Results: We observed a variation of factors which seemed to contribute to the active ingredients. Most prevalent was (eliciting) ‘change talk’, but also factors such as ‘experiencing competency’ and ‘changing sense making’. Since mechanisms of change refer to psychological processes within the patient’s mind, it is impossible to observe these. But we recognised clues for mechanisms of change, the most prevalent mechanism was ‘arguing oneself into change’. The most important conversational techniques are reflections and questions addressing medication adherent behaviour or intentions, which was often (in 74% and 69% of the time respectively) followed by change talk. Conclusions: Active ingredients of MI seem to consist of a sufficient combination of factors, to which both patient and therapist contribute. This combination may act as an active ingredient and can trigger mechanisms of change. Our study suggests that in particular the patient factors are a pool of factors from which, after proper activation by therapist factors, different combinations can form active ingredients.
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Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐ interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk— as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.
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Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event. Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation. Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”
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Artikel proefschrift Jos Dobber verschenen in Frontiers in Psychiatry 24 maart 2020: Background: Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms. Methods: First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk. Results: We found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change. Conclusions: Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
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Considering recent calls for change towards a more liveable tourism academia, critical participatory action research is combined with duoethnography to develop The Academic Line—a humorous comic project about academic life. Traditional theories of humour are used to leverage the effectiveness of comics as communicative devices and explored how and to what extent the project promoted solidarity, reflexivity, well-being, and change. This study reveals the concrete commitment to fostering change within and potentially improving academia, and to experiment with a form of communication, which is still underexplored in the scholarly sphere but fruitfully applied in other contexts to raise awareness of and prompt discussion about crucially important issues.
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In this paper the Feltscaping-method is described, its characteristics and requirements, and some examples of how it was used and further developed. In doing so this paper aims at embedding feltscaping into the existing discourse of arts-based research. Furthermore, it will reflect on possibilities for further development of the Feltscaping method.The development of the method started seven years ago, as Cora Jongsma as a way of delving into the different layers of the landscape connected with the landscape. The product of this process is a feltscape, a representation of the landscape made up of several layers of wool that tells a story about a specific area. The layering in the feltscape, in the beginning, was purely the result of interaction between the creative process, conversations with land users, landscape research and visual experience, drawing a parallel to the formation process of the landscape. Starting as a personal search of the artist on how to connect the feltscapes to the landscape, after a few years, developed into an instrument to stimulate good conversation with people that in one way or another are connected to the landscape. In this way, feltscapes enable the researcher to test and exchange own sensory perceptions and to extent existing knowledge or questions about the landscape by eliciting social interactions.
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The capacity to deal with digital transformation is a valuable asset for established organizations, and employees play a crucial role in this process. This study contributes to the understanding of employees’ sensemaking of digital transformation in the tour operating industry. Using prior digital transformation research, construal-level theory (CLT), and dynamic change perspectives, our scholarly work focuses on the complexities of organizational change in a digital transformation context. Although employees generally support digital transformation, our findings show that their perceptions change over time across a range of specific challenges experienced during the employee change journey. Our findings stress the importance of adopting a social exchange lens in digital transformation knowledge as this represents deep structure change that might cause well-designed transformation processes to fail. Implications for hospitality and tourism management are discussed.
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The number of out-of-school science programs, which refers to science education at outside school environments, is gradually increasing. Although out-of-school programs are generally considered to be important for the development of pupils’ science knowledge and skills, more evidence concerning the learning effect of these programs is needed. In the present study, we explored whether different degrees of implementation of a connected in-school and out-of-school science program affect pupils’ cognitive science skills in relation to teachers’/instructors’ support. We used a multiple case study design with four cases comprising three different degrees of program implementation: optimal, intermediary and marginal. The cases comprised pupils of upper grade elementary school classes, their teachers, and the instructors of the out-of-school activity. The effect of the program was measured by coding pupils’ performance with a scale based on skill theory, and by coding teacher’s/instructor’s support with the Openness Scale. The data was gathered from microgenetic measurements over time, corresponding with an in-depth analysis of the process of change in naturalistic conditions. We found the highest learning effect in the optimal program implementation, which indicates that it is favorable to implement the complete program, and train teachers/instructors to use open teaching focused on conceptual understanding.
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Motivational Interviewing (MI) can effectively stimulate motivation for health behavior change, but the active ingredients of MI are not well known. To help clinicians further stimulate motivation, they need to know the active ingredients of MI. A psychometrically sound instrument is required to identify those ingredients. The purpose of this study is to describe and evaluate the capability of existing instruments to reliably measure one or more potential active ingredients in the MI process between clients and MI-therapists.
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