Assessing motivational interviewing integrity in the Toddler Oral Health Intervention study

Area of Science:

• Public Health
• Behavioral Science
• Pediatric Dentistry

Background:

• The Toddler Oral Health Intervention (TOHI) program was established in 2017 to enhance preventive oral health practices for young children (6-48 months) through well-baby clinics.
• Motivational interviewing (MI) is a key component of the TOHI intervention, aiming to support parents in adopting positive oral health behaviors.

Purpose of the Study:

• To evaluate the fidelity and integrity of motivational interviewing (MI) delivery by oral health coaches (OHCs) within the TOHI study.
• To assess the quality of MI based on technical and relational components and adherence to MI principles.

Main Methods:

• The study analyzed audio recordings of 11 OHCs' counseling sessions from nine well-baby clinics in the Netherlands.
• MI integrity was assessed by an independent coder using the MITI 4.2.1 scale, evaluating technical and relational elements.
• Data analysis included descriptive statistics, frequencies, percentages, median scores, and interquartile ranges to quantify MI skills and adherence.

Main Results:

• Median ratings for technical and relational MI components were 2.5 and 3.5 (out of 5), with 45% and 58% of recordings deemed fair or good, respectively.
• The median percentage of complex reflections was 38%, and the reflection-to-question ratio was 0.7; 47% and 24% of recordings showed fair or good integrity for these metrics.
• MI-adherent statements were more frequent (median 3.0) than non-adherent statements (median 0.0), but integrity varied significantly among OHCs.

Conclusions:

• Despite comprehensive training, not all OHCs in the TOHI study achieved satisfactory levels of MI integrity.
• Sustained training, reflective practice, and ongoing support are essential for OHCs to consistently deliver high-quality MI in pediatric oral health interventions.