Motivational Interviewing Techniques Research Articles

Early Feeding and Weaning Practices of Indian Children with Early Childhood Caries: A Qualitative Exploration.

To describe the early feeding, weaning, and oral hygiene practices of children with early childhood caries (ECC), their parents' knowledge and attitudes regarding infant feeding, and the feeding-related challenges faced by the parents. This descriptive qualitative study involved parents of children with ECC who sought dental treatment at an academic dental college in India. Data were collected though focus groups conducted with the 27 parents of children with ECC, using a focus group discussion guide. Data were analyzed using the content analysis method. Community norms, such as learning from the older women in the families or neighborhoods, guided the feeding method, duration of feeding, and weaning. Breastfeeding or bottle-feeding at bedtime beyond 12 mo of age and feeding sugary drinks during weaning were standard practices, despite knowing the risk for dental caries. Parents faced multiple challenges regarding weaning and were unaware of the significance of infant oral hygiene practices. In children with ECC, infant feeding practices included prolonged breastfeeding or bottle-feeding beyond the required age, feeding at bedtime, and feeding sugary drinks. Although the parents knew that these feeding habits could increase the risk for caries, they lacked the self-efficacy to translate their knowledge into action during weaning. Also, they lacked awareness regarding infant oral hygiene practices. The study provides information on the feeding habits of infants that can increase the risk for caries, the challenges faced by the parents of these children in altering these risky habits, and their lack of knowledge on infant oral hygiene practices. Policy/decision makers can advocate for pediatricians and pediatric dentists to incorporate anticipatory guidance or motivational interviewing techniques to tailor the preventive program for ECC for Indian children.

A phone and text message intervention to improve physical activity in midlife: initial feasibility testing

ABSTRACT Background Physical activity during midlife (ages 45-64) plays a major role in the prevention of chronic and serious medical conditions. Unfortunately, many midlife adults struggle to be physically active in the setting of low levels of psychological well-being and the management of multiple confluent sources of stress. Effective, scalable, midlife-specific interventions are needed to promote physical activity and prevent the development of chronic medical conditions. Objectives In an initial proof-of-concept trial, we assessed the feasibility and acceptability of a new, midlife-adapted, phone- and text message-based intervention using positive psychology (PP) skill-building and motivational interviewing (MI) techniques. We secondarily analyzed post-intervention changes in accelerometer-measured physical activity and self-reported outcomes. Methods The PP-MI intervention included six weekly phone sessions with a study trainer, with completion of PP activities and physical activity goals between calls, and in the subsequent six weeks briefer phone check-ins were conducted. Text messages over the 12-week intervention period were utilized to support participants and identify barriers to goal completion. Feasibility (session completion rates) and acceptability (participant ratings of intervention ease and utility) were assessed via descriptive statistics, and pre-post improvements in psychological, functional, and physical activity outcomes at 12 weeks were examined via mixed effects regression models. Results Twelve midlife adults with low baseline physical activity enrolled in the single-arm trial. Overall, 76.8% of all possible sessions were completed by participants, and mean ratings of weekly phone sessions were 8.9/10 (SD 1.6), exceeding our a priori thresholds for feasibility and acceptability. Participants demonstrated generally medium to large effect size magnitude improvements in accelerometer-measured physical activity, psychological outcomes, and function. Conclusions A novel, midlife-specific phone- and text-based PP-MI intervention was feasible and had promising effects on physical activity and other clinically relevant outcomes, supporting next-step testing of this program via a randomized controlled trial.

Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review.

Medication non-adherence is a leading cause of poor treatment outcomes among Thai patients with psychiatric disorders and creates challenges for psychiatric nurses. This systematic review synthesized research on intervention effectiveness for antipsychotic medication adherence in Thai schizophrenic populations. Following PRISMA guidelines, searches were completed in seven databases, including PubMed, PsycINFO, CINAHL, Web of Science, Scopus, ThaiJO, and Google Scholar. No restriction dates were used. Screening and extraction of data were performed systematically. Eligible studies consisted of nine quasi-experimental and two randomized control trial studies. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to assess the studies’ methodological quality. This review revealed that individual counseling combined with cognitive-behavioral therapy (CBT) and motivational interviewing (MI) techniques improved and maintained medication adherence behavior over time. Post-testing after intervention completion and at 3- and 6-month follow-ups showed that treatment group participants were more adherent than control group participants (p < 0.01). These findings suggest that incorporating CBT and MI into clinical practice can enhance medication adherence behavior. Booster session efficacy for reinforcing and sustaining adherence should be investigated. Greater rigor is warranted in future intervention studies based on a quality appraisal of previous studies.

Impact of a school-based and primary care-based multicomponent intervention on HPV vaccination coverage among French adolescents: a cluster randomised controlled trial protocol (the PrevHPV study)

IntroductionVaccination is an effective and safe strategy to prevent Human papillomavirus (HPV) infection and related harms. Despite various efforts by French authorities to improve HPV vaccine coverage (VC) these past...

An Eclectic Model of Motivational Interviewing with Islamic Ontological Orientation and Motivation of Change in Domestic Violence

Aim: The aim of this paper was to offer an eclectic model of motivational interviewing with Islamic ontological orientation in motivation of change in domestic violence. Methods: This research was qualitative and was carried out using Hermeneutics and content analysis. The sources for analysis were the collection of books and articles representing model of motivational interviewing and collection of verses of the holy Quran, Allame Tabatabaie and Javad Amollie including Tabatabaie Alimizan Tafsir and written works of Motahhary and Javad Amollie published until 2020. Analysis sample were subjects and words related to basics and principles of motivation (orientation, desire, and wish), motivation for change, and violence that was extracted using theoretical sampling. Findings: Research results in qualitative section were based on principles, process, content and techniques of motivational interviewing in motivation to change related to domestic violence and principles of ontological orientation about motivation in natural and innate dimensions. Conclusion: Based on the results, eclectic model of motivational interviewing with Islamic ontological orientation was offered in four sections including principles, processes, content and techniques.

Online health promotion program and individualized health coaching for veteran wellbeing

The pandemic has highlighted the need for accessible and effective health promotion as Canadians are isolated from their communities during social distancing measures. A web-based health promotion program in which participants also received individualized email-based health coaching from medical students has been available during the pandemic to empower veterans and their family members to engage in healthy lifestyle change. Health coaches’ email interactions with participants used techniques of motivational interviewing, including an empathetic style, statements of affirmation, and reflections. Open-ended questions were useful in gaining insight into the participant’s current lifestyle, including habits, challenges, and coping strategies. As services have transitioned online and individuals have become more isolated, the connection formed between online health coaches and individuals participating in the health promotion program became crucial in countering the mental and physical health repercussions of the pandemic. In a preliminary analysis, we show that web-based health promotion with health coaching, for Canadian Veterans and their families, leads to significant weight loss, increased activity and improvement in wellbeing metrics such as sleep and stress. The medical students acting as health coaches were able to gain a deeper understanding of the challenges involved in behaviour change, something that is seldom covered in detail in the medical school curricula. Medical students were also able to practice their motivational counseling skills surrounding lifestyle changes. Given the lack of available evidence for web-based health promotion that targets veterans and their families, these preliminary results appear promising, with longer-term follow-up planned for the next two years.

MIA

Since online discussion platforms can limit the perception of social cues, effective collaboration over videochat requires additional attention to conversational skills. However, self-affirmation and defensive bias theories indicate that feedback may appear confrontational, especially when users are not motivated to incorporate them. We develop a feedback chatbot that employs Motivational Interviewing (MI), a directive counseling method that encourages commitment to behavior change, with the end goal of improving the user's conversational skills. We conduct a within-subject study with 21 participants in 8 teams to evaluate our MI-agent 'MIA' and a non-MI-agent 'Roboto'. After interacting with an agent, participants are tasked with conversing over videochat to evaluate candidate résumés for a job circular. Our quantitative evaluation shows that the MI-agent effectively motivates users, improves their conversational skills, and is likable. Through a qualitative lens, we present the strategies and the cautions needed to fulfill individual and team goals during group discussions. Our findings reveal the potential of the MI technique to improve collaboration and provide examples of conversational tactics important for optimal discussion outcomes.

Screening for Information Environments: A Role for Health Systems to Address the Misinformation Crisis.

Misinformation about health topics is a public health issue. We are bombarded with information from many sources, across many digital means of communication, affecting the ways in which we are born, grow, work, live, and age. This makes information environments a social determinant of health (SDoH), but one not currently adequately addressed by clinical or public health practitioners. Since health systems are already screening for social determinants of health, existing mechanisms can additionally screen for unhealthy information environments. Then, for those patients who screen positive, we can apply best practices learned from initiatives addressing vaccine hesitancy: providing a non-judgmental environment in which to discuss health beliefs, using motivational interviewing techniques to gage patient perspectives and readiness for change, and taking a harm-reduction approach in recognizing that behavior change evolves over time. Displacing misinformation is a process, not an event. As such, we need to address the underlying psychological and sociological reasons that people maintain unscientific beliefs as we would hope to do with any other SDoH. Furthermore, as information environments are the product of both individual choices and structural factors, clinicians should approach patients immersed in unhealthy information environments without blame or ostracism, much as we would approach any patient adversely impacted by social determinants of health.

They Have the Ability to Say Yes or No: Providers' Perspectives on Veterans' Service Refusal as a Cause of Readmissions

Service refusal, where patients actively refuse clinicians’ recommendations for additional services needed to achieve safe and full recovery after discharge, is a key but often overlooked cause of readmissions. There is a dearth of literature on the extent of service refusal and providers’ (e.g. clinicians, nurses, social workers) observations regarding how to deal with these situations. As part of a larger, 10 VA site organizational case study of readmission, semi-structured interviews exploring causes of readmission were conducted with 21-41 staff members at each site (n=314). 41 providers identified Veteran service refusal and decision-making as causes of readmission. Providers acknowledged the need to honor patient autonomy/self-determination in decisions while at the same time worrying about potential adverse outcomes. Incongruence between Veterans’ and providers’ perceptions (especially for capacity for self-care), goals, and discharge plans was also cited as a factor in service refusal. Frustration was also raised about initial acceptance of service followed by refusal at time of service delivery. Providers also felt readmissions increased even further when combined with lack of or inadequate caregiving arrangements/family support, lack of cognitive capacity, homelessness, or home care affordability. Findings point to the need for interventions to evaluate congruence between provider and patient assessment of self-care capabilities and provide more in-depth goal setting and motivational interviewing techniques to help patients reach more realistic post-discharge care goals.

Impact of a Pharmacist-Led Diabetes Management Intervention to Improve Health Equity

The COVID-19 pandemic and Black Lives Matter movement brought increased recognition to the need for health equity. Diabetes, the 7th leading cause of death, is one of many conditions where health inequities are evident. A higher percentage of Black (11.7%) and Hispanic (12.5%) U.S. adults are diagnosed with diabetes compared to non-Hispanic Whites (7.5%). To address this health inequity, a nationwide pharmacy chain implemented telephonic ‘Advanced Care’ (AC) outreach for patients with diabetes. During the AC call, pharmacists used motivational interviewing techniques to counsel patients on the importance of closing gaps in care and reducing barriers to medication adherence. Gaps included timely A1C testing, exams (eye, foot, kidney), immunizations (influenza, pneumonia, Hepatitis B), and recommendation of additional therapies for patients with multiple chronic conditions (ACE/ARB, statins). Medication fill gaps were compared between the Intervention period (8/1/20-1/31/-21) and a pre-intervention period (2/1/20-7/31/20). The AC pilot occurred in 8 Chicago Walgreens locations that primarily serve Black and Hispanic patients. Eight control stores were matched on census block-level household income and race/ethnicity, patient volume, and insurance mix. A pre/post-test vs. control difference-in-difference (DID) analysis was conducted to compare on-time refill rates. Of the 1,009 older patients (age≥50) called, 59.9% were reached. The DID analysis showed that patients in pilot stores had improved pre-post on-time refill rates compared to controls (p<0.0001). Diabetes self-management is key to reducing diabetes-related complications. Early findings from this pilot demonstrate that the Walgreens AC intervention improves medication adherence - an important step toward improving health equity.

Efficacy of short-term telemedicine motivation-based intervention for individuals with Internet Use Disorder - A pilot-study.

BackgroundInternet Use Disorders (IUD) cover a range of online-related behavioral addictions, which are acknowledged and strengthened by the inclusion of (online) gaming disorder in the ICD-11 by the World Health Organization. Internet-based telemedicine interventions offer the possibility to reach out for individuals with IUD where the disorder emerges, in order to enhance their motivation to change their Internet use behavior.MethodsIn the course of the short-term telemedicine motivation-based intervention, adult participants took part in two webcam-based counselling sessions based on Motivational Interviewing techniques. Two weeks after the first webcam-based counselling session the second took place. Participants completed questionnaires regarding the motivation to change their Internet use behavior (iSOCRATES) and symptoms of IUD (s-IAT) at three times of measurement: t0 (pre-intervention), t1 (mid-intervention) and t2 (post-intervention).Results73 affected individuals (83.6% male, average age 35 years (SD = 12.49) took part in the whole intervention including the questionnaire-based post intervention survey (t2). Over the course of the telemedicine intervention, a significant increase in the motivation to change with regard to the own Internet use behavior as well as a significant reduction in the symptom severity of an IUD and duration of Internet use (reduction of 2 hrs/d) were shown.ConclusionThe telemedicine pilot study shows that online-based consultation can be effective and helpful for individuals with IUD. Therefore, such a telemedicine intervention may be a suitable extension to the already existing analogous care system.

The use of motivational interviewing to overcome COVID-19 vaccine hesitancy in primary care settings.

Vaccine hesitancy is not a new phenomenon. However, the COVID‐19 pandemic has highlighted the impact of political, racial, and health disparities on vaccine hesitancy at a global level. With the creation of the COVID‐19 vaccine, a resurgence of vaccine hesitancy has emerged and many are reluctant to receive the vaccination. The reluctance varies from concerns about government interference in vaccine development, to the speed of vaccine development, to long‐term health outcomes and potential side effects. Health care professionals need to consider evidence‐based approaches that are effective in assisting patients with health care decision‐making regarding vaccine uptake. Motivational Interviewing (MI) is an effective technique to positively impact behavior change. Definitions and examples of MI techniques are provided to illustrate how MI can be used to support patient autonomy and provide a safe and trusting environment, with the goal of increasing COVID‐19 vaccination uptake.

Promoting readiness and engagement in pain rehabilitation for youth and families: Developing a pediatric telehealth motivational interviewing protocol.

ObjectiveIntensive interdisciplinary pain treatment (IIPT) is a promising approach for youth with complex, disabling, refractory pain conditions. However, youth and families who initiate IIPT without sufficient acceptance of its focus on functional rehabilitation or readiness to adopt a self‐management approach to their pain may face challenges in IIPT and/or experience suboptimal outcomes. Motivational interviewing (MI) techniques have been shown to enhance readiness to make a number of health behavior changes for adults and youth, but it has not been systematically examined in the context of pediatric IIPT. The authors developed an MI telehealth intervention protocol explicitly designed to prepare youth and families for admission to IIPT.MethodThe protocol development process is detailed here, including influential models, expert consultation, and feedback from IIPT clinical experts. The intervention protocol was then piloted with a group of eligible families to elicit feedback and prompt further refining. Feasibility and acceptability were explored through measures of treatment engagement and satisfaction.ResultsThe Promoting Readiness and Engagement in Pain Rehabilitation (PREPaRe) intervention protocol contains four modules aimed to enhance youth and parent readiness to adopt a self‐management approach to persistent pain, through a motivational interviewing approach. Initial responses from the test group suggested high levels of treatment engagement and treatment satisfaction with PREPaRe.ConclusionsPREPaRe appears feasible to administer and acceptable to families of youth with persistent pain seeking IIPT. Implications for implementation are discussed. Further study via randomized control trial is warranted.Trial registrationClinicalTrials.gov identifier: NCT04093921.

Using motivational interviewing techniques to inform decision-making for COVID-19 vaccination.

Motivational interviewing is a patient-centered communication style used to enhance a person’s internal motivation for attitudinal change by exploring and solving inherent ambivalences. In the face of rising COVID-19 vaccine hesitancy, pharmacists and other health care professionals may use motivational interviewing to enable individuals making informed decisions with regards to the COVID-19 vaccines. The purpose of this article is to integrate theory with practice by describing a scenario that illustrates how motivational interviewing skills and strategies can be used to reduce COVID-19 vaccine hesitancy.

The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients.

This study was conducted to determine the effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. There are many studies using Motivational Interviewing for individuals with schizophrenia. However, there are no studies on whether the concept of "adherence to treatment," which is clearly shown to be corrected with 6 to 8 weeks of motivational interviewing, will positively affect concepts such as "hope and well-being," which require longer interventions, in a shorter time. In this context, there are not enough studies in which motivational interviewing techniques are integrated into psychoeducational interventions that can be organized with more individuals. The study was conducted with a pretest-posttest control group design. The sample size of the study was determined as 150 schizophrenia patients including 75 in the experimental group and 75 in the control group based on power analysis. The researcher provided the patients in the experimental group with a six-session psychoeducation program based on motivational interview techniques. A "Descriptive Characteristics Form," the "Herth Hope Index," the "Morisky Medication Adherence Scale," and the "Psychological Well-Being Scale" were used to collect the data. In the study, psychoeducation based on motivational interview techniques created a statistically significant difference in the medication adherence, hope and psychological well-being levels of the patients in the experimental and control groups (p < .05). Psychoeducation based on motivational interview techniques provided for schizophrenia patients was found to be effective in enhancing their medication adherence, hope, and psychological well-being levels.

Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services

ObjectiveLittle is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. MethodsSemi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15–25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. ResultsApart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP’s individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP’s cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. ConclusionBy adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. Practice implicationsUsing a structured conversation model combined with a tool to encourage YP’s agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.

An Exploration of the Application of Step Counter-Based Physical Activity Promotion Programs in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review.

Objective: This paper aimed to systematically review the application methods and components of step counter-based physical activity (PA) promotion programs in patients with chronic obstructive pulmonary disease (COPD). The effects of longer-duration (≥12 weeks) programs on PA, exercise capacity, quality of life, and dyspnea were discussed.Methods: This review was performed in accordance with the preferred reporting items for systematic reviews and meta-analysis. Online data resources PubMed, Web of Science, Embase, and EBSCO were searched. The publication year was limited between January 2000 to August 2020. All randomized controlled trials with ≥12-week duration of step counter-based PA promotion programs of COPD were included. Two researchers independently assessed the quality of the included studies and extracted their characteristics.Results: Nine studies involving 1,450 participants were included. Step counters, counseling, exercise goals, diaries, and tele-communicational approaches were common components of these programs. The PA feedback tools were mostly pedometers (n = 8), whereas accelerometers were often used as assessment tools of PA (n = 5). All studies implemented counseling: five applied behavioral change theories, and three reported motivational interview techniques simultaneously. Six studies reported detailed exercise goals. The usual exercise goal was to reach a total of 8,000–10,000 steps/day. Three research studies used diaries, and five applied tele-communication approaches to deliver interventions. The programs could be implemented alone (n = 4), in combination with exercise training (n = 2), or with pulmonary rehabilitation (n = 2). All studies showed a significant increase in the PA (≥793 steps/day). Three studies observed a significant improvement in exercise capacity (≥13.4 m), and two reported a significant increase in the quality of life (p < 0.05). No study showed significant between-group differences in dyspnea.Conclusion: There are a few studies assessing the impact of long-duration (≥12 weeks) step counter-based interventions in COPD, with different methodologies, although all studies included counseling and exercise goal setting. These interventions seem to have a positive effect on PA. A few studies also showed benefit on exercise capacity and quality of life.

Developing a Psychological Intervention for Decreasing Bedtime Procrastination: The BED-PRO Study

ABSTRACT Introduction Bedtime Procrastination (BP) is defined as the behavior of going to bed later than intended, without having external reasons for doing so. Previous studies have shown that BP has a negative effect on sleep and health, emphasizing the need to develop interventions to decrease BP. This intervention development study is a proof-of-concept study for a psychological intervention designed for decreasing bedtime procrastination, namely BED-PRO. Material and Method The intervention was developed based on behavioral modification principles and motivational interviewing techniques. The final intervention was a weekly three-session intervention, with one additional booster call. Twenty individuals with high BP participated in the study, and data was collected for pre- and post-intervention, and one-month follow-up. Individuals completed the Bedtime Procrastination Scale, Epworth Sleepiness Scale, Fatigue Severity Scale, Morningness-Eveningness Questionnaire, Insomnia Severity Index, and a sleep diary. Result Significant changes were found for BPS scores, bedtime procrastination duration (Δ51 mins, 63.8% reduction compared to baseline), wake after sleep onset, sleep efficiency and feeling refreshed upon awakening measured by sleep diaries following the intervention. In addition, changes in BPS, ISI, and ESS scores, wake after sleep onset, sleep efficiency and feeling refreshed upon awakening were maintained or continued to improve at 1-month follow-up. Conclusion This study verified the feasibility and acceptability of the BED-PRO intervention and the potential for being the first intervention to target bedtime procrastination. Considering the research about negative implications of BP, we expect that this intervention could be a step forward in considering BP as a serious health behavior.

The development of an intervention to support uptake and adherence to antiretroviral therapy in people living with HIV: the SUPA intervention. A brief report.

The effectiveness of antiretroviral therapy (ART) depends on prompt uptake of treatment and a high level of adherence over the long-term, yet these behaviors are suboptimal. Previous interventions have significantly improved adherence but effect sizes are generally small. The aim of this article is to describe the design and content of an intervention to support uptake and adherence to treatment in HIV positive patients (SUPA intervention), utilizing cognitive behavioral and motivational interviewing (MI) techniques. The intervention was developed in line with Medical Research Council (MRC) guidance for the development of complex interventions and informed by the NICE (National Institute for Health and Care Excellence) Guidelines for adherence, empirical evidence and focus groups. Behavior change techniques were mapped to perceptual and practical barriers to uptake and adherence to ART, identified in previous research. Intervention materials were designed and later discussed within focus groups, where feedback enabled an iterative process of development. We conclude it is possible to transparently report the design and content of a theory-based intervention to increase uptake and adherence to ART. The intervention has been evaluated within a randomized controlled trial (RCT) at 10 HIV clinics in England, the results of which will be reported elsewhere.

Occupational Health Nurses' Self-Efficacy in Implementing Smoking Cessation Interventions for Workers: A Manufacturing Company Quality Improvement Project.

Effective smoking cessation interventions (SCIs) are urgently needed for the working population where smoking continues at high rates. Occupational health nurses (OHNs) could be effective in providing SCI, but self-efficacy was found to be a major barrier. The purpose of this study was to improve the delivery of SCI to those who smoke in the workplace and to explore nurse self-efficacy. Pretest and posttest were conducted on two groups, OHNs (n = 5) and smokers (n = 11) working at U.S. manufacturing facilities. OHNs were trained on motivational interviewing (MI) techniques who then recruited smokers to help them practice their newly acquired skills. The two groups were measured by Likert-type scale for OHN self-efficacy and smoker level of change toward quitting. Paired t-tests detected statistically significant differences in OHN's preintervention and postintervention self-efficacy scores, t(4) = -4.46, p < .001,; d = 2.92) and smokers' preintervention and postintervention stage of change toward quitting scores, t(10) = -9.07, p < .001,; d = 2.09), suggesting that the training and MI intervention were effective in increasing OHN self-efficacy and smokers' motivation to change. This quality improvement (QI) project indicated smokers can be successfully recruited and counseled using MI techniques, while simultaneously improving OHN self-efficacy toward helping patients. Theory-based applications brought OHNs and smokers together in a new paradigm resulting in positive changes for both. Secondary findings in the reverse nurse-patient role revealed success in an innovative recruitment method for smoking cessation.