After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing?

Hall, Kate; Staiger, Petra K.; Simpson, Angela; Best, David; Lubman, Dan I.

doi:10.1111/add.13014

Cited by 113 publications

(107 citation statements)

References 49 publications

(90 reference statements)

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“…A limitation of the current review was the decision by Hall and colleagues [1] to examine 'MI Spirit' as the primary outcome of clinician practice change. This captures a clinician's overall approach to interacting with a client by balancing respect for autonomy, collaboration and evoking the client's own reasons for change [4].…”

Section: Lessons Learned About the Dissemination Of Motivational Intementioning

confidence: 97%

“…Hall and colleagues [1] are to be commended for their important effort to evaluate the extent to which dissemination efforts of motivational interviewing (MI) have led to meaningful change in practice efforts among substance abuse clinicians who have received training. While MI has undoubtedly increased in popularity since its introduction, and the knowledge base surroundings its mechanisms of action is expanding [2,3], less is known about how well training efforts have translated into clinical practice change.…”

Section: Lessons Learned About the Dissemination Of Motivational Intementioning

confidence: 99%

“…Hall et al question the extent to which sustained practice change in motivational interviewing (MI) has been achieved and highlight the need for cost-benefit analyses of implementation efforts [1]. These are important questions, with clear parallels for the implementation of evidence-based treatments in many settings.…”

Section: Integrating MI Into Services: Challenges and Opportunitiesmentioning

confidence: 99%

See 2 more Smart Citations

Lessons learned about the dissemination of motivational interviewing

Apodaca

2016

Addiction

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Section: Lessons Learned About the Dissemination Of Motivational Intementioning

confidence: 97%

Section: Lessons Learned About the Dissemination Of Motivational Intementioning

confidence: 99%

Section: Integrating MI Into Services: Challenges and Opportunitiesmentioning

confidence: 99%

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Lessons learned about the dissemination of motivational interviewing

Apodaca

2016

Addiction

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“…As a result, effective training in MI should be a key concern for service providers and agencies in this domain, to achieve cost-effective use of training dollars and to maximize treatment outcomes. Unfortunately, the paper by Hall and colleagues [2] provides an important series of cautionary tales. Its most direct caution is that while most researchers who conduct training in MI assess the effectiveness of that training (15 of 20 studies in their review), the proficiency of trainees is assessed less commonly.…”

Section: Cautionary Tales Regarding the Dissemination Of Motivationalmentioning

confidence: 99%

Cautionary tales regarding the dissemination of motivational interviewing

Dobson

2016

Addiction

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drinking status, peer motivational interviewing microskills, and drinking outcomes in a brief alcohol intervention for matriculating college students: a replication. CAUTIONARY TALES REGARDING THE DISSEMINATION OF MOTIVATIONAL INTERVIEWINGThere is important work to be conducted to identify key elements of proficiency in motivational interviewing that are relevant to its goals, to develop appropriate assessment tools and to find effective ways of training practitioners to achieve a minimum standard of proficiency measured using these tools.Motivational interviewing (MI) has a strong claim as an evidence-based intervention for substance use [1]. As a result, effective training in MI should be a key concern for service providers and agencies in this domain, to achieve cost-effective use of training dollars and to maximize treatment outcomes. Unfortunately, the paper by Hall and colleagues [2] provides an important series of cautionary tales. Its most direct caution is that while most researchers who conduct training in MI assess the effectiveness of that training (15 of 20 studies in their review), the proficiency of trainees is assessed less commonly. The second major caution is that when a threshold is set for trainees to achieve beginning proficiency (75% in the Hall et al. paper), only a small proportion (two of 20 studies) can document such a training effect. The challenges embedded in these cautions are manifold. Is it that the training formats employed in most trials are inadequate, as Hall and colleagues suggest, and that more elaborate, time-consuming and expensive training protocols are needed to attain proficiency? Are the conceptualization and measurement of proficiency themselves at issue, given the various measures that exist, their relative emphasis in adherence to MI-consistent behaviours versus ratings of perceived competency, and the discrepancies in proficiency observed across measures? Or is there perhaps a practical limit on the percentage of trainees who can attain proficiency in MI? For example, in the most elaborate training method in their study (a combination of workshop, feedback and coaching), Miller et al. [3] were only able to attain a beginning proficiency level for 70% of trainees. Perhaps this level represents the asymptote of training outcomes and, if so, then perhaps there needs to be a focus in MI work on the evaluation of trainees and the 'licensing' or approval of only those who can attain a standard of proficiency that allows them to provide services.The above questions require a series of conceptual and pragmatic studies to consider how best to consider proficiency in MI, and then how to maximally train that proficiency. Trainers in other research areas sometimes discuss the issue of fidelity [4], which is a complex construct that involves both adherence to an identified treatment method (and non-adherence to conceptually incompatible models or methods), as well as the competence to apply the correct method at the correct time with an appropriate client. While adherence can...

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“…This is unsurprising, as FIs would not be expected to promote autonomy [11,12] Lastly, we would suggest that the intervention approach used is far from fair. The most socially deprived citizens deserve better living conditions, an intervention which we think works [13] We believe that motivational interviewing is a cornerstone for treating chronic conditions and addicted individuals [14] yet the improvement of health-care providers' skills remains a major issue [15].…”

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confidence: 99%

Choosing between financial incentives to patients or teaching practitioners basic pharmacology and motivational interviewing

Braillon

Bewley

2016

Addiction

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The journal publishes both invited and unsolicited letters. CHOOSING BETWEEN FINANCIAL INCENTIVES TO PATIENTS OR TEACHING PRACTITIONERS BASIC PHARMACOLOGY AND MOTIVATIONAL INTERVIEWINGIn their recent study on financial incentives (FI) to promote smoking cessation among economically deprived pregnant women, Boyd et al. conclude that these are 'are highly cost-effective'. We argue that this is questionable when extrapolating short-term cessation to life-time analysis [1].We believe that the original Phase II randomized controlled trial had several limitations:• The control group had a higher Fagerström score for all items [2].• FIs improve retention rates and patients might be more circumspect with the truth. False reporting of smoking status may be low when both saliva and urine cotinine are monitored systematically [3] but is more likely in this study [1] which used self-report or exhaled carbon monoxide before giving participants £400. In the FI group, 30 were never contactable for validation versus 23 controls; among 18 tested during routine care and considered as quitters (self-report), four had blood cotinine levels indicating that they were smoking [2].• The authors considered that patients who were lost to follow-up had continued to smoke. This will overestimate positive results, as any lost controls who had quit smoking would have had no reward from reporting. These limitations may explain why, despite a seemingly 2.5-fold increase in cessation rate in the FI group, the relative risk of premature birth was non-significantly higher than in controls and babies' birth weight was not significantly different [2].Additionally, we would argue that the treatment was inadequate:• Both groups only received a single form of nicotine replacement therapy (NRT), at an inadequate dose (16 mg/24 h). Smoking cessation rates in pregnant women are reported as 16% without medication and 36% with a combination of various forms of NRT. A single form of NRT at 16 mg/24 h alone has shown no benefit [4,5]. Combining patches with faster-acting forms of NRT (a 'belt-and-braces' strategy) works substantially better than patches alone in all populations [6]. As pregnancy increases nicotine metabolism, remembering the basic pharmacological principle of dose-response effect is crucial [7,8].• Telephone calls can hardly replace face-to-face visits for psychological therapy, particularly in the deprived.We further consider that the Markov design to extrapolate short-term to life-time cessation is inadequate [1]. While FIs appear to increase attempts to quit and shortterm treatment use, smoking cessation rates show only small absolute increases at best. Long-term quit rates are not improved [9,10]. This is unsurprising, as FIs would not be expected to promote autonomy [11,12] Lastly, we would suggest that the intervention approach used is far from fair. The most socially deprived citizens deserve better living conditions, an intervention which we think works [13] We believe that motivational interviewing is a cornerstone for treating chro...

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After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing?

Cited by 113 publications

References 49 publications

Lessons learned about the dissemination of motivational interviewing

Lessons learned about the dissemination of motivational interviewing

Cautionary tales regarding the dissemination of motivational interviewing

Choosing between financial incentives to patients or teaching practitioners basic pharmacology and motivational interviewing

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