Literature Review – Evidence Based Practice Report: Motivational Interviewing
This report expansively reviews different literature regarding the use of motivational interviews and their effectiveness in enabling occupation in adults with chronic health conditions. The report majorly considers how motivational interviewing leads to increased physical activity and functional exercise capacity in adults with chronic health conditions.
Formulated Research Question
The research question below was formulated to help gather relevant information and compare relevant articles about how motivational interviewing leads to improved physical activity and functional exercise capacity in adults with chronic health conditions.
Is motivational interviewing effective for enabling occupation in adults with chronic diseases?
Justification of Research Question
Hospital Admission Risk Program (HARP) is a motivational interviewing (MI) program that is designed to help adults with chronic health conditions to achieve better quality of life (Rubak et al., 2005). HARP as an MI is an Occupational Therapy (OT) fourth year community-based fieldwork aimed at delivering community based services to people with chronic health conditions, psychosocial issues and complex needs (McGovern et al., 2004). HARP’s main objective is to decrease demand for hospitals by providing comprehensive assessment, care planning together with timely responsive specialist care in the community setting for individuals with complex needs. It is a multidisciplinary team made of community clinicians who provide case management / care coordination for HARP clients aimed at improving patient outcomes by redirecting clients away from unnecessary acute services and reducing length of stay. Similarly, it is a client-centered care based on needs identification, linking into more appropriate community services, and advocating where needed.
The research question above was formulated to help acquire information regarding the generic role of a community clinician working in a multi-disciplinary team to provide care coordination and/or case management for HARP clients (Miller et al., 2006). The question was chosen due to that fact that some individuals with chronic health conditions have complex needs and through motivational interviewing they can attain commendable improvements. Consequently, they also need motivational interviewing in order to jump-start treatment, actively engaged through tough moments, and to help in sustaining therapeutic progress post-treatment (Madson, Andrew and Claire 2009). In addition, MI is also applicable to general mental health, eating disorders, substance use treatment, and medical compliance (Resnicow, Rachel, and Stephen 2006). Given this understanding, motivational interviewing can be used as occupational therapy (OT) intervention alternative as it helps in narrowing the clients’ disconnects to their goals and behaviors which is essential in resolving ambivalence (Rapp et al., 2008). Similarly, the question has the ability to develop a report with the client which on the other hand is essential in improving the results (Miller et al., 2005).
For HARP to achieve excellent results across various therapies largely depend on the extent to which clients are engaged with their treatment and adherence to lifestyle changes recommended to them. By using MI intervention, the community clinicians are empowered to enhance clients’ motivation for behavior change among adults with chronic health conditions (Beidas and Philip 2010). They will be more focused on encouraging clients to participate in physical activities which will in turn improve their health thus preventing them to present to hospitals. Poor adherence to motivation is a key problem among clients and therefore, increasing emphasis on guiding and helping patients to be more responsible for their own care is highly required (Amodeo et al., 2011).
Vast up to date material evidence was found relating to the research question; however, five peer-reviewed journal articles were located through Google scholar as well as Deakin online database (CINAHL complete and Academic Search complete). Some of the articles were sourced through a reference list from the CINAHL complete, MEDLINE, and EMBASE were key online databases where most of the articles were sourced (Tucker and David 2006). A search strategy was undertaken using keywords “adult with chronic disease” as patient group, “motivational interviewing” as the intervention, AND “enable occupation” OR “occupational therapy” as the outcome. The articles were all current with the oldest being 2006 and provided a good basis for stronger and more rigorous evidence to be undertaken on the research question.
The articles were selected according to the following inclusion criteria.
- Peer reviewed articles published from 2006-2014,
- Participants diagnosed with chronic health condition,
- Human participants from the age of 18 above,
- Participants with experience of motivational interviewing as intervention,
- Participants were outpatients with chronic health conditions,
- Studies investigating motivational interviewing effectiveness in enabling occupation in adults with chronic health conditions,
- Studies published in English.
Articles that never met the above described inclusion criteria were excluded due to the fact that their literature reviews, opinion pieces, editorials and studies had little or no rigorous evidence. This was done in order to come up with a strong conclusion from the articles.
The articles were appraised using The McMasters Critiquing Tools (1998) which were found in by Law and Macdermid’s (2008) “Evidence Based Rehabilitation.” Similarly, the articles were characterized by a level of evidence (LOE) which use the Rosalind Franklin Qualitative Appraisal Tool (Henderson & Rheault, 2004) for qualitative articles and the Howick (2009) “Oxford Center for Evidence-Based Medicine Levels of experience” for the quantitative studies. The selected articles provided the best evidence regarding motivational interviewing.
Summary of Literature’s Purpose and Findings
|Author & Date||Purpose||Design||Sample||Findings||Level of evidence||Limitations|
|O’Halloran, Blackstock, Shields, Holland, Iles, Kingsley, Bernhardt, Lannin, Morris & Tylor (2014)||– To determine if motivational interviewing leads to increased physical activity, cardiorespiratory fitness or functional exercise in people with chronic health conditions||Systematic review and meta-analysis of randomized controlled experiments||11 trials||– 8 trials showed moderate evidence that motivational interviewing increased physical activity levels for people with chronic health conditions
– one high quality and two moderate quality trials showed that motivational interviewing has high effect on cardiorespiratory fitness.
– Motivational interviewing has positive effect on functional exercise capacity of people with chronic health condition
|Level I||– The number of included trials was restricted by the stringent criteria that was designed to assess the independence of motivational interviewing effects
-physical activity findings were confined to self-report measures in six out of eight trials
|Sanders, Whited & Martino (2013)||– To determine the effect of motivational interviewing in patients with chronic kidney disease||Personal interviews through:
– exchange of information
– ask evocative questions
Conducting decisional balance
– use of confidence rulers
|– increase physical activity
– better fluid management
– improved exercise adherence
-Better management of phosphorous and albumin levels
– Improved treatment adherence and disease self-management
|Level I||– it is time consuming. Literature Review – Evidence Based Practice Report: Motivational Interviewing|
|Brodie, Inoue & Shaw (2006)||To examine the effectiveness of motivational interviewing, compared with standard care, and both combined in a sample of elderly heart failure patients||Questionnaire
|60||– non-significant differences between groups at baseline for age, coronary risk factor, medication and social support.
– improved self efficacy: motivational interview resulted into behavioral change.
– improved quality of life
– increased readiness for change across all groups
|3b||The exclusion of patients with normal systolic function restricted the ability to generalize the findings
No consensus exists regarding which approach is essential when assessing broader health status of elderly people with chronic health conditions.
|Linden, Butterworth, and Prochaska (2009)||To evaluate the impact of motivational interviewing based health coaching on chronically ill group of participants compared with non-participants||Quasi-experimental study||2815||-Improved self efficacy
– Improved patient activation
– patients changed their lifestyle
– improved perceived health status
|Level IV||The use of participants who were not chronically ill compromised the validity of the results.|
|Tse, Vong & Tang (2012)||To examine the effectiveness of an integrated motivational interviewing and physical exercise program on pain, physical and psychological function, quality of life, self efficacy, and compliance with exercise community – dwelling older persons with chronic pain||Questionnaire||56||After motivational interviewing and physical exercise program significant improvement was exhibited in:
|Level IV||– Chronic diseases and health-related quality of life are stable cannot be improved by MI counseling program
8-week program is a short period of time for changing quality of life.
Reviewing the Research
Four quantitative and one qualitative articles were reviewed based on above set criteria. The reviewed articles above provide significant and up to date evidence that motivational interviewing has the ability of enabling occupation in adults with chronic health conditions. When comparing the findings from the reviewed articles it can be deduced that there is wide similarities; for instance, improvement of physical exercise, increased readiness for change, self-efficacy, willingness to self-manage diseases, and improved perceived health status. The studies were conducted for en extended period of time thus improving their validity. For instance, O’Halloran, Blackstock, Shields, Holland, Iles, Kingsley, Bernhardt, Lannin, Morris & Tylor (2014), used 11 study trials that were conducted over several years and using different approaches to motivational interviewing to come up with their conclusions. However, the trials selection was restricted by stringent criteria that compromised the results. Sanders, Whited & Martino (2013) used qualitative methodology in their research; they conducted personal interviews which increased the reliability of their results. Brodie, Inoue & Shaw (2006) used a questionnaire in determining the effectiveness of MI in comparison to standard interventions.
Linden, Butterworth, and Prochaska (2009) evaluated the effect of motivational interviewing based on health coaching using quasi-experimental study, by using none-chronically ill participants lead to results that are not reliable and consistent with the study question. Tse, Vong & Tang (2012), used a questionnaire to examine the effectiveness of an integrated motivational interviewing and physical exercise program on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise community. Although, they study provided significant results, the 8-week time period was too short to fully obtain exhaustive results.
Implication to Field Practice
HARP as discussed from the above is an excellent community based program using motivational interviewing intervention to help adults with chronic health conditions to achieve better quality of life. It is an essential program for instilling behavioral change in individuals with chronic health conditions. Planning for behavioral change particularly in individuals with chronic health conditions demands for participation of health providers with patients. When HARP is used in this scenario, it should be patient driven assisted by the health provider; motivational interviewing is key in maintaining a patient centered stance. The effects of motivational interviewing as observed from the above review can largely be improved by clinicians adhering to the core components of motivational interviewing. HARP ensures that clinicians work together with their clients to help them alleviate their chronic health conditions through physical exercise. Literature Review – Evidence Based Practice Report: Motivational Interviewing.
HARP is an ideal program using motivational interviewing intervention in individuals with chronic health conditions helps in incorporating behavior change principles of promoting quality of life and physical activity. This approach should be embraced by health providers especially in matching individuals to treatment (Norcross and Bruce 2010). Accordingly, given the fact that motivational interviewing engenders focuses on ambivalence and other barriers preventing individuals from acting on treatment guidelines and making life changes; clinicians will find it as a potential tool for strengthening patients’ belief and perception about the importance of the change together with the ability to accomplish it successfully (Day and Kevin 2002). HARP provides success evidence in improving different chronic health conditions including physical mobility, psychological well-being, and self-efficacy in adults and thus enabling occupation in individuals with chronic health conditions.
This literature review indicates the motivational interviewing was instrumental in improving the physical functioning and self-efficacy in individuals with chronic health conditions. With regard to this it is highly recommended for clinicians to employ the use of motivational interviewing intervention to help improve or in enabling occupation of adults with chronic health conditions.
Amodeo, M., L. Lundgren, A. Cohen, D. Rose, D. Chassler, C. Beltrame, and M. D’Ippolito. “Barriers to implementing evidence-based practices in addiction treatment programs: comparing staff reports on motivational interviewing, adolescent community reinforcement approach, assertive community treatment, and cognitive-behavioral therapy.” Evaluation and Program Planning 34, no. 4 (2011): 382-389. Literature Review – Evidence Based Practice Report: Motivational Interviewing.
Beidas, Rinad S., and Philip C. Kendall. “Training therapists in evidence‐based practice: A critical review of studies from a systems‐contextual perspective.” Clinical Psychology: Science and Practice 17, no. 1 (2010): 1-30.
Day, Andrew, and Kevin Howells. “Psychological treatments for rehabilitating offenders: Evidence-based practice comes of age.” Australian Psychologist 37, no. 1 (2002): 39-47.
Madson, Michael B., Andrew C. Loignon, and Claire Lane. “Training in motivational interviewing: A systematic review.” Journal of Substance Abuse Treatment 36, no. 1 (2009): 101-109.
McGovern, Mark P., Thomas S. Fox, Haiyi Xie, and Robert E. Drake. “A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system.” Journal of substance abuse treatment 26, no. 4 (2004): 305-312.
Miller, William R., James L. Sorensen, Jeffrey A. Selzer, and Gregory S. Brigham. “Disseminating evidence-based practices in substance abuse treatment: A review with suggestions.” Journal of substance abuse treatment 31, no. 1 (2006): 25-39.
Miller, William R., Joan Zweben, and Wendy R. Johnson. “Evidence-based treatment: Why, what, where, when, and how?.” Journal of Substance Abuse Treatment 29, no. 4 (2005): 267-276.
Norcross, John C., and Bruce E. Wampold. “Evidence-based therapy relationships: research conclusions and clinical practices.” Psychotherapy 48, no. 1 (2011): 98.
Rapp, Charles A., Diane Etzel-Wise, Doug Marty, Melinda Coffman, Linda Carlson, Dianne Asher, Jennifer Callaghan, and Rob Whitley. “Evidence-based practice implementation strategies: results of a qualitative study.” Community Mental Health Journal 44, no. 3 (2008): 213-224.
Resnicow, Ken, Rachel Davis, and Stephen Rollnick. “Motivational interviewing for pediatric obesity: Conceptual issues and evidence review.” Journal of the American Dietetic Association 106, no. 12 (2006): 2024-2033. Literature Review – Evidence Based Practice Report: Motivational Interviewing.
Rubak, Sune, Annelli Sandbæk, Torsten Lauritzen, and Bo Christensen. “Motivational interviewing: a systematic review and meta-analysis.” British Journal of General Practice 55, no. 513 (2005): 305-312.
Salyers, Michelle P., and Sam Tsemberis. “ACT and recovery: integrating evidence-based practice and recovery orientation on assertive community treatment teams.” Community Mental Health Journal 43, no. 6 (2007): 619-641.
Suarez, Mariann, and Sharon Mullins. “Motivational interviewing and pediatric health behavior interventions.” Journal of Developmental & Behavioral Pediatrics 29, no. 5 (2008): 417-428.
Tucker, Jalie A., and David L. Roth. “Extending the evidence hierarchy to enhance evidence‐based practice for substance use disorders.” Addiction 101, no. 7 (2006): 918-932.
Weisz, John R., Amanda Jensen-Doss, and Kristin M. Hawley. “Evidence-based youth psychotherapies versus usual clinical care: a meta-analysis of direct comparisons.” American Psychologist 61, no. 7 (2006): 671.
Literature Review – Evidence Based Practice Report: Motivational Interviewing