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Challenges of learning and practicing motivational interviewing
Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. (LIR-gruppen)
2009 (English)Licentiate thesis, comprehensive summary (Other academic)Alternative title
Motiverande samtal – en metod för att påverka barns övervikt och fetma? (Swedish)
Abstract [en]

Background: The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.

Aims: The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.

Methods: Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.

Results: In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.

Conclusions: Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 70 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 93
Keyword [en]
Children, counselling, health promotion, motivational interviewing, nurse, overweight, pharmacist
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:liu:diva-17351ISBN: 978-91-7393-708-5 (print)OAI: oai:DiVA.org:liu-17351DiVA: diva2:208755
Presentation
2009-03-31, Aulan, Hälsans Hus (ingång 16), Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-14 Created: 2009-03-19 Last updated: 2009-04-29Bibliographically approved
List of papers
1. Feasibility of using motivational interviewing in a Swedish pharmacy setting
Open this publication in new window or tab >>Feasibility of using motivational interviewing in a Swedish pharmacy setting
2009 (English)In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, 143-149 p.Article in journal (Refereed) Published
Abstract [en]

Aims: Motivational interviewing (MI) is widely established as an effective counselling approach for many lifestyle issues, but is largely untested in pharmacy settings. The aim of this study was to identify factors that impact on the feasibility of using MI with pharmacy clients in routine community pharmacy work in Sweden.

Methods: Interviews were conducted with 15 pharmacists at two pharmacies after they had participated in a manualbased MI skills training and used MI with clients for 6 months. The pharmacists were offered hands-on training from “pilot pharmacists” who had received more MI training and were involved in assembling the manual that adapted MI for use in pharmacies. Three focus groups with the pharmacists and five individual interviews with pharmacists in leading positions were conducted. Data were interpreted from a phenomenological perspective.

Results/conclusions: Pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. Pharmacists experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations. The opportunity to decide on appropriate clients and/or health-related behaviours for counselling was an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. The organizational context in which MI was applied affected the pharmacists’ attitudes to using MI.

Keyword
Counselling; Health promotion; Pharmacist
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-17314 (URN)10.1211/ijpp/17.03.0004 (DOI)
Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved
2. Applying motivational interviewing to counselling overweight and obese children
Open this publication in new window or tab >>Applying motivational interviewing to counselling overweight and obese children
2009 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, 442-449 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-17312 (URN)10.1093/her/cyn039 (DOI)
Available from: 2009-03-19 Created: 2009-03-17 Last updated: 2017-12-13Bibliographically approved

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Lindhe Söderlund, Lena

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