Sinds de dieetbehandeling in 2012 uit het basispakket werd gehaald, is het voor de diëtist extra belangrijk om de effectiviteit van een behandeling aan te kunnen tonen. In hoeverre een dieetbehandeling effectief zal zijn, hangt onder meer af van de bereidheid van de cliënt om gedrag te veranderen. Een methode om verandering in gedrag te bevorderen, is motivational interviewing (MI). Binnen de diëtetiek leidt het toepassen van MI in vergelijking met andere of geen interventies tot betere resultaten, namelijk: meer lichaamsbeweging, een lagere calorie-inname, een lagere BMI bij overgewicht en lagere bloedglucosewaarden bij diabetes mellitus type 2.1,2 Dit inzicht heeft ertoe geleid dat er sinds enkele jaren diverse scholingen op het gebied van MI worden aangeboden gericht op diëtisten. Daarnaast is MI onderdeel van de hbo-opleiding Voeding en Diëtetiek.
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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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Motivational interviewing (MI) may be an effective intervention to improve medication adherence in patients with schizophrenia. However, for this patient group, mixed results have been found in randomized controlled trials. Furthermore, the process of becoming (more) motivated for long-term medication adherence in patients with schizophrenia is largely unexplored
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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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PURPOSE: The current article provides a description of the construction process of a short questionnaire that measures patients' experiences with a motivational interviewing consultation by a (sports) counselor in rehabilitation. Subsequently, results from confirmatory factor analyses are presented to investigate a first perspective on factorial construct validity of the questionnaire.MATERIAL AND METHODS: Based on motivational interviewing literature, an initial item pool was created. All items were critically reviewed, resulting in the new "Evaluation of Motivational Interviewing Consultation on Active Lifestyle and Sports" questionnaire. The final items were determined by a confirmatory factor analysis based on 890 completed questionnaires.RESULTS: The initial 26-item questionnaire consisted of four inter-correlated subscales. Factor analyses underpinned the proposed factors: acceptance, evocation, partnership, and non-adherent. After removing six items, an alternative model remained and showed an acceptable model fit. The internal consistency of the subscales derived varied from 0.70 to 0.90.CONCLUSION: The shortened questionnaire provides a feasible and easy to administer tool and may provide a cost saving method of assessing motivational interviewing fidelity from a patient's perspective in disability and rehabilitation. Implications for rehabilitation Many persons with a physical disability do not obtain the recommended amount of physical activity in order to maintain health. Stimulation of a physically active lifestyle through motivational interviewing is promising. Measuring motivational interviewing treatment fidelity is time consuming and often from a counselor's perspective. We developed a short questionnaire facilitating the assessment of treatment fidelity at the side of the client. Our questionnaire provides a feasible and easy to administer tool for assessing MI fidelity in daily rehabilitation practice.
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Background: If nurses have the communication skills and the time, they can play an important role in increasing the intrinsic motivation of patients with coronary artery disease (CAD) to change their lifestyle. Motivational Interviewing (Mo-Int) can be used to further support this role. However, few nurses are sufficiently proficient in applying Mo-Int skills. Increasing these complex communication skills may contribute significantly to achieve lifestyle changes in CAD patients. Aims: The aim of this study was to evaluate the coaching of nurses to skilfully use Mo-Int in a secondary prevention programme for CAD patients.Methods: The design was a before–after study of a learning strategy as a follow-up on a short Mo-Int workshop. At (on average) four-monthly intervals, the nurses received, three times, feedback and coaching by telephone and email on their use of Mo-Int skills in audio-recorded conversations on lifestyle change with CAD patients. The Mo-Int consistency of the nurses’ communication skills was scored using the Motivational Interviewing Target Scheme 2.1 (range 0–32). Results: Of the 24 nurses, 13 completed all audio recordings. The mean change in Mo-Int consistency of these completers between the first and the last audio recording was 6.4 (95% confidence interval 3.2 to 9.5). This change indicates an improvement from ‘a small part of Motivational Interviewing practice’ to ‘a mainly sufficient degree of Motivational Interviewing practice’.Conclusion: A one-year follow-up on a Mo-Int workshop with feedback and coaching improves Mo-Int skills of nurses. Healthcare professionals should be aware of the importance of a follow-up on training in complex communication skills, to develop and preserve competency.
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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.”Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.
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OBJECTIVE: 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.METHODS: We systematically searched MedLine, Embase, Cinahl, PsycInfo, Cochrane Central, specialised websites and reference lists of selected articles.RESULTS: We found 406 papers, 60 papers were retrieved for further evaluation, based on prespecified criteria. Seventeen instruments that were specifically designed to measure MI or aspects of MI were identified. Fifteen papers met all inclusion criteria, and reported on seven instruments that assess potential active ingredients of the interactive MI process. The capability of these instruments to measure potential active ingredients in detail and as a part of the interactive MI process varies considerably. Three of these instruments measure one or more potential active ingredients in a reliable and valid way.CONCLUSION: To identify the potential active ingredients in the interactive MI process, a combination of the SCOPE (which measures potential technical active ingredients) and the GROMIT or the global ratings of the MISC2 (to measure potential relational ingredients) seems favourable.
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BackgroundPodiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists’ attitudes and experiences towards MI.MethodsEighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice.ResultsThe MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p = 0.008 and change talk, p = 0.008), on one of five core MI-adherent behaviours (affirmation, p = 0.041) and on one of the other behaviour counts (simple reflections, p = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value.ConclusionsThe MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice.Trial registrationNetherlands Trial Register NL7710. Registered: 6 May 2019.
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