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  • 1.
    Lindhe Söderlund, Lena
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Challenges of learning and practicing motivational interviewing2009Licentiate thesis, comprehensive summary (Other academic)
    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.

    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, p. 143-149Article 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.

    Keywords
    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, p. 442-449Article 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
  • 2.
    Lindhe Söderlund, Lena
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Motivational Interviewing in Theory and Practice2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    An estimated 50% of mortality from the 10 leading causes of death is due to behaviour. Individuals can make important contributions to their own health by adopting health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a counselling approach for behavioural change that builds on a patient empowerment perspective by supporting autonomy and self-efficacy.

    The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on general health care professionals’ learning and practice of MI. Specific aims are; study I was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies; study II was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services; study III was to evaluate the attitudes towards MI and clinical use of MI with children´s weight issues one year after child health care nurses’ participation in MI training; study IV was to systematically review studies that have evaluated the contents and outcomes of MI training for general health care professionals.

    Participants in study I were 15 community pharmacy pharmacists in Östergötland, Sweden. Participants in study II were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Data for both studies were obtained through focus group interviews. Study III, participants were 76 nurses from child health care centres in Östergötland, Sweden. 1-year after MI training they answered a survey. Study IV, the material was 10 empirical studies that have evaluated different aspects of MI training.

    MI training for general health care providers is generally of short duration and tends to focus on specific topics such as diabetes, smoking, and alcohol. The training seems to contain more training on phase I elements, such as clients’ inner motivation, than on phase II, which involves strengthening clients’ commitment to change. MI is seen as practical and useful in work with lifestyle and health promotion issues, especially with issues that may be perceived as sensitive, such as alcohol and obesity. General health care providers have positive attitudes to MI and view MI as being compatible with their values and norms about how they want to work. Clients’ resistance reactions are difficult to handle in the first stages of learning MI, and may lead to frustration. Strategies to avoid resistance are including in the final stages of learning MI. Learning and clinical use of MI for general health care providers is influenced by interactions with their environment (colleagues, staff and organization). Unlearning of old knowledge can be a problem for general health care providers in the learning and clinical use of MI.

    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, p. 143-149Article 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.

    Keywords
    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, p. 442-449Article 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
    3. Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care
    Open this publication in new window or tab >>Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care
    2010 (English)In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 69, no 4, p. 390-400Article in journal (Refereed) Published
    Abstract [en]

    Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children’s weight issues and their attitudes to MI.

    Design: Cross-sectional survey, descriptive design.

    Setting: Nurses were recruited from 33 different child healthcare centres in Östergötland, Sweden.

    Method: Seventy-six nurses who had participated in an MI training course (held in 2008) were approached one year later to answer a questionnaire by telephone. Most questions concerned the respondents’ routine use of MI in clinical practice and their attitudes towards MI as a method.

    Results: The response rate was 82 per cent. Nearly half of the nurses had changed the content and structure of their discussions regarding weight issues. Three-quarters of the nurses stated that they had sufficient time to use MI and that they had support from leadership and colleagues to use MI in their routine practice. The nurses’ attitudes to MI were positive, especially their perception that MI was consistent with their values and was better than traditional advice-giving approaches. Most MI techniques were found to be simple to use: 78 per cent found it very or quite simple to listen actively, 63 per cent believed it was very or quite simple to summarize parents’ opinions, 63 per cent found it very or quite simple to pay attention to parents’ change talk, and 60 per cent said that it was very or quite simple to ask permission before providing information.

    Conclusion: MI training can have a substantial effect on child healthcare nurses’ clinical work on paediatric weight issues.

    Place, publisher, year, edition, pages
    London, UK: Sage Publications, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60327 (URN)10.1177/0017896910373136 (DOI)000285087600004 ()
    Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2018-07-03Bibliographically approved
    4. A systematic review of motivational interviewing training for general health care practitioners
    Open this publication in new window or tab >>A systematic review of motivational interviewing training for general health care practitioners
    2011 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 16-26Article in journal (Refereed) Published
    Abstract [en]

    Objectiv: This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.

    Method: Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.

    Result: Ten studies were found. The median length of the training was 9 h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.

    Conclusion: The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.

    Practice implication: This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

    Place, publisher, year, edition, pages
    Shannon, Co. Clare Ireland: Elsevier, 2011
    Keywords
    Motivational interviewing; Education; Behaviour change; Counselling
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-60329 (URN)10.1016/j.pec.2010.06.025 (DOI)000292674000004 ()20667432 (PubMedID)
    Available from: 2010-10-11 Created: 2010-10-11 Last updated: 2018-07-03Bibliographically approved
  • 3.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Madson, Michael B.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rubak, Sune
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    A systematic review of motivational interviewing training for general health care practitioners2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 16-26Article in journal (Refereed)
    Abstract [en]

    Objectiv: This article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals.

    Method: Studies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training.

    Result: Ten studies were found. The median length of the training was 9 h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality.

    Conclusion: The generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies.

    Practice implication: This review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

  • 4.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Malmsten, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Applying motivational interviewing (MI) in counselling obese and overweight children and parents in Swedish child health care2010In: Health Education Journal, ISSN 0017-8969, E-ISSN 1748-8176, Vol. 69, no 4, p. 390-400Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children’s weight issues and their attitudes to MI.

    Design: Cross-sectional survey, descriptive design.

    Setting: Nurses were recruited from 33 different child healthcare centres in Östergötland, Sweden.

    Method: Seventy-six nurses who had participated in an MI training course (held in 2008) were approached one year later to answer a questionnaire by telephone. Most questions concerned the respondents’ routine use of MI in clinical practice and their attitudes towards MI as a method.

    Results: The response rate was 82 per cent. Nearly half of the nurses had changed the content and structure of their discussions regarding weight issues. Three-quarters of the nurses stated that they had sufficient time to use MI and that they had support from leadership and colleagues to use MI in their routine practice. The nurses’ attitudes to MI were positive, especially their perception that MI was consistent with their values and was better than traditional advice-giving approaches. Most MI techniques were found to be simple to use: 78 per cent found it very or quite simple to listen actively, 63 per cent believed it was very or quite simple to summarize parents’ opinions, 63 per cent found it very or quite simple to pay attention to parents’ change talk, and 60 per cent said that it was very or quite simple to ask permission before providing information.

    Conclusion: MI training can have a substantial effect on child healthcare nurses’ clinical work on paediatric weight issues.

  • 5.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Feasibility of using motivational interviewing in a Swedish pharmacy setting2009In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, Vol. 17, no 3, p. 143-149Article in journal (Refereed)
    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.

  • 6.
    Lindhe Söderlund, Lena
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nordqvist, Cecilia
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Angbratt, Marianne
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Applying motivational interviewing to counselling overweight and obese children2009In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, p. 442-449Article in journal (Refereed)
    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.

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