A pilot randomized controlled trial on motivational interviewing in return to work after work disability

Online training improves motivational counseling in health insurance practitioners: a pre-post analysis of return-to-work conversations

PURPOSE

Health insurance practitioners need to evaluate sick-listed workers, motivate them for return-to-work (RTW), and guide them in doing so. This study evaluates the effectiveness of a 10-h, online and interactive training in "motivational counseling," on practitioners' communication behaviors. The training is based on Motivational Interviewing (MI) and Self-Determination Theory (SDT)'s basic psychological need support for autonomy, relatedness, and competence.

MATERIALS AND METHODS

We observed and rated video recordings of online patient encounters, simulated by experienced actors enacting fictive scenarios. Two-tailed Wilcoxon signed-rank tests compared pre- and post-training outcomes of 31 practitioners using observational instruments based on MI and SDT.

RESULTS

After training, the practitioners showed significantly more technical (e.g., using reflections) and relational (i.e., seeking collaboration and taking perspective) MI behaviors. Autonomy- and competence-supportive behaviors increased (e.g., providing rationales or feedback) while autonomy-thwarting behaviors decreased (e.g., using controlling language).

CONCLUSIONS

The training in motivational counseling effectively promoted motivating communication behaviors among health insurance practitioners, in line with SDT and MI. The online format makes the training practically more feasible for RTW stakeholders operating in time-restrained contexts. More research is needed on training transfer and implementation barriers, as on the impact on sick-listed workers' motivational processes and RTW trajectories.

Developing a Training in Motivational Counselling to Promote Return to Work: An Intervention Mapping Approach

PURPOSE

Due to the Belgian health insurance system's controlling nature, work-disabled claimants can feel forced to return to work (RTW), increasing their risk of relapse. RTW out of interest or importance is considered more sustainable. Such autonomous motivation for RTW can be promoted through 'motivational counselling', an integration of self-determination theory and motivational interviewing. To adopt this, health insurance practitioners need training, which can be designed through intervention mapping as an evidence-based planning tool. This paper reports on the development of a motivational counselling training for health insurance practitioners.

METHODS

Intervention mapping's six steps guided the formulation of programme goals and learning outcomes, matching the context. We then identified change methods which were translated into practical components. Together with the health insurances' input, this resulted in a concrete training programme with an implementation and evaluation plan.

RESULTS

The training was designed to increase practitioners' knowledge, skills, and beliefs relevant for learning motivational counselling, which also requires solution-focused strategies. Methods like guided practice were translated into built-in exercises, feedback, and information, which were implemented through an online training format of five sessions including one follow-up.

CONCLUSION

Reporting about training development increases understanding of its effectiveness and implementation, which will be evaluated via pre- and post-training data collection amongst practitioners. Future trainings can benefit from this by accounting for health insurances' organizational barriers or building on the training's evidence-based backbone whilst only requiring specific adaptations for other stakeholders and contexts. Further research should evaluate motivational counselling's impact on claimants' RTW trajectories.

Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients

Purpose Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI's relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary. Methods Eighteen people (29-60 years; sick leave > 12 weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI's mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis. Results Main mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI's effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW). Conclusions These results stress the importance of self-determination theory's support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients' engagement regarding RTW. These mechanisms' instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium's social security system's premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI's long-term effects as well as its complex interaction with external factors.

Testing a modified motivational interviewing counseling program

BACKGROUND

Motivational Interviewing is a well-established person-centered counseling approach toward positive behavioral change. However, several limitations have been reported using motivational interviewing applications.

PURPOSE

This study explored the potential of an innovative intervention (namely, modified motivational interviewing) to address the limitations associated with the original form of Motivational Interviewing.

METHODS

The research used a phenomenological qualitative design to include three focus groups with a total sample size of 24 university nursing students to examine their experiences with the Modified Motivational Interviewing. The focus groups were transcribed verbatim and then coded to extract the themes.

RESULTS

The following ten themes emerged from the data analysis: increasing discrepancy; ambivalence; ready, willing, and able; change as a natural process; the role of the modified motivational interviewing facilitator; spontaneous generalization; peer support facilitates change; help-seeking behavior; practical applications of the modified motivational interviewing; and problems encountered during the implementation of modified motivational interviewing.

CONCLUSIONS

The proposed intervention can potentially be a cost-effective replacement for the original format of motivational interviewing intervention. Further research is needed to support the modified motivational interviewing.