Implementation of motivational interviewing in the general practice setting: a qualitative study

Abstract

Background General Practitioners (GPs) and Practice Nurses (PNs) collaboratively play an important role in preventing and monitoring chronic diseases. They are trained in Motivational Interviewing (MI), which is a communication style to intrinsically motivate patients to a healthier lifestyle. However, being trained in MI skills does not necessarily mean that it is implemented in daily practice so patients actually benefit. The aim of this study is to identify factors that facilitate or impede the implementation of MI in General Practice. Methods A total of 152 participants (93 GP-trainees and 59 PN-trainees) who were trained in MI completed a questionnaire regarding the implementation of MI. Semi-structured interviews (N = 17) were conducted with GPs and PNs (ranging from almost graduated to highly experienced) who were selected through the process of maximum variation sampling. The interview guide was based on the five-stage implementation model of Grol and Wensing. Results Thirteen factors that influence the implementation of MI in General Practice were identified. They can be allocated to three categories: (1) setting factors such as time, (2) GP/PN factors such as self-efficacy, and (3) patient factors such as cultural background. Conclusions Overall, GPs and PNs considered MI to be useful and part of their professional responsibility. Most difficulties become apparent in stage 4 (change: applying MI skills in practice) and 5 (consolidation: integrating MI into daily routine and embedment in organisation) of Grol and Wensing’s model. Therefore, it is important that training does not only focus on MI skills. It is essential to pay explicit attention to the factors that impact implementation, as well as the appropriate tools to tackle the barriers. These insights can help trainers to effectively support GPs and PNs to apply and maintain their MI skills in daily practice.

Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study

“…Children are almost 10 times more likely to receive the HPV vaccine if their parents receive a strong recommendation [ 15 ]. Motivational interviewing to guide conversations with vaccine-hesitant parents during a clinic visit has also been impactful [ 16 ]. This is critical because one-quarter of parents report secondary acceptance (ie, a parent who declines the HPV vaccine and later accepts it) after learning about the vaccine and the diseases it prevents [ 17 ].…”

“…Nevertheless, providers often have difficulty conversing with vaccine-hesitant parents and patients, and time constraints limit clinic visit discussion or communication training participation. Some providers also have low self-efficacy and limited skills to discuss the vaccine [ 16 , 18 - 21 ]. Therefore, many do not provide a recommendation and communication or give a poor-quality recommendation and communication [ 15 ].…”

Motivational counseling in the prevention of the development and progression of cardiovascular diseases

“…Наибольшие сложности возникали на этапах применения навыков МК непосредственно в практической деятельности и интеграции МК в рутинный регламент деятельности медицинской организации, в связи с чем исследователи делают вывод, что помимо обучения медицинских специалистов непосредственно технологии и навыкам МК крайне важно уделять внимание факторам, влияющим на внедрение данных навыков в повсе дневную практику (выделение достаточного количества времени на консультирование, необходимость совмещать МК с другими задачами, например, с медицинским осмотром или сбором анамнеза, в условиях ограниченного времени, сложность поддержания континуума и организации повторных консультаций, например, для врачей стационара, разный уровень понимания пациентов и др.) [40].…”

Acceptability of Mobile App–Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study

“…With the growing adoption and penetration of smartphones, automated MI techniques powered by artificial intelligence (AI) on mobile devices may offer effective motivational support to patients, complementing the traditional model of in-person counseling. In addition, the delivery of MI using AI could allow more sustainable scaling up and implementation of MI in clinical practice [ 20 ]. However, there is little evidence supporting the use of mobile app–based MI in improving health outcomes of patients with T2DM.…”