Training medical students to conduct motivational interviewing: a randomized controlled trial

Objective

To examine the effectiveness of motivational interviewing (MI) training among medical students.

Methods

All students (n = 131) (year 5) at Lausanne Medical School, Switzerland were randomized into an experimental or a control group. After a training in basic communication skills (control condition), an 8-h MI training was completed by 84.8% students in the exprimental group. One week later, students in both groups were invited to meet with two standardized patients. MI skills were coded by blinded research assistants using the Motivational Interviewing Treatment Integrity 3.0.

Results

Superior MI performance was shown for trained versus control students, as demonstrated by higher scores for “Empathy” [p < 0.001] and “MI Spirit” [p < 0.001]. Scores were similar between groups for “Direction”, indicating that students in both groups invited the patient to talk about behavior change. Behavior counts assessment demonstrated better performance in MI in trained versus untrained students regarding occurences of MI-adherent behavior [p < 0.001], MI non-adherent behavior [p < 0.001], Closed questions [p < 0.001], Open questions [p = 0.001], simple reflections [p = 0.03], and Complex reflections [p < 0.001]. Occurrences were similar between groups regarding “Giving information”.

Conclusion

An 8-h training workshop was associated with improved MI performance.

Practice implications

These findings lend support for the implementation of MI training in medical schools.     

Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case

Objective

We sought to evaluate a year 3 motivational interviewing (MI) curriculum using a standardized patient case.

Methods

The 2-h small group MI curriculum included a didactic presentation followed by interactive role plays. During a clinical skills assessment at the end of year 3 the MI skills of 80 students who had participated in the curriculum were compared with those of 19 students who had not participated.

Results

The standardized patient reliably rated the students on their performance of 8 items. Students who had participated in the MI curriculum were significantly more proficient than nonparticipating students in the performance of 2 strategic MI skills, importance and confidence rulers (ps < .006). The groups did not differ in their use of patient-centered counseling skills or collaborative change planning commonly used in MI.

Conclusions

Third year medical students can learn to use MI skills that specifically aim to enhance patients’ motivations for change.

Practice implications

Medical schools should consider providing students with MI training and MI skill assessments using standardized patient cases to help students prepare to counsel patients for behavior change.     

An integrative review of the efficacy of motivational interviewing in HIV management

ObjectiveThe purpose of this integrative review is to examine the use of motivational interviewing (MI) to improve health outcomes in persons living with HIV (PLWH).MethodsWe reviewed the existing literature, using the PRISMA model. The PubMed, Web of Science, Embase, and CINAHL databases were searched for all relevant studies, using the terms HIV, AIDS, and motivational interviewing.ResultsOf 239 articles identified initially, 19 met our criteria for synthesis. These studies were conducted throughout the world, including the U.S., Thailand, and South Africa. In general, studies that used MI, either alone or in conjunction with other interventions, reported improved adherence, decreased depression, and decreased risky sexual behaviors.ConclusionThis review demonstrates a positive relationship between MI-based interventions and behavioral change, which may lead to improved health outcomes in PLWH.Practice implicationsMotivational interviewing can be an effective method of therapeutic communication for PLWH, who struggle with adherence, depression, and risky sexual behaviors.     

Motivational interviewing training for medical students: A pilot pre-post feasibility study

Objective

To evaluate the impact of brief training in motivational interviewing (MI) from a non-specialist professional for medical students.

A systematic review of motivational interviewing training for general health care practitioners

Objective

This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.

Methods

Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.

Results

Ten studies were found. The median length of the training was 9 h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.

Conclusions

The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.

Practice implications

This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.     

Mechanisms of change in self-care in adults with heart failure receiving a tailored,motivational interviewing intervention

Self-care is challenging but we previously demonstrated that motivational interviewing (MI) was effective in improving heart failure (HF) self-care.ObjectiveTo identify the mechanisms of intervention effectiveness by elucidating the MI techniques used and the relationship between the techniques and changes in self-care.MethodsAudiotaped sessions (first and subsequent sessions) from 8 participants were transcribed verbatim and coded to evaluate changes in self-care. Using a sequential mixed method design, quantitative and qualitative self-care data were triangulated; congruence was 97%. The MI techniques used and mechanisms of intervention effectiveness were identified from the qualitative data.ResultsThree MI techniques used were related to improved self-care: 1) reflection and reframing, 2) genuine empathy, affirmation, and humor, and 2) individualized problem solving. These techniques stimulated openness to goal setting, positive self-talk, perceived ability to overcome barriers, and change talk. The mechanisms by which the techniques achieved the desired outcomes were the development of discrepancy and self-efficacy, which are consistent with the principles of MI.ConclusionThis study contributes to clarifying the mechanism by which MI facilitates behavioral change.Practice implicationsUsing MI to discuss self-care can help to overcome barriers and engage HF patients in goal setting for behavior change.     

Motivational interviewing to improve health screening uptake: A systematic review

ObjectiveHealth screenings, physical tests that diagnose disease, are underutilized. Motivational interviewing (MI) may increase health screening rates. This paper systematically reviewed the published articles that examined the efficacy of MI for improving health screening uptake.MethodsArticles published before April 28, 2015 were reviewed from PubMed, PsycINFO, and CINAHL. Study methodology, participant demographics, outcomes and quality were extracted from each article.ResultsOf the 1573 abstracts, 13 met inclusion criteria. Of the 13 studies, 6 found MI more efficacious than a control, 2 found MI more efficacious than a weak control yet equivalent to an active control, and 3 found MI was not significantly better than a control. Two single arm studies reported improvements in health screening rates following an MI intervention.ConclusionsMI shows promise for improving health screening uptake. However, given the mixed results, the variability amongst the studies and the limited number of randomized trials, it is difficult to discern the exact impact of MI on health screening uptake.Practice implicationsFuture research is needed to better understand the impact of MI in this context. Such research would determine whether MI should be integrated into standard clinical practice for improving health screening uptake.     

The development of a motivational interviewing intervention to promote medication adherence among inner-city, African-American adolescents with asthma

Objective

To develop and assess the feasibility of a motivational interviewing (MI) based asthma self-management program for inner-city, African-American, adolescents with asthma.

Methods

37 African-American adolescents (age 10-15 years) recently seen in an inner-city emergency department for asthma and prescribed an asthma controller medication participated in the newly developed program consisting of 5 home visits. Adolescents and their caregivers completed phone-based surveys before and after the intervention.

Results

95% of the adolescents completed all 5 sessions; 89% of caregivers and 76% of adolescents believed other families would benefit from the intervention. Caregivers were more likely to report 100% adherence post-intervention compared to pre-intervention and reported a trend for adolescents taking greater responsibility for their asthma. There were no pre-post-differences in adolescent-reported medication adherence, but adolescents did reported increased motivation and readiness to adhere to treatment. Caregivers and adolescents each reported statistically significant increases in their asthma quality of life.

Conclusions

The findings from this pilot study suggest that MI is a feasible and promising approach for increasing medication adherence among inner-city adolescents with asthma and is worthy of further evaluation in a randomized trial.

Practice Implications

Incorporating MI into disease management programs may enhance their effectiveness.     

Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials

BackgroundPromoting interconception health can improve birth outcomes and long-term women’s health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.ObjectiveThis scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.MethodsWe searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.ResultsThere were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes.DiscussionMI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.Practical valueMI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.     

Application of a stage based motivational interviewing approach to adolescent smoking cessation: the Transtheoretical Model-based study

OBJECTIVE: To evaluate the results of stage-based motivational interviewing (MI) efforts to help adolescents quit smoking using the three constructs of Transtheoretical Models (TTM). The validity of Turkish translations of two key scales was also assessed. METHODS: A methodological and single group pre-post test study design was utilized. 275 adolescent smokers from one high school were recruited for validation of the scales and 60 of them participated in MI intervention. Change in smoking stage, interpretation of pros and cons of smoking, temptations, and smoking status were measured prior to the intervention, and follow-up was conducted at 3 and 6 months after intervention. RESULTS: The scales showed adequate reliability and validity for use in Turkish adolescent. Of the MI participants, 40% and 55% had made positive movements in stage at 3 and 6 months, respectively. The interpretations of the cons of smoking significantly increased and temptations dropped toward the action stage at 3 months, and pros of smoking and temptations decreased at 6 months consistently with TTM. The percentages of those who had quit smoking at 3 and 6 months were 18.3% and 33.3% respectively. CONCLUSION: A modest, short-term benefit of the intervention was provided to students towards stopping smoking and positive movement in stages was apparent. PRACTICAL IMPLICATIONS: Using the MI principles in specific stages based on TTM, health care providers can influence and empower adolescent smokers positively for quitting smoking.     

Impact of a motivational interviewing intervention targeting statins on adherence to concurrent hypertension or diabetes medications

ObjectiveThis study explored if a motivational interviewing intervention customized for statins impacted adherence to concomitantly used antidiabetic/antihypertensive medications.MethodsThe intervention was conducted among patients with a history of suboptimal adherence to statins and included 152 patients in intervention and 304 controls. This retrospective study design identified patients with claims for statins and either antidiabetic/antihypertensive medications. The outcome variable was adherence, measured as proportion of days covered ≥ 0.80, to antidiabetic/antihypertensive medications. Multivariable linear and logistic regression evaluated the effect of intervention on adherence to antidiabetic/antihypertensive medications during the 6 months post-intervention.ResultsThe antidiabetic group had 53 intervention patients and 102 controls. The antihypertensive group had 80 intervention patients and 159 controls. There was no significant improvement in adherence for antidiabetic/antihypertensive medications following the intervention. Adherence at baseline was a significant predictor of adherence post-intervention in the antidiabetic (OR = 6.5;P < 0.0001) and antihypertensive (OR = 4.1; P = 0.0001 & β = 0.09; P = 0.008) users. Physician specialty (OR = 3.902; P = 0.01& β = 0.09; P = 0.015) among antidiabetic users and age >70 years (OR = 2.148; P = 0.025) among antihypertensive users were predictors of adherence.ConclusionThe intervention targeting statin did not significantly improve antihypertensive/antidiabetic adherence.Practice ImplicationsTargeted interventions tailored to patient past adherence and specific medications should be explored.     

Assessment of motivational interviewing: Psychometric characteristics of the MITS 2.1 in general practice

ObjectiveMotivational Interviewing (MI) is increasingly used in healthcare. The Motivational Interviewing Target Scheme 2.1 (MITS) can be used to assess MI in short consultations. This quantitative validation study is a sequel to a qualitative study, which showed that the MITS is suitable for low-stakes assessment. We collected validity evidence to determine whether its suitability for high-stakes assessment in the GP-setting.MethodsConsultations of GPs and GP-trainees were assessed using the MITS. The internal structure was studied using generalizability theory; intra class correlation (ICC), convergent and divergent validity was determined.ResultsTwo coders and seven consultations were found to be necessary for high stakes assessment. We found higher ICCs as coders were more experienced. Convergent validity was found; results for divergent validity were mixed.ConclusionThe MITS is a suitable instrument for high-stakes MI assessments in GP-setting. The number of consultations and coders that are needed for assessment are comparable to other instruments for assessing communication skills.Practice implicationsThe MITS can be used to assess conversations for their MI consistency in GP-setting where most consultations are relatively short and are only partially dedicated to behaviour change. As the MITS assesses complex communication skills, experienced coders are needed.     

Identifying content-based and relational techniques to change behaviour in motivational interviewing

Motivational interviewing (MI) is a complex intervention comprising multiple techniques aimed at changing health-related motivation and behaviour. However, MI techniques have not been systematically isolated and classified. This study aimed to identify the techniques unique to MI, classify them as content-related or relational, and evaluate the extent to which they overlap with techniques from the behaviour change technique taxonomy version 1 [BCTTv1; Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W.,?…?Wood, C. E. (2013). The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: Building an international consensus for the reporting of behavior change interventions. Annals of Behavioral Medicine, 46, 81–95]. Behaviour change experts (n?=?3) content-analysed MI techniques based on Miller and Rollnick’s [(2013). Motivational interviewing: Preparing people for change (3rd ed.). New York: Guildford Press] conceptualisation. Each technique was then coded for independence and uniqueness by independent experts (n?=?10). The experts also compared each MI technique to those from the BCTTv1. Experts identified 38 distinct MI techniques with high agreement on clarity, uniqueness, preciseness, and distinctiveness ratings. Of the identified techniques, 16 were classified as relational techniques. The remaining 22 techniques were classified as content based. Sixteen of the MI techniques were identified as having substantial overlap with techniques from the BCTTv1. The isolation and classification of MI techniques will provide researchers with the necessary tools to clearly specify MI interventions and test the main and interactive effects of the techniques on health behaviour. The distinction between relational and content-based techniques within MI is also an important advance, recognising that changes in motivation and behaviour in MI is a function of both intervention content and the interpersonal style in which the content is delivered.     

Everyday use of patient-centred, motivational techniques in routine consultations between doctors and patients with diabetes

Objective

Facilitating lifestyle change and improved self-management are important aspects of diabetes treatment. Previous research shows motivational, patient-centred approaches are more effective at this than traditional, didactic approaches. This study explores the degree to which doctors with no previous training in motivational techniques employ these methods to affect behaviour change in routine consultations.

Methods

A cross-sectional design was employed. Forty-four routine consultations with nine physicians were tape-recorded, of which nineteen focussed on behaviour change; patient questionnaires assessed patient demographics, intention to self-manage and satisfaction with consultation. Physician behaviour was coded for use of motivational, behaviour change techniques, patient-centeredness and other verbal communication variables; patient communication was also assessed.

Results

Lifestyle issues were raised in 43% of consultations but few motivational strategies were employed; 10% of physicians’ communication was patient-centred. An association was found between physicians’ use of patient-centred strategies and patients expressing views (r = .44, p < .05). Higher patient satisfaction with the consultation was related to physician partnership-building (r = .37, p ≤ .05) and patients asking questions (r = −.31, p ≤ .05). Familiarity between doctor and patient was associated with more physician recommendations and directives (r = .35, p ≤ .05) and information giving (r = .30, p ≤ .05), and more assertive responses by the patient (r = .31, p ≤ .05).

Conclusion

Effective communication strategies related to behaviour change were not used routinely in diabetes consultations in the clinic studied. More patient-centred approaches were associated with higher indicators of patient satisfaction.

Practice implications

Physicians require training and support in employing behaviour change techniques if these are to be integrated into routine care.     

The evaluation of a brief motivational intervention to promote intention to participate in cardiac rehabilitation: A randomized controlled trial

Objectives

Cardiac rehabilitation (CR) is an effective treatment for cardiovascular disease, yet many referred patients do not participate. Motivational interviewing could be beneficial in this context, but efficacy with prospective CR patients has not been examined. This study investigated the impact of motivational interviewing on intention to participate in CR.

Ongoing supervision as a method to implement Motivational interviewing: Results of a randomized controlled trial

ObjectiveTo assess skills in Motivational interviewing (MI) at the Swedish National Board of Institutional Care (SiS), and to evaluate different ways to provide MI supervision.MethodsSiS practitioners (n = 134) were randomized to regular group supervision, or individual telephone supervision based on only the behavioral component of a feedback protocol, or the full protocol. Participant’s mean age was 43.2 (SD =10.2), and the majority (62.7%) were females.ResultsMany participants showed beginning proficiency already at baseline, indicating a successful implementation. Still, results varied widely. The regular supervision and the supervision based on objective feedback were equally effective, and the group receiving feedback based on fewer variables of the protocol performed better on only one of the seven skill measures. The objective feedback did not provoke supervisee discomfort/distress, or negatively affect the supervisory relationship.ConclusionsExtensive MI implementation can increase practitioners’ skills in MI, but the question of the best mode of ongoing supervision needs further attention.Practice ImplicationsObjective feedback does not seem to negatively affect the supervisee’s skill acquisition or the supervisor-supervisee working alliance, but the question of how to most efficiently provide feedback from multifaceted feedback tools remains unanswered.     

Effectiveness of a minimal virtual motivational interviewing training for first years medical students: differentiating between pre-test and then-test

BackgroundShifting towards patient-centeredness, medical doctors need patient-centered communication skills. Motivational Interviewing (MI) is an evidence-based, collaborative, goal-oriented communication technique to strengthen a person’s own motivation and commitment to change. The purpose of this study is to evaluate the effectiveness of a brief virtual role-play MI-training program on MI-knowledge and skills in first-year undergraduate medical students, making use of both a pre-test and a then-test (retrospective pre-test) to check for response shift in evaluating the educational intervention.MethodsFour 10–15 min MI-game-based training conversations embedded in the Kognito Conversation Platform? were offered to the students using a single-group Interrupted Time Series design.ResultsParticipants included 339 undergraduate medical students (RR= 83.1%). The one-hour MI virtual training proved effective in two ways: participants gained knowledge and skills, and increased awareness of the existing intrinsic knowledge and skill they already possess to communicate with future patients in a patient-centered way.ConclusionA brief one-hour MI-training simulation can be effective even if offered at an early stage during medical education. Furthermore, response shift varied and was not present in all students.Practice ImplicationThe addition of a then-test to the study design reveals results that otherwise would not have been found.