BackgroundTrials 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.MethodsFirst, 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.ResultsWe 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.ConclusionsMechanisms 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.
MULTIFILE
Our current smart society, where problems and frictions are smoothed out with smart, often invisible technology like AI and smart sensors, calls for designers who unravel and open the smart fabric. Societies are not malleable, and moreover, a smooth society without rough edges is neither desirable nor livable. In this paper we argue for designing friction to enhance a more nuanced debate of smart cities in which conflicting values are better expressed. Based on our experiences with the Moral Design Game, an adversarial design activity, we came to understand the value of creating tangible vessels to highlight conflict and dipartite feelings surrounding smart cities.
LINK
De geestelijke gezondheidszorg is op veel vlakken in beweging. Financiële herstructurering heeft grote impact op vorm en inhoud van de zorg. Een groeiend aantal zorgvragers zonder uitbreiding van financiële middelen vraagt om innovatie en effectieve interventies. De visie op psychiatrie verandert waarbij meer aandacht komt voor de gevolgen van psychiatrische symptomen op het functioneren. De focus wordt verlegd van ziekte naar positieve gezondheid waarmee thema’s als bevorderen van zelfmanagement en herstelondersteunende zorg centraal komen te staan. Deze veranderingen hebben grote impact op de zorg voor mensen met een psychische kwetsbaarheid en vraagt daarmee andere competenties van professionals. Het lectoraat Zorg & Innovatie in de Psychiatrie richt zich op het ontwikkelen en onderzoeken van effectieve interventies die bijdragen aan het verbeteren van de zorg voor mensen met een psychische kwetsbaarheid binnen deze veranderende context
