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Embedding and sustaining motivational interviewing in clinical environments: a concurrent iterative mixed methods

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  • 1College of Medicine and Public Health, Flinders University, Bedford Park, Australia. d.lim@flinders.edu.au.

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Summary

This study explores embedding and sustaining motivational interviewing (MI) in clinical practice. Findings highlight strategies at micro, meso, and macro levels for effective health behavior change interventions.

Keywords:
BarriersFidelityHealth educationImplementationMotivational interviewing; lifestyle counselling; health behaviour changeSystems analysis

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Area of Science:

  • Healthcare delivery
  • Behavioral science
  • Health services research

Background:

  • Motivational interviewing (MI) is an effective intervention for health behavior change.
  • Implementation and maintenance of MI in routine clinical practice remain unclear.
  • This study aims to understand MI's embedding and sustainability in clinical and learning environments.

Purpose of the Study:

  • To identify barriers and enablers for embedding and sustaining MI in healthcare.
  • To understand how MI is embedded and fidelity is sustained in clinical settings.
  • To explore the role of clinical educators in sustaining MI.

Main Methods:

  • Utilized a concurrent iterative mixed-methods approach.
  • Conducted a scoping review of 11 studies on MI barriers and enablers.
  • Surveyed 30 health professionals at an international workshop, integrating data using a 'following a thread' approach.

Main Results:

  • Micro-level sustainability strategies include technology, patient-centered care, personnel development, and process improvement.
  • Meso-level strategies involve shared vision, opportunities, and a supportive organizational culture for continuous learning.
  • Macro-level sustainability requires systems thinking and a learning organization approach.

Conclusions:

  • Addressing barriers to MI implementation requires a systemic approach.
  • Clinical educators can act as change agents to embed and sustain MI.
  • Strategies for sustainability exist at multiple levels of the healthcare system.