The persistent theory-practice gap shows how challenging it can be for healthcare professionals to keep updating their practices. The continuing education challenges are partly explained by the tremendous stream of new discoveries in health and the epidemic of multi-morbid conditions. Participatory action research (PAR) is used in healthcare as a research approach that capitalizes on people's resources to better understand and enhance their professional practices. PAR thus can consolidate our knowledge on workplace learning in continuing interprofessional education while directly improving quality of care. However, PAR lacks clear scientific criteria to ensure the consistency between the investigators' methodology and philosophy, which jeopardize its credibility. This paper outlines the principles of rigour in PAR and describes the additions of a preliminary planning phase to Kemmis and McTaggart's PAR description as well as the use of the professional co-development group, an action-oriented data collection method. We believe that this will help PAR co-participants achieve improved scientific rigour and encourage more investigators to collaborate through this research approach contributing to the advancement of knowledge on workplace learning in continuing interprofessional education.
Motivational interviewing is an evidence-based counseling approach. However, its learning processes and their influencing factors are understudied, failing to address the suboptimal use of motivational interviewing in clinical practice. A participatory action research was conducted in collaboration with 16 primary care clinicians, who encountered similar challenges through their previous counseling approaches. The study aimed to facilitate and describe the clinicians’ professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI). Data were collected using the principal investigator’s research journal and participant observation of four independent ICP-MIs (76 h) followed by focus groups (8 h). The co-participants performed inductive qualitative data analysis. Results report that learning motivational interviewing requires a paradigm shift from health experts to health guides. The learning processes were initiated by the creation of an openness to the MI spirit and rapidly evolved into iterative processes of MI spirit embodiment and MI skill building. The intrinsic influencing factors involved the clinician’s personal traits and professional background; the extrinsic influencing factor was the shared culture disseminating the expert care model. Previously described in a fragmented manner, motivational interviewing learning processes, and its influencing factors were presented as integrated findings. Considerations in elaborating effective MI training/implementation programs are discussed for clinicians, trainers, and decision-makers. Future areas of investigation are also highlighted calling forth the research community to contribute to knowledge advancement on health education in primary care.
BackgroundMotivational Interviewing (MI) is a humanistic and evidence-based counseling approach within primary care. However, MI rarely translates to clinical practice that follows the usual introductory training programs; a lack of evidence regarding its implementation persists today. A participatory action research was conducted to (1) facilitate and describe the clinicians’ professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI), and (2) explore the contribution of ICP-MI in transforming their daily practices. This article addresses the first objective. MethodsData collection involved the principal investigator’s research journal, participant observation of four ICP-MIs (76 hours, 16 clinicians), and four appraisal focus groups. A general inductive approach was used for qualitative data analysis. ResultsFindings describe the four processes of MI implementation in primary care as motivational endeavors: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent with respect to MI implementation, taking into consideration the significant challenges involved. After introspecting previous practices, they realized the limits of their clinician-centered counseling approach, which consolidated their engagement in ICP-MI. Thus, the experimentation of MI implementation initiatives in the workplace followed and enabled clinicians to witness the feasibility and effectiveness of MI. Finally, the clinicians were intrinsically mobilized to ensure MI sustainability in their practices. Two categories of influencing factors were reported. Intrinsic factors included personal traits, and perception about MI as a clinical priority. Extrinsic factors related to organizational support that was crucial in providing the appropriate resources and supporting the clinicians’ implementation efforts. Results are discussed according to the Consolidated Framework for Implementation Research (CFIR).ConclusionsAs described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented in our study as integrated findings; we also suggest innovative avenues for future research projects. Considerations in elaborating effective training programs are highlighted, especially when it comes to providing motivational and organizational support to succeed at MI implementation within primary care.
Introduction Motivational interviewing (MI) is an evidence-based counseling approach within primary care. However, MI rarely translates to practice following introductory training programs, and a lack of evidence regarding its implementation persists today. This study describes primary care clinicians’ professional transformation in implementing MI through interprofessional communities of practice (ICP-MI). Method Qualitative data collection involved the research journal, participant observation of four ICP-MIs (76 hours/16 clinicians), and focus groups. A general inductive approach was used for data analysis. Results were conceptualized based on the Consolidated Framework for Implementation Research. Results Four processes of MI implementation in primary care are presented as a motivational endeavor: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent, taking into consideration the significant challenges involved. After introspecting actual practices, they realized the limits of their previous clinician-centered approaches. The experimentation of MI in the workplace followed and enabled clinicians to witness MI feasibility and its added value. Finally, they were mobilized to ensure MI sustainability in their practices/organization. Intrinsic factors of influence included the clinicians’ personal traits and their perception about MI as a clinical priority. Organizational support was also a crucial extrinsic factor in encouraging the clinicians’ efforts. Conclusion As described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented as integrated findings. Incorporating engaging educational activities to provide clinicians with motivational support and collaborating with health care organizations to plan appropriate resources should be considered in the development of MI implementation programs from the onset.
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