Fidelity of Motivational Interviewing in School-Based Intervention and Research

Evidence for motivational interviewing in educational settings among medical schools: a scoping review

BACKGROUND

Motivational interviewing (MI) is a person-centred approach focused on empowering and motivating individuals for behavioural change. Medical students can utilize MI in patient education to engage with patients' chronic health ailments and maladaptive behaviours. A current scoping review was conducted to 1) determine the types of MI (conventional, adapted, brief and group MI) education programs in medical schools, delivery modalities and teaching methods used; 2) classify educational outcomes on the basis of Kirkpatrick's hierarchy; and 3) determine the key elements of MI education via the FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy) model.

METHODS

This scoping review was conducted via the framework outlined by Arksey and O'Malley. Two online databases, CINAHL and MEDLINE Complete, were searched to identify MI interventions in medical education. Further articles were selected from bibliography lists and the Google Scholar search engine.

RESULTS

From an initial yield of 2019 articles, 19 articles were included. First, there appears to be a bimodal distribution of most articles published between the two time periods of 2004--2008 and 2019--2023. Second, all the studies included in this review did not use conventional MI but instead utilized a variety of MI adaptation techniques. Third, most studies used face-to-face training in MI, whereas only one study used online delivery. Fourth, most studies have used a variety of interactive experiences to teach MI. Next, all studies reported outcomes at Kirkpatrick's Level 2, but only 4 studies reported outcomes at Kirkpatrick's Level 3. According to the FRAMES model, all studies (n=19; 100%) reported the elements of responsibility and advice. The element that was reported the least was self-efficacy (n = 12; 63.1%).

CONCLUSION

Our findings suggest that motivational interviewing can be taught effectively in medical schools via adaptations to MI and a variety of teaching approaches. However, there is a need for further research investigating standardized MI training across medical schools, the adequate dose for training in MI and the implementation of reflective practices. Future studies may benefit from exploring and better understanding the relationship between MI and self-efficacy in their MI interventions.

Mixed-method evaluation of fidelity of motivational interviewing-based coaching in 5Minutes4Myself Wellness Program for caregivers of children with autism

Objective

This mixed method analysis examined fidelity of the motivational interviewing (MI) delivered during the 5Minutes4Myself wellness program for caregivers of children with Autism Spectrum Disorders.

Methods

Coaches used a manualized MI-approach to collaboratively design participants' individualized wellness programs, and then used it in monthly coaching sessions to support goal pursuit. Audio-recorded consultations and post-participation focus groups were transcribed verbatim. Consultation transcripts were rated for MI adherence using Motivational Interviewing Treatment Integrity Code. Focus group data was coded by the team to identify conceptual categories.

Results

Eighty-seven percent of consultations achieved a beginning (competent) level expert-derived MI standard. Caregivers noted that coaches' MI approach evoked deep emotions and understandings about their lives related to wellness goals, allowed for a permissive flexibility in goal pursuit, and fostered supportive accountability.

Conclusion

MI was used with high levels of fidelity. Participants described the MI approach as more productive, precise, and useful in addressing their needs compared to other available interventions.

Implementing Evidence-Based Motivational Interviewing Strategies in the Care of Patients with Heart Failure

Motivational interviewing (MI) has positive effects on heart failure patient outcomes related to self-care. MI can be effectively used by the interprofessional team in the hospital and clinic settings, and it can be effective even in brief patient interactions. The spirit of MI uses collaboration, evocation, and honoring the patient's autonomy. Open-ended questions, affirmations, reflective listening, and summarization are skills used to build empathy and elicit change talk with the MI framework. Clinicians can consider obtaining feedback to improve their practice of MI techniques for enhanced efficacy in helping heart failure patients improve self-care behaviors.

“Sometimes It Felt Great, and Sometimes It Just Went Pear-Shaped”: Experiences and Perceptions of School Nurses’ Motivational Interviewing Competence: A Convergent Mixed-Methods Study

In this convergent mixed-methods study, the aim was to explore how objective and subjective quality ratings of school nurses’ motivational interviewing (MI) correlate whilst also considering the perceptions of delivering and participating in the same MI sessions. Quantitative and qualitative data were derived from seven intervention schools participating in the Healthy School Start Plus parenting support intervention. School nurses were trained in MI and conducted an MI session with parents of 6–7-year-old children to discuss children’s physical health and development. Quantitative data comprised objective ratings of school nurses’ MI competence using the Motivational Interviewing Treatment Integrity 4.2 [MITI-4] protocol, as well as parents’ and school nurses’ subjective ratings of the MI sessions. Qualitative data comprised semi-structured interviews with parents and school nurses about their perceptions of the MI sessions. First, quantitative data were analysed using Spearman’s rank correlation, and qualitative data were analysed using content analysis. Next, quantitative and qualitative findings were merged. Our findings suggest that school nurses’ MI performances were rated and perceived as valuable and family-centred by both school nurses and parents who had left the meeting feeling motivated and empowered to promote their children’s healthy behaviours. Nonetheless, school nurses were critical to their own MI technical performance, and they found that reflections were easier to deliver and to self-rate. Overall, MITI ratings were the lowest and parents’ ratings were the highest. Future studies should focus on relating clients’ subjective ratings of MI with clients’ behavioural outcomes.

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.

Taking a Motivational Interviewing Approach to Prevention Science: Progress and Extensions

This commentary reviews advances gleaned from the current set of papers to Motivational Interviewing (MI) in prevention science. We begin by acknowledging the pioneering work of Miller and Rollnick to develop the construct of MI, then Dishion's use of MI principles to adapt applications of MI for the field of prevention science. We then highlight some of the contributions provided by the current set of papers and other recent extensions of MI. These novel applications are directed to parents, teachers, and older youth in the service of facilitating behavior change to promote youth development.