Barriers to Implementing Motivational Interviewing in Addiction Treatment: A Nominal Group Technique Process...

Area of Science:

• Implementation Science
• Behavioral Health Services Research
• Organizational Psychology

Background:

• Successful implementation of evidence-based practices (EBPs) demands adaptive strategies and continuous process evaluation.
• Predicting all barriers to EBP implementation and sustainment is challenging, necessitating ongoing assessment.
• This article details a process evaluation identifying emergent and persistent barriers during EBP implementation in behavioral health settings.

Purpose of the Study:

• To describe a process evaluation identifying emergent and persistent barriers impacting EBP implementation.
• To categorize and rank barriers to EBP implementation from the perspectives of clinic leaders.
• To contextualize identified barriers through qualitative interviews and suggest adaptations.

Main Methods:

• A modified nominal group technique (NGT) was employed with clinic leaders during a cluster randomized controlled trial.
• Barriers to implementing motivational interviewing (MI) in substance use disorder treatment agencies were identified, categorized, ranked, and rated.
• Qualitative interviews were conducted to contextualize barriers and inform potential adaptations.

Main Results:

• Fifteen barriers were identified across staff, management, and implementation program levels.
• Key staff-level barriers included time constraints and resistance to MI; management barriers included time, turnover, and contractual constraints.
• Client apprehension regarding recording for fidelity assessment was the most influential implementation program barrier.

Conclusions:

• EBP implementation is dynamic, requiring proactive and strategic tailoring of strategies to address emergent barriers.
• The process evaluation identified 15 significant barriers related to staff, management, and the implementation program.
• Tailorable and adaptable implementation strategies are critical for achieving effective EBP implementation.