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Fortune J1, Breckon J2, Eva G1, Frater T1, Norris M1
1Brunel University, Department of Clinical Sciences, London, United Kingdom, 2Sheffield Hallam University, Advanced Wellbeing Research Centre, Sheffield, United Kingdom
Background: A core competency of physiotherapy (PT) and occupational therapy (OT) practice involves helping persons adopt positive health behaviours. Motivational Interviewing (MI) is an evidence-based, patient-centred communication approach which is emerging in health care as a viable strategy to elicit health behaviour change and promote treatment programme adherence. While increasingly adopted by practitioners, it has rarely been considered in undergraduate education.
Purpose: The purpose of this quasi-experimental study was to examine the effectiveness of a three-day training workshop on knowledge, confidence and competence in MI delivery in an undergraduate occupational therapy and physiotherapy student cohort (n=25).
Methods: Training outcomes were assessed pre-training, immediately post-training and following a subsequent clinical placement. The Motivational Interviewing Knowledge and Attitudes Test (MIKAT) and an 8-item survey assessed knowledge, attitudes and confidence respectively. In order to assess treatment fidelity, student competence in MI was evaluated by an audio-recorded simulated patient interview rated with the Motivational Interviewing Treatment Integrity scale (MITI) by an independent, qualified assessor. The MITI assesses 4 global criteria (partnership, empathy, cultivating change talk and softening sustain talk) as well as behavioural counts of MI adherent language. Differences were analysed using one-way repeated measures ANOVA. Student perceptions of the training were collected from two focus groups and coded through thematic analyses.
Results: Self-report measurements indicated increased confidence but no effect on knowledge or attitude as a result of training (p>0.05). Analysis of the MITI showed superior performance post-training as demonstrated by higher mean scores in all four global criteria and increased frequency of MI adherent behaviours (e.g. open questions, simple reflections, complex reflections and seeking collaboration) and a decrease in non-adherent behaviours (e.g. unsolicited advice giving, closed questions and arguing for change) (p 0.05). Positive changes were maintained following a subsequent clinical placement. MITI summary scores indicated an improvement in relational and technical scores. Question to reflection ratio increased in line with beginner competency. Proficiency thresholds were not met for any other measure. Themes identified from the focus groups include the benefit of client-centred communication, the importance of experiential learning, and structural barriers to implementation in clinical practice. Lastly, students provided suggestions for training improvement.
Conclusion(s): Participation in a three-day MI training programme significantly improved student confidence and MI skilfulness. Overall the students valued the training at multiple levels, but found difficulty navigating barriers to implement during practice placements.
Implications: This study highlights the educational benefits of MI training for allied health professional students. Where feasible, context specific MI training should be considered and embedded within the curriculum for allied health education. Further research is needed elucidate the best practices to incorporate teaching this skill set within the curriculum in order to best prepare students to counsel clients in behaviour change in their applied settings.
Keywords: Motivational interviewing, education, behaviour change
Funding acknowledgements: Funding for this study was provided by a grant from Health Education England North West London (HEE NWL).
Purpose: The purpose of this quasi-experimental study was to examine the effectiveness of a three-day training workshop on knowledge, confidence and competence in MI delivery in an undergraduate occupational therapy and physiotherapy student cohort (n=25).
Methods: Training outcomes were assessed pre-training, immediately post-training and following a subsequent clinical placement. The Motivational Interviewing Knowledge and Attitudes Test (MIKAT) and an 8-item survey assessed knowledge, attitudes and confidence respectively. In order to assess treatment fidelity, student competence in MI was evaluated by an audio-recorded simulated patient interview rated with the Motivational Interviewing Treatment Integrity scale (MITI) by an independent, qualified assessor. The MITI assesses 4 global criteria (partnership, empathy, cultivating change talk and softening sustain talk) as well as behavioural counts of MI adherent language. Differences were analysed using one-way repeated measures ANOVA. Student perceptions of the training were collected from two focus groups and coded through thematic analyses.
Results: Self-report measurements indicated increased confidence but no effect on knowledge or attitude as a result of training (p>0.05). Analysis of the MITI showed superior performance post-training as demonstrated by higher mean scores in all four global criteria and increased frequency of MI adherent behaviours (e.g. open questions, simple reflections, complex reflections and seeking collaboration) and a decrease in non-adherent behaviours (e.g. unsolicited advice giving, closed questions and arguing for change) (p 0.05). Positive changes were maintained following a subsequent clinical placement. MITI summary scores indicated an improvement in relational and technical scores. Question to reflection ratio increased in line with beginner competency. Proficiency thresholds were not met for any other measure. Themes identified from the focus groups include the benefit of client-centred communication, the importance of experiential learning, and structural barriers to implementation in clinical practice. Lastly, students provided suggestions for training improvement.
Conclusion(s): Participation in a three-day MI training programme significantly improved student confidence and MI skilfulness. Overall the students valued the training at multiple levels, but found difficulty navigating barriers to implement during practice placements.
Implications: This study highlights the educational benefits of MI training for allied health professional students. Where feasible, context specific MI training should be considered and embedded within the curriculum for allied health education. Further research is needed elucidate the best practices to incorporate teaching this skill set within the curriculum in order to best prepare students to counsel clients in behaviour change in their applied settings.
Keywords: Motivational interviewing, education, behaviour change
Funding acknowledgements: Funding for this study was provided by a grant from Health Education England North West London (HEE NWL).
Topic: Education; Education: methods of teaching & learning; Education: continuing professional development
Ethics approval required: Yes
Institution: Brunel University
Ethics committee: Clinical Sciences, College of Health and Life Sciences ResearchandEthics Committee
Ethics number: 3701-A-May/2017- 7222-1
All authors, affiliations and abstracts have been published as submitted.
