Within-Provider Variability in Motivational Interviewing Integrity for Three Years after MI Training: Does Time Heal?

Area of Science:

• Behavioral Psychology
• Clinical Psychology
• Healthcare Quality Improvement

Background:

• Motivational Interviewing (MI) is a key intervention for behavior change.
• Ensuring consistent delivery of MI is crucial for its effectiveness.
• Variability in therapist skills can impact treatment outcomes.

Purpose of the Study:

• To assess the variability in Motivational Interviewing Treatment Integrity (MITI) among providers over three years post-training.
• To determine the extent of within-provider versus between-provider variation in MI fidelity.
• To examine changes in MI integrity over time.

Main Methods:

• Analysis of audio-recorded sessions from 15 providers in an effectiveness trial.
• Coding of MI integrity using the Motivational Interviewing Treatment Integrity (MITI) 3.1.1 rating system.
• Examination of both behavior count scores and global MI Spirit scores.

Main Results:

• Significant within-provider variability in MI integrity was observed, particularly for specific MI behaviors (e.g., open questions, complex reflections).
• Global scores for MI Spirit and Empathy also showed substantial within-provider variation.
• Within-provider variability was generally larger than between-provider variability, with no significant improvement over time.

Conclusions:

• Findings indicate substantial inconsistencies in MI delivery, even among trained providers.
• Concerns exist regarding the quality and fidelity of MI in large-scale implementations.
• Improved monitoring and enhanced training strategies are necessary to ensure higher quality MI.