Process evaluation of an exercise counseling intervention using motivational interviewing

Background: Exercise continues to be promoted for the primary and secondary prevention of heart disease, yet many adults remain inactive and ethnic minority adults are less active than Whites. One of the goals of Healthy People 2020 is to increase the proportion of office visits that include counseling about exercise with patients diagnosed with heart disease; one approach may be the use of motivational interviewing (MI). However, adherence to the essential principles of MI is critical in achieving desired outcomes. Purpose: The purpose of this study was to evaluate the use of MI in an exercise counseling intervention in a sample of minority adults with heart failure (HF). Methods: Twenty ethnic minority adults with stable HF were recruited from an urban HF clinic. Measures of physical activity (International Physical Activity Questionnaire (IPAQ); weekly step-counts via accelerometer) and functional status (Duke Activity Status Index (DASI); 6-minute walk test [6MWT]) were taken at baseline and 12-weeks. The initial exercise counseling session (15 minutes) using MI discussed previous exercise experience, future goals, and practical exercise guidelines, including symptom management. The interview guide, written using principles of MI, was reviewed with an expert in MI and revised prior to the first interview. During subject recruitment, four subjects’ interviews were reviewed (#3, #4, #16, #20) by another independent expert and scored for use of MI. After each scoring and discussion of results, the interview guide was again revised to further facilitate the use of MI. The initial session was followed by 12 weekly 5-minute phone calls. Results: Interview #3 scored 50% overall adherence to MI with more closed than open questions (6 vs.4) and 44% of reflections were complex (vs. simple). Interview #4 ranked 40% MI adherent with more closed vs. open questions (9 vs. 3) and only 30% complex reflections. Interview #16 ranked 100% adherent with more closed than open questions (6 vs. 3) but more complex reflections (54%). Interview #20 ranked 80% adherent with more open vs. closed questions (8 vs. 1) and 42% complex reflections. At 12 weeks, there were concurrent significant improvements in the IPAQ walking score (p=.04), weekly step-counts (p=.03), and 6MWT (p=.0006) with a trend toward significant improvement in the DASI (p=.08). Conclusion: The use of MI in brief exercise counseling and phone follow-up may lead to increases in physical activity and functional status. Independent scoring and repeated review of the practice of MI over time may improve its continued use. Further testing of the intervention in a randomized trial is warranted.

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Barriers to implementing motivational interviewing in addiction treatment: A nominal group technique process evaluation

Implementation Research and Practice ◽

10.1177/26334895211018400 ◽

2021 ◽

Vol 2 ◽

pp. 263348952110184

Author(s):

Melissa R Hatch ◽

Kristine Carandang ◽

Joanna C Moullin ◽

Mark G Ehrhart ◽

Gregory A Aarons

Keyword(s):

Motivational Interviewing ◽

Process Evaluation ◽

Nominal Group Technique ◽

Implementation Strategies ◽

Implementation Process ◽

Nominal Group ◽

Management Level ◽

Implementation Program ◽

Ebp Implementation ◽

Staff Level

Background: The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods: This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders’ perceptions of each barrier’s influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results: Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion: EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness. Plain Language Summary Unforeseen barriers often arise during the course of implementation. Conducting evaluations during implementation allows for tailoring the implementation strategy. As part of a larger study using the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI), we collected data from the first cohort of LOCI clinic leaders to identify barriers to MI implementation that persisted despite advanced planning and to understand unanticipated barriers that arose during implementation. Leaders identified 15 barriers faced during the implementation process that fell into three categories: staff-level barriers, management-level barriers, and implementation program barriers. The leaders ranked time as the most influential barrier at both the staff and management levels. Staff apprehension, resistance to MI implementation, and staff turnover were also of significant concern to leaders. Future implementation efforts may benefit from conducting a similar process evaluation during the implementation phase.

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The Impact Of Psychological Characteristics On The Effectiveness Of Motivational Interviewing Based Psychological Counseling

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n15p95 ◽

2016 ◽

Vol 12 (15) ◽

pp. 95

Author(s):

Raimonda Petroliene ◽

Liuda Sinkariova ◽

Dalia Karpovaite ◽

Loreta Zajanckauskaite-Staskeviciene ◽

Jurga Misiuniene ◽

...

Keyword(s):

Alcohol Consumption ◽

Cardiac Rehabilitation ◽

Motivational Interviewing ◽

Personality Traits ◽

Emotional State ◽

Cardiac Patients ◽

Psychological Characteristics ◽

Psychological Counseling ◽

Counseling Intervention ◽

Unhealthy Behavior

It is well known that in order to control the morbidity and mortality of cardiovascular disease patients, their lifestyle should be taken into account (American Heart Association, 2012; Klumbiene et al., 2002). Studies of various disease patients’ manners (Knight et al., 2006; Thompson et al., 2011) confirm that motivational interviewing (Miller & Rollnick, 2013) is an effective method for changing unhealthy behavior. Nevertheless, our practical experience of motivational interviewing based psychological counseling with rehabilitation hospitals’ cardiac patients’ (Sinkariova et al., 2015) revealed noteworthy observations about some participants lack of motivation to change unhealthy behavior. This observation encouraged us to start a study with the aim to find out if cardiac rehabilitation participants’ personality traits and emotional state are related to the effectiveness of motivational interviewing based psychological counseling. The study used a quasi-experiment where cardiac rehabilitation patients were assigned to control (regular rehabilitation, n=55) or experimental (rehabilitation plus motivational interviewing based psychological counseling intervention, n=64) groups. A total of 119 participants (male=83, female=36, M age=60.47, SD=8.762) attended a survey, which included NEO-FFI, HADs, and “Readiness to change questionnaire” at the beginning and end of cardiac rehabilitation. Nonparametric data analysis showed that patients’ personality traits are not related to the effectiveness of motivational interviewing based counseling, whereas depression is positively related to the effectiveness of intervention to change alcohol consumption. Conclusions/Implications: Depression as an expression of emotional state is an important feature for the effectiveness of motivational interviewing based counseling to change cardiac patients’ alcohol consumption. Further understanding of relationships between psychological characteristics and the effectiveness of intervention could help to improve cardiac diseases prevention, treatment, and rehabilitation.

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Motivational interviewing competencies among UK family nurse partnership nurses: a process evaluation component of the building blocks trial

BMC Nursing ◽

10.1186/s12912-016-0176-0 ◽

2016 ◽

Vol 15 (1) ◽

Cited By ~ 4

Author(s):

Sue Channon ◽

Marie-Jet Bekkers ◽

Julia Sanders ◽

Rebecca Cannings-John ◽

Laura Robertson ◽

...

Keyword(s):

Motivational Interviewing ◽

Process Evaluation ◽

Building Blocks ◽

Family Nurse Partnership

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Effectiveness of motivational interviewing for improving physical activity self-management for adults with type 2 diabetes: A review

Chronic Illness ◽

10.1177/1742395317699449 ◽

2017 ◽

Vol 14 (1) ◽

pp. 54-68 ◽

Cited By ~ 20

Author(s):

Patricia Davern Soderlund

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Motivational Interviewing ◽

Diabetes Mellitus Type 2 ◽

Statistical Significance ◽

Health Behavior Change ◽

Diabetes Mellitus Type ◽

Self Management ◽

Counseling Intervention

Objectives This review examines the effectiveness of motivational interviewing for physical activity self-management for adults diagnosed with diabetes mellitus type 2. Motivational interviewing is a patient centered individually tailored counseling intervention that aims to elicit a patient’s own motivation for health behavior change. Review questions include (a) How have motivational interviewing methods been applied to physical activity interventions for adults with diabetes mellitus type 2? (b) What motivational interviewing approaches are associated with successful physical activity outcomes with diabetes mellitus 2? Methods Database searches used PubMed, CINAHL, and PsycINFO for the years 2000 to 2016. Criteria for inclusion was motivational interviewing used as the principal intervention in the tradition of Miller and Rollnick, measurement of physical activity, statistical significance reported for physical activity outcomes, quantitative research, and articles written in English. Results A total of nine studies met review criteria and four included motivational interviewing interventions associated with significant physical activity outcomes. Discussion Findings suggest motivational interviewing sessions should target a minimal number of self-management behaviors, be delivered by counselors proficient in motivational interviewing, and use motivational interviewing protocols with an emphasis placed either on duration or frequency of sessions.

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A motivational interviewing-based counseling intervention to increase postabortion uptake of contraception: A pilot randomized controlled trial

Patient Education and Counseling ◽

10.1016/j.pec.2016.05.011 ◽

2016 ◽

Vol 99 (10) ◽

pp. 1663-1669 ◽

Cited By ~ 16

Author(s):

Amy K. Whitaker ◽

Michael T. Quinn ◽

Elizabeth Munroe ◽

Summer L. Martins ◽

Stephanie Q. Mistretta ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Motivational Interviewing ◽

Controlled Trial ◽

Counseling Intervention ◽

Randomized Controlled ◽

Pilot Randomized Controlled Trial

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Can Motivational Interviewing Make a Difference in Supporting Employees to Deal with Elevated Blood Pressure? A Feasibility Study at the Workplace

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084179 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4179

Author(s):

Martina Michaelis ◽

Carmen Witte (née Farian) ◽

Barbara Schüle ◽

Katrin Frick ◽

Monika A. Rieger

Keyword(s):

Blood Pressure ◽

Occupational Health ◽

Arterial Hypertension ◽

Motivational Interviewing ◽

Feasibility Study ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Health Coach ◽

Counseling Intervention ◽

Health Related

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses (‘health coach’) has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the ‘health coach’ in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.

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Motivational interviewing to improve postabortion contraceptive uptake by young women: development and feasibility of a counseling intervention

Contraception ◽

10.1016/j.contraception.2015.06.015 ◽

2015 ◽

Vol 92 (4) ◽

pp. 323-329 ◽

Cited By ~ 12

Author(s):

A.K. Whitaker ◽

M.T. Quinn ◽

S.L. Martins ◽

A.N. Tomlinson ◽

E.J. Woodhams ◽

...

Keyword(s):

Motivational Interviewing ◽

Young Women ◽

Counseling Intervention ◽

Contraceptive Uptake

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Motivational interviewing with community-dwelling older adults after hip fracture (MIHip): protocol for a randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-047970 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047970

Author(s):

Nicholas F Taylor ◽

Paul D O'Halloran ◽

Jennifer J Watts ◽

Rebecca Morris ◽

Casey L Peiris ◽

...

Keyword(s):

Hip Fracture ◽

Health Service ◽

Motivational Interviewing ◽

Process Evaluation ◽

Community Dwelling ◽

Dietary Advice ◽

Control Group ◽

Related Function ◽

Randomised Controlled ◽

Experimental Group

IntroductionCommunity-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation.Methods and analysisAn assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews.Ethics and disseminationEthical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars.Trial registration numberACTRN12619000936123.

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Study Protocol Feasibility and Pilot Trial of Brief Behaviour Change Counseling Using Five as and a Guiding Style From Motivational Interviewing on Lifestyle Behaviour in Patients With Hypertension or Diabetes in Mangochi, Malawi: BBCC+5 A's+GS Quasi-experimental Study Protocol

10.21203/rs.3.rs-683402/v1 ◽

2021 ◽

Author(s):

prosper Mukobelwa Lutala ◽

Adamson Muula

Keyword(s):

Motivational Interviewing ◽

Process Evaluation ◽

Behaviour Change ◽

Study Protocol ◽

Pilot Trial ◽

Intervention Group ◽

Sub Saharan Africa ◽

Behavioural Intervention ◽

Positive Effects ◽

Quasi Experimental

Abstract BackgroundDiabetes and hypertension and their lifestyle risk factors are on the increase in sub-Saharan Africa. Despite positive effects of behavioural intervention such as brief behaviour change in some African countries, there has not been significant implementation of the same in Malawi. We therefore decided to conduct this study aimed at implementing brief behaviour change counseling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) in Mangochi with specific objectives of determining its feasibility and its efficacy.MethodsThis study is a mixed, quasi-experimental, feasibility study which comprises an exploratory 2 arms quantitative part with a qualitative component at the end of the trial. Fifty consecutive eligible participants will be recruited among patients attending two Non-Communicable Diseases (NCDs) clinics (Mangochi District Hospital and Monkey Bay Rural Hospital) and allocated equally to intervention group (receiving brief behaviour change counseling) and non-intervention (routine care only). In addition to a qualitative process evaluation at the end of the third time points, the groups will be assaessed at baseline - 12 weeks and 24 weeks’ post-implementation on the following factors: feasibility outcomes, sociodemographic factors, lifestyle factors, body mass index, waist circumference, hip to waist ratio, lipids (cholesterols, triglycerides), glycated hemoglobin, quality of life domains and theory of planned behaviour constructs’ changes and process evaluation. DiscussionIt is anticipated that the results of this pilot trial will help to determine and assess the feasibility and the provisional efficacy of this intervention, as well as key useful elements of this trial in order to develop it for further exploration in a larger trial.Registration and status of the trialTrial registration: ClinicalTrials.gov, NCT04625452, registered 12 November 2020, https://clinicaltrials.gov/ct2/show/NCT04625452, and recruitment: June 1, 2021.

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