Date Presented 4/1/2017
Motivational interviewing is a useful tool to promote partnership skills in occupational therapy practice. This presentation introduces a motivational interviewing curriculum for occupational therapy practitioners working in physical disability settings and describes results of the evaluation.
Primary Author and Speaker: Maureen Gecht-Silver
Additional Authors and Speakers: Elizabeth Peterson, Joy Hammel
PURPOSE: The Patient Protection and Affordable Care Act of 2010 advocates for self-management of the increasing number of adults with chronic health conditions (Fisher & Friesema, 2013). Self-management involves preparing people with chronic conditions or disabilities to actively partner with health care providers to manage chronic illness (Lorig, Holman, & Sobel, 2012). There is increased demand for occupational therapists (OTs) to use a self-management approach, but training in partnership approaches was not found in the literature. A motivational interviewing (MI) curriculum was developed to make evidence-based self-management support and MI strategies (e.g., reflective listening, evoking change talk, information exchange skills, and action plans; Miller & Rollnick, 2012) relevant and usable to OTs working in physical disabilities.
METHOD: This pilot study used mixed methods with a pretest and posttest design. OTs working in physical disability settings were recruited through electronically distributed flyers. Twelve OTs completed the curriculum delivered in a full-day and a half-day session 1 wk apart. Pretest–posttest quantitative measures included a 12-item knowledge questionnaire, an attitude self-assessment questionnaire rating self-efficacy and importance of 10 specific behavioral statements, and the Video Assessment of Simulated Encounters–Revised, a video-based validated 18-item instrument to assess skill in MI (Rosengren, Hartzler, Baer, Wells, & Dunn, 2008). The two qualitative measures, (1) reflection on use of strategies in practice and (2) course evaluation, assessed the content, facilitator, educational effectiveness, strengths, and suggestions to improve the program.
Pre–post data were analyzed using paired t tests calculated using a two-tailed method with a significance level set at p < .05. Cohen’s d was used to quantify the difference between two groups and show relative effect sizes. Qualitative discrete data on course evaluation and self-reflection on practice was tallied with frequency counts. Open-ended questions were coded by thematic analysis.
RESULTS: Results demonstrate significant positive changes (p < .05) in knowledge, importance, and self-efficacy ratings of MI-relevant behaviors and MI skills. Collectively, all approaches and strategies taught were tried in practice settings by study participants during the week between sessions. Thematic analysis indicated an increase in collaboration with clients and mutual respect and trust, a decrease in OTs’ confrontation or arguments with clients, more productive treatment sessions, and desire to practice with multiple clients. OTs expressed high satisfaction with program content and found it relevant and easy to use. Education effectiveness was rated very high.
CONCLUSION: Although large-scale, controlled studies are needed to demonstrate the effectiveness of this curriculum, these pilot study findings illustrate the curriculum’s potential to impact knowledge, attitudes, motivational interviewing skills, and practice behaviors of OTs working in physical disability practice settings. This curriculum offers a feasible approach to teach specific strategies to promote occupational therapists’ transition from a traditional to a partnership approach in patient care. These strategies and approaches promote client activation and client identification of health behaviors to prevent and manage chronic health conditions. The motivational interviewing curriculum offers a potential means to promote use of a self-management approach among occupational therapists.
References
Fisher, G., & Friesema, J. (2013). Health Policy Perspectives—Implications of the Affordable Care Act for occupational therapy practitioners providing services to Medicare recipients. American Journal of Occupational Therapy, 67, 502–506. http://dx.doi.org/10.5014/ajot.2013.675002
Lorig, K., Holman, H., & Sobel, D. (2012). Living a healthy life with chronic conditions: Self-management of heart disease, arthritis, diabetes, depression, asthma, bronchitis, emphysema and other physical and mental health conditions. Boulder, CO: Bull Publishing.
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change. New York: Guilford Press.
Patient Protection and Affordable Care Act, Pub. L. 111–148, 42 U.S.C. §§ 18001–18121 (2010).
Rosengren, D. B., Hartzler, B., Baer, J. S., Wells, E. A., & Dunn, C. W. (2008). The Video Assessment of Simulated Encounters–Revised (VASE–R): Reliability and validity of a revised measure of motivational interviewing skills. Drug and Alcohol Dependence, 97, 130–138. https://doi.org/10.1016/j.drugalcdep.2008.03.018
