including rape, online grooming and sexual assault against children in the United Kingdom (UK) increased by 57% from 2014/15 to 2019/20. The interview process is central to information gathering, but empirical research regarding the obtention of information through child sexual abuse (CSA) suspect interviewing is still limited. The current study analyses 45 hours of interviews with CSA suspects focusing on behaviours consistent (and inconsistent) with motivational interviewing (MI) using the Observing Rapport-Based Interpersonal Techniques coding manual. In line with previous research demonstrating the efficacy of MI with terrorist suspects, this article focuses on the same four key interviewer skills identified in the therapeutic literature (reflective listening, summarising, rolling with resistance and developing discrepancies). It looks at their effects on information yield (information of intelligence value) and suspect engagement. Results revealed that the four MI-consistent behaviours increased information gain. Also, approaches antithetical to MI (including assumptive questioning, judgemental summaries, fighting resistance and accusatory challenges) had a significant negative impact on suspect engagement and, by extension, reduced yield – potentially by creating suspect reactance (where the individual is motivated to regain a freedom they feel is being threatened). Hence, MI approaches are efficacious for information-gathering efforts, and using an approach antithetical to the spirit of motivational interviewing (like pressuring, confronting and judging) with CSA suspects will always make things worse.

Theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury

Objectives This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI). Methods Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members’ own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices. Results The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client’s physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate. Conclusion We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Supporting Clinical Development Through Integrative Continuing Education for Field Instructors.

Field education is the signature pedagogy of social work education, but there is no standardized mechanism to ensure field instructors are trained in the same clinical modalities as social work students or are well-trained in the provision of clinical supervision. Feasibility was assessed of providing field instructors (n = 9) with a continuing education (CE) program to train them in a specialized evidence-based practice, motivational interviewing (MI) in a recovery context, and strategies for supervision. Participants of the CE program gained confidence (p < .05) and knowledge in the spirit (p < .01) and skills (p < .001) of MI; while participants described initial reactions of disdain when role-plays were introduced in the training, they ultimately identified role-plays and facilitator modeling as key features in producing their own practice change and mimicked the use of parallel process - using MI as a way to teach MI - in their provision of supervision. Findings suggest that offering a CE program to train field instructors in a specialized evidence-based practice embedded in course work and strategies for supervision is feasible and may result in enhanced supervision in field education.

Mechanism of Changes within Motivational Interviewing in Relation to Dietary Behavior Outcome of Diabetics Patients in Thailand

Background: For diabetics, healthy eating or dietary management is essential. Motivational interviewing (MI) is found to be effective for facilitating Thai clients with diabetics to change their dietary behavior. At present, little is known about what therapeutic processes and mechanisms improvements occur within MI. Objective: To explain the mechanism within MI in relation to dietary behavior outcome. Materials and Methods: The present study was a qualitative study that explored mechanism of change within the MI program conducted in diabetic clients and use the self-determination theory (SDT) as a lens to explore the mechanism of change within MI. A qualitative approach was adopted in the present study. Results: The mechanisms that influenced the change in dietary control of the diabetic clients were the patient perception of competence, a sense of autonomy, and therapist-patient relationship. These three kinds of perceptions are found to be related to therapist’s skills and techniques used in the MI program. Conclusion: The present study result reveals the most promising mechanisms of MI is the patient perception of competence, sense of autonomy, and therapist-patient relationship. There is a need to ensure that a relational ingredient of MI focused on empathy and the interpersonal spirit of MI will be employed by MI counselor consistently. MI self-supervision tool might be a good option to assist MI counselors adhere to MI spirit. Keywords: Motivational interviewing program; Diabetes clients; Diet behavior

It Is “All About Relationships” in Lifestyle Programmes for Adults Living With Type Two Diabetes Underpinned by a Person/Whānau-Centred Care Approach

BackgroundLifestyle programmes are important in the management of type 2 diabetes (T2D). The Diabetes Community Exercise Programme (DCEP) is an exercise and educational programme for adults living with T2D with the aim of enhancing exercise self-efficacy and supporting wellbeing. DCEP is underpinned by a model of person/whānau-centred care and the spirit of Motivational Interviewing. Person-centred care models in the context of rehabilitation and long-term health conditions are still evolving. This paper explores what those involved in DCEP perceived important to its person/whānau-centredness.MethodAn evaluative qualitative methodological approach was used with data collected by open-ended interviews and a focus-group at completion of the initial 12-week part of DCEP. Interviews were audio-recorded and transcribed verbatim. Participants were 16 DCEP attendees and 13 healthcare professionals (HCPs) involved in DCEP delivering. Data were analysed using the General Inductive Approach.ResultsThe three interconnected themes constructed from the analysis were ‘It's all about relationships’, Balancing the Outside World, and Empowering through Knowledge. Through the experience and motivation of positive person-centred relationships, DCEP addressed attendees' T2D health needs, but they were constantly balancing these needs with those of family, employers, finances, other health needs and life interests. DCEP relationships facilitated ongoing discussions between attendees and between attendees and HCPs. The ability to discuss in a supportive and non-judgmental environment helped attendees to make sense and process the information they gained at DCEP. This empowering through knowledge in turn helped attendees to work out ways of balancing the outside world and thus better address their T2D needs.ConclusionIt is “all about relationships” was key to DCEP's person/whānau-centred approach—all other factors related back to the development and maintenance of relationships. These relationships were between all whānau involved: the attendees, their family, the wider community, the healthcare provider organisations, and the HCPs and personnel involved in delivering DCEPs. These relationships created an accepting, understanding and social atmosphere that enabled attendance and facilitated both knowledge exchange and ability to exercise, both considered to be beneficial by attendees. Importantly, these relationships took time to develop, but the benefits were worth the investment.

62.4 MOTIVATIONAL INTERVIEWING AS A COMMUNICATION FRAMEWORK TO FACILITATE ADHERENCE TO PEDIATRIC TRANSPLANT CARE

Behavior change is an innately human experience. We all know the feeling of being asked, pushed, cajoled, or even being forced into engaging in a behavior that we may not be invested in pursuing. The experience can be frustrating and result in a mix of responses. In many of these situations, the result is a state of ambivalence. Despite our awareness of this shared human experience, we often neglect this inherent understanding when conducting health behavior change counseling. Motivational interviewing is a framework to empower patients and families to enact behavior change to improve their health and quality of life in a way that is feasible to them. It takes the spotlight for health behavior change off of the clinician and refocuses that light onto the patient’s thoughts, understandings, emotions, and abilities. There has been an emergence of interest, research, and practice utilizing motivational interviewing to support youth receiving pretransplant and posttransplant care. In this presentation, we will describe the current evidence of the utility and practice of implementing motivational interviewing as a foundational language style in pediatric transplant care. We will highlight the spirit of motivational interviewing, the general principles and microskills, the 4 processes, and the practical applications for youth and families. We will highlight case-based examples relevant to transplantation and clinical pearls to support engagement, enhance reflective listening, and facilitate opportunity for behavior change. We will explore examples of successful models of implementing motivational interviewing systemically in the delivery of pediatric transplant care. As motivational interviewing grows in its evidence base, application, and dissemination, it can become a vehicle to fuel integrated care and interdisciplinary education. Child and adolescent psychiatry has the unique opportunity to foster and nurture the education and dissemination of motivational interviewing to enhance evidence-based, patient-centered health behavior change counseling within pediatric transplant care.

Long Term Exercise Engagement of Adults Living With Type Two Diabetes Is Enhanced by a Person-Centred Care Approach Delivered by Knowledgeable, Well Trained Health Care Professionals.

Background: Regular engagement in exercise or physical activity is a key evidence-based recommendation in the self-management of type 2 diabetes (T2D). The Diabetes Community Exercise Programme (DCEP) is an exercise and educational programme aimed at supporting adults living with T2D to take control of their health and to live well with T2D. It was specifically developed to enhance the self-efficacy of people to engage in exercise for a long term and is underpinned by the spirit of motivational interviewing. This study explores what DCEP attendees and health care professionals (HCPs) who deliver the programme perceived DCEP to be and what motivated attendance. Such insights further the knowledge of how people with T2D can be supported to engage in exercise or physical activity programmes.Method: This qualitative study used open-ended interviews of 17 DCEP attendees and 12 HCPs delivering DCEP. Interviews occurred at the completion of the initial twice-a-week, 12-week duration part of the programme and prior to attendees starting with a twice-weekly maintenance exercise class, which forms the second part of the programme. Interviews were audio-recorded, transcribed verbatim and analysed with the General Inductive Approach.Results: The two themes constructed from the analysis were person-centred care and attention to logistics and administration. Person-centred care comprised four subthemes: monitoring, individualised exercise within a sociable group setting, flexible education and discussion, and HCP training, and these components appeared to support attendees to engage in exercise. The second theme spoke about the processes, that was either present or that should be included, that enabled DCEP delivery, such as appropriate venues, flexible approaches to time of day and the requirement of good administrative support.Conclusion: The Diabetes Community Exercise Programme did motivate people with T2D to engage in exercise. Important to this was the emphasis on a person-centred approach that focussed on the health status monitoring and educational and social aspects of the programme, which in turn facilitated exercise engagement. Knowledgeable HCPs who require training in the delivery of person-centred care to tailor the exercise and education to the individual is imperative. Equally important are optimal exercise environments and well-trained administrative support.

Brief Motivational Interviewing Training for Outreach in School Health Programming

This study assessed a brief 6-week motivational interviewing (MI) training program for extension field specialists (EFS) involved in supporting a statewide school wellness initiative called SWITCH. A total of 16EFS were instructed in MI principles to support the programming and half (n = 8) volunteered to participate in the hybrid (online and in-person) MI training program. Phone calls between EFS and school staff involved in SWITCH were recorded and coded using the Motivational Interviewing Treatment Integrity (MITI) system to capture data on utilization of MI principles. Differences in MI utilization between the trained (n=8) and untrained (n=8) EFS were evaluated using Cohen’s d effect sizes. Results revealed large differences for technical global scores (d=1.5) and moderate effect sizes for relational global components (d=0.76) between the two groups. This naturalistic, quasi-experimental study indicates a brief MI training protocol is effective for teaching the spirit and relational components of MI to EFS.

Understanding the Link Between Motivational Interviewing and Self-Compassion

In this article, the authors posit that the accepting and compassionate spirit of motivational interviewing (MI), along with specific content-based techniques (i.e., reframing), can help to cultivate a self-compassionate mindset within clients receiving MI. The authors explore this link further while discussing potential moderators that may influence this process as well as practical implications for counselling practice and future research recommendations. This article is innovative in that it could provide a new theoretical foundation for conducting research that supports the effectiveness of MI in enhancing self-compassion, which has been associated with a myriad of improved psychological outcomes. The concepts of this paper and the exploration between specific MI techniques would be valuable to many clinicians with the desire to increase self-compassion in their clients.

Dissemination Of Motivational Interviewing Training: Use In Extension Outreach And School Health Programming

PURPOSE: Motivational interviewing (MI) is a popular conversational strategy used to evoke intrinsic motivation for behavior change. Although a number of training programs have been described to build MI skills, there are few that evaluate the fidelity of training. The present study evaluated MI fidelity following a brief online training. METHODS: This study was conducted as an ancillary component of a school wellness training initiative (SWITCH) that focused on building capacity for schools to plan and lead school wellness programming. A quasi-experimental design was used to evaluate the impact of brief MI training on a sample of 16 extension field specialists (EFS) that facilitated the SWITCH implementation process. EFS were provided guidelines and suggestions for using MI to elicit change talk and promote goal setting by school leaders. A subsample of 8 EFS voluntarily agreed to participate in supplemental MI training prior to interacting with the schools. All EFS recorded phone calls with the schools as part of the standard practice in the SWITCH project, and a trained assistant blinded from group allocation coded them for MI proficiency levels using the Motivational Interviewing Treatment Integrity Coding Manual 4.2.1. RESULTS: A one-way ANOVA followed by Bonferroni post-hoc corrections were conducted to examine differences in MI techniques between trained and untrained EFS. No statistically significant results were found. However, differences between groups for technical global scores (F (1, 14) = 8.9, p = 0.05, d = 1.5) and reflection-to-question ratios (F (1, 14) = 5.3, p = 0.19, d = 1.15) were approaching statistical significance with large effect sizes. Relational global components (d = 0.76) and total adherence (d = 0.38) demonstrated moderate group differences. CONCLUSIONS: This study indicates that a brief MI training protocol is effective for teaching the spirit and relational components of MI. Although proficiency levels were not achieved by the majority of EFS, trained individuals were better at using technical and relational aspects of MI than untrained individuals. Future work should focus on ways to enhance skill acquisition with this type of distributed online training model as well as testing applications with other professionals and diverse settings.

Effectiveness of Motivational Interviewing Training for Primary Care Dentists and Dental Health Technicians: Results from a Community Clinical Trial.

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.

Motivational interviewing and oral health education: Experiences from a sample of elderly individuals in North and Northeast Philadelphia.

Health education has a focus on knowledge dissemination and advice giving, which seldom translates into behavioral changes. Motivational interviewing (MI)has potential for helping elderly patients. However, most oral health studies conducted to date have excluded older individuals, and the outcomes examined have been exclusively clinical. This study examines the treatment fidelity of an individual-based MI intervention and assesses baseline characteristics related to older adults' self-efficacy (SE), oral-health-related quality of life (OHRQoL), oral health knowledge, and facilitators, barriers, and confidence on achieving MI goals. A convenience sample of 60 seniors was recruited. Participants were obtained through the flow of patients at dental clinics, and received a 45-min individual-based MI education session during a scheduled dental appointment. Regarding MI treatment fidelity, basic proficiency or higher was achieved in all global areas. Significant correlations were found between SE and OHRQoL scores and rating elements of the MI intervention (P=0.0001). Lack of knowledge related to connections between poly pharmacy and caries risk, and the importance of use of fluorides were evident. Findings from the study support the reliability of this new MI intervention. Dental professionals are encouraged to adopt the spirit of MI in their one-on-one patient counseling.

Motivational interviewing with alcohol-dependent patients

Motivational interviewing with alcohol-dependent patients Alcohol-dependent patients do not need to be motivated from the outside. They are mostly ambivalent, and the inner voice, which already speaks for change (change talk), is heard through motivational interviewing, carefully strengthened and developed together with the patient. The practitioner has to deal with the human spirit of motivational interviewing and should be able to communicate with empathy, respect, congruence, and openness. The patient's autonomy should always be maintained. Advice is only given upon request. The conversation style is directive-guiding instead of authoritariansteering. OARS and the EPE principle are the motivational interviewing basics, which are consistently applied over 4 processes of motivational interviewing: engaging, focusing, evocing, and planning. The likelihood of change talk increases as soon as discrepancies between life goals and alcohol consumption emerge. An increased rate of change talk makes a change in behavior more likely. If a patient argues against change (sustain talk), one should not confront, but should consistently work with reflections, reframing, and an emphasis on autonomy. Motivational interviewing can be applied in different settings and populations, should be learned by the entire team (best professional guidance) in teamwork, and be subjected to a critical and constant evaluation.

Effect of Faculty Development Activities on Dental Hygiene Faculty Perceptions of and Teaching About Motivational Interviewing: A Pilot Study.

The aims of this pilot study were to assess dental hygiene faculty members' perceptions of the importance of motivational interviewing (MI) and their confidence in teaching students about MI and to determine the effect of MI training sessions on those perceptions. Participants were a convenience sample of all 16 dental hygiene faculty members who teach in the clinic at the University of Michigan School of Dentistry. Participants' perceptions were assessed prior to a workshop in MI (pretest), immediately after the workshop (posttest 1), and eight months after the workshop, at the end of the academic year (posttest 2). During the same period, some of the workshop participants took part in team grading sessions of audio recordings of student-patient MI interactions. The results showed that the majority of the faculty members perceived it was important to personally embrace the overall spirit of MI during patient care, and they were confident supporting students as well. Their ratings for embracing the spirit of MI increased from pretest to posttest 1, but slightly decreased at posttest 2. This trend was also seen in their assessment of the importance of and their confidence in teaching the eight MI strategies over time. Among the workshop participants, 56% were part of team grading; they reported the most helpful professional development activities overall were team grading (58%) and the workshop (25%). These results suggest the importance of making use of a variety of faculty development activities and of introducing appropriate follow-up to training sessions over time to ensure long-lasting effects. Future research using carefully designed, multi-institution, longitudinal studies is needed to determine the most effective ways to prepare dental hygiene faculty members to educate their students about MI.

Relational Skills and Client Language Predict Outcome in Smoking Cessation Treatment

ABSTRACTBackground: We currently lack insight into the predictive processes of Motivational Interviewing (MI) in smoking cessation treatment. More knowledge is necessary to be able to further enhance the treatment effect in smoking cessation interventions. Objectives: To examine certain hypothesized active components of MI in smoking cessation treatment delivered in an ordinary clinical setting. Methods: Audio-recordings of 106 smoking cessation treatment sessions were analyzed 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. Results: Client Activation utterances in favor of change were positively associated with smoking cessation at follow-up. The combined category of client language expressing a Desire or a Need to continue to smoke was negatively predictive of smoking cessation. In addition, we found preliminary support for a negative interaction effect between counselors' demonstration of the spirit of MI and clients Activation utterances in favor of change. Conclusions/Importance: Our data suggest that if smoking cessation counselors cultivate client Activation utterances in favor of abstinence and softening client utterances expressing desire or perceived need to smoke, this could contribute to higher rates of treatment success. In addition, counselors' demonstration of the spirit of MI was a statistically significant predictor of outcome when the negative interaction effect between Activation utterances in favor of change and MI spirit was taken into account. These findings should be evaluated in larger studies in the future.

SafeTalk: Training Peers to Deliver a Motivational Interviewing HIV Prevention Program.

As multiple effective interventions emerge to reduce the spread of HIV, there is a need to implement and disseminate such programs cost-effectively, such as by expanding service delivery through integration of peer supporters. The benefits of peer support are well established. However, knowledge about peer counseling initiatives remain limited. This pilot study tested the feasibility, fidelity, and acceptability of a motivational interviewing (MI) counseling training with individuals living with HIV to serve as peer counselors in order to address medication adherence and safer sex. We adapted, SafeTalk, an evidence-based intervention previously delivered by health professionals to reduce risky sexual behaviors among people living with HIV. We trained six peers in a 5-day program (24 hours total) over a 2-month period. We used a combination of training observation, pre-and posttests, debriefing, and the Motivational Interviewing Treatment Integrity (MITI 3.1) scale 3.1 to assess implementation of the training. Results suggest the program was feasible, and there was positive acceptability. However, fidelity to MI was poor. While participants were dedicated and enthusiastic about the training and able to learn some skills and demonstrate the "spirit of MI," they had difficulty with reflecting and moving away from giving direct advice. Training challenges and successes are discussed.

Dental Hygienists’ Experiences with Motivational Interviewing: A Qualitative Study

The effectiveness of Motivational Interviewing (MI) to change health behaviors is well documented. Previous studies support use of MI to change oral health behaviors in the areas of early childhood caries and periodontal diseases, but research is limited due to the sparse number of oral health care providers with training in MI. The University of Missouri-Kansas City (UMKC) formally integrated MI training into its dental hygiene curriculum five years ago. Summative program evaluation of UMKC's MI training shows that it effectively equips graduates with MI skills. The aim of this qualitative study was to use semi-structured interviews with nine program alumni to provide insight into the experiences of MI-trained dental hygienists in clinical practice. All interviews were captured with a digital voice recorder, were transcribed, and were resubmitted to the interviewees for checking. Five themes emerged from the data analysis: salience, best practices, barriers, facilitators, and lessons learned. These dental hygienists strongly valued and embraced the spirit of MI. They reported feeling strongly that it should be part of all dental hygiene curricula, and they upheld MI as a best practice. The participants approved of their MI instruction as a whole but felt it was difficult and sometimes not viable in practice. They reported that MI training had improved their communication skills and increased treatment acceptance. Time, difficulty, and managing patient resistance were the most often cited barriers, while a supportive climate and creating a routine were the most often cited facilitators.