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Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care

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Abstract

We conducted a randomized trial comparing the effect of two different levels of motivational interviewing training on clinician communication behaviors and patient experiences. We enrolled 12 HIV clinicians who attended a one-day MI workshop focusing on behavior change counseling skills. We then randomized clinicians to receive (or not) 3–5 rounds of personalized feedback from the MI trainer. We compared outcomes before and after the interventions and between the intervention groups. We tested time-by-study arm interactions to determine if one group improved more than the other. For all analyses, we used generalized estimating equations to account for clustering of patients within clinicians, with Gaussian or negative binomial distributions as appropriate. Patients of clinicians in both intervention groups rated their visits as more MI consistent (6.86 vs. 6.65, p = 0.005) and audio-recording analysis revealed that visits were more patient-centered (1.34 vs. 0.96, p = 0.003) with a more positive patient affect (22.36 vs. 20.84, p < 0.001) after versus before the intervention, without differences between intervention arms. Several specific clinician behaviors such as empathic statements, asking patient opinions and open-ended questions improved more in the workshop+feedback versus the workshop-only intervention arm. A few specific communication behaviors increased (total and complex reflections) after versus before the intervention, without differences between intervention arms. The workshop alone was as effective as the workshop plus feedback in improving patient experiences and overall communication measures. Certain communication behaviors improved more with the more intensive intervention, but these additional benefits may not warrant the extra financial and logistical resources required.

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Acknowledgements

Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools hosted at Johns Hopkins. REDCap is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources. The authors wish to thank all the providers and patients who participated in the study.

Funding

This work was supported by R34MH089279 from the National Institute of Mental Health. In addition, Dr. Beach was supported by K24 DA037804 from the National Institute on Drug Abuse.

Author information

Authors and Affiliations

  1. Johns Hopkins University, Baltimore, MD, USA

    Mary Catherine Beach, Debra Roter, Geetanjali Chander, Tanita Woodson & Richard D. Moore

  2. Brown School of Public Health, Providence, RI, USA

    M. Barton Laws, Yoojin Lee & Ira B. Wilson

  3. William James College, Boston, MA, USA

    Gary Rose

  4. Institute for Health Care and Clinical Policy Studies, Tufts Medical Center, Boston, USA

    William Rogers

Authors
  1. Mary Catherine Beach
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  2. M. Barton Laws
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  3. Gary Rose
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  4. Debra Roter
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  5. Yoojin Lee
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  6. Geetanjali Chander
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  7. Tanita Woodson
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  8. Richard D. Moore
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  9. William Rogers
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  10. Ira B. Wilson
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Corresponding author

Correspondence to Mary Catherine Beach.

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Conflict of interest

None of the authors have a conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Appendix: One-Day MI Training Details

Appendix: One-Day MI Training Details

Learning Objectives

  1. 1.

    Practitioners will understand the value of a reflective listening interview style and will be able to formulate simple reflective statements in response to patient utterances.

  2. 2.

    Practitioners will understand the concepts of sustain talk and change talk and be able to recognize examples of each.

  3. 3.

    Practitioners will understand the limitations of a direct persuasion approach to motivational enhancement, and be able to use simple reflective statements and ask questions that elicit change talk.

  4. 4.

    Practitioners will understand the value of and be able to demonstrate the ability to ask permission before directive conversational utterances.

  5. 5.

    Practitioners will understand the “ask-tell-ask” model of information exchange and its utility with respect to non-conflictual discussions and action planning.

  6. 6.

    Practitioners will understand and demonstrate in skills practice sessions the capacity to discuss difficult and/or conflictual topics in a manner that maintains rapport with the patient.

  7. 7.

    Practitioners will demonstrate an understanding of the use of structuring techniques to develop and maintain focus in clinical conversations.

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Beach, M.C., Laws, M.B., Rose, G. et al. Effects of Minimal Versus Intensive Intervention to Enhance Motivational Interviewing in HIV Care. AIDS Behav 22, 276–286 (2018). https://doi.org/10.1007/s10461-017-1794-6

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