Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis

Abstract

BackgroundResearch indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS).MethodsMotivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction.ResultsMotivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed.ConclusionsConversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.

Beyond the consultation room: Proposals to approach health promotion in primary care according to health‐care users, key community informants and primary care centre workers

“…The health‐care users of this study convey the difficulties of translating theory into practice with regard to behavioural change. In relation to HP intervention, health‐care users claim a holistic approach based on their characteristics and needs, and not only focused on health problems . Moreover, the person‐centred approach model implies that the person is an active agent of her changes and her life and that the role of the professional is not managerial but based on unconditional acceptance, empathy and authenticity .…”

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

“…At odds with the ideal of increased patient participation, the heavy workload of nurses, notably, can lead to bureaucratic interactions, (Jones, 2007), even when guidelines meant to increase patient participation are in place (Codern-Bové et al, 2014). There is a distribution of labor where most topics are initiated by nurses, and answers are provided by patients (Jones, 2007;Leydon et al, 2013).…”

Prevalência de estratégias para cessação do uso do tabaco na Atenção Primária à Saúde: uma revisão integrativa

“…Categorização temática individual a partir da análise dos 111 artigos selecionados das bases de dados LILACS, Web of Science e MEDLINE em setembro de 2015 e organizados conforme a prevalência do tipo de estratégia utilizada na APS para a cessação do tabaco. Elaborado pela autora, 2015. rir, pois, equipes bem preparadas e treinadas na linha de frente de seus atendimentos para tornar a prevenção clínica efetiva tanto em nível prático (recursos e qualificação profissional) quanto em nível do sistema de saúde (financiamento para cuidados clínicos preventivos desde a medicação até o apoio de pessoal) 20,[23][24][25] .…”

“…Finalmente, a incorporação de diferentes formas de expressão durante a Entrevista Motivacional ajuda a construir relacionamentos de cuidados de saúde centrados no doente, oferecendolhe oportunidade para refletir sobre o consumo de tabaco e favorecendo indivíduos com baixa motivação para a mudança. Ainda, os dados obtidos podem ser incluídos na formação profissional visando melhorar a qualidade da abordagem, além do registro eletrônico de saúde aprimorar o feedback sobre cada atendimento gerando informações em saúde 24,[69][70][71][72][73] .…”