Author ORCID Identifier
Doctor of Philosophy
Social and Behavioral Health
INTRODUCTION: Motivational Interviewing (MI) is an evidenced based counseling style to elicit health behavior change. Team-based student clinics are an ideal climate for students to learn and practice team-based care, yet little is understood as to how client-centered communication styles such as MI are implemented in a team setting.
PURPOSE: The purpose of this dissertation was to conduct an exploratory study using mixed methods to better understand how an MI training translates to team-based communication with clients, the factors impacting team-based implementation of MI, and how team-based MI impacts clients’ perceived autonomy at a student-led, interprofessional, team-based wellness clinic for low-income seniors.
METHODS: Fifty-five clinic sessions were audio recorded and participants completed the Health Care Climate Questionnaire to measure perceived autonomy support, 16 clinic participants were interviewed, and 15 health care students participated in four focus groups. The recordings were coded with the Motivational Interviewing Treatment Integrity code (MITI 4.2.1). Independent t-tests, and multiple regression models were used to assess differences in MITI scores, association between MITI scores and team/patient characteristics, and associations between MITI scores and perceived autonomy support. Interviews and focus groups were qualitatively analyzed to identify themes.
RESULTS: A short training in MI was not associated with MI proficiency as measured by the MITI, and student teams were found to overstate their use of MI on team-report measures. Less education, older age, and a larger team size were associated with lower MITI scores. High levels of perceived autonomy support were found across all clients, but MITI scores were not associated with perceived autonomy support. Clinic participant interviews identified benefits to engaging with the student teams including opportunities to socialize, as well as support in managing their health. The students found the MI training to be beneficial but noted that team dynamics ultimately effected MI use.
CONCLUSION: It is possible to implement MI in team-based settings, but sufficient training and ongoing coaching is needed to ensure translation to practice. As health care programs continue to promote team-based care, further research is needed to fully understand how teams can effectively communicate with clients, and how they can provide the autonomy supportive environment needed to elicit internal motivation to engage clients in their own health management.
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Available for download on Thursday, December 05, 2024