Classification(s): Behavior/Lifestyle Modification
Introduction: Motivational interviewing (MI) is a method of communication that can significantly improve the health behaviors of cardiac rehabilitation (CR) patients. However, healthcare provider (HCP) skill levels may vary, and MI proficiency is not typically measured in CR patient consultations.
Purpose: This study was designed to assess MI proficiency during health education consultations in an outpatient CR program.
Design:
Methods: Patients were given the Consultation and Relational Empathy (CARE) Measure immediately following a 30-minute CR consultation with a health educator who was trained in MI. The CARE Measure is a 10-item questionnaire that asks patients to anonymously assess the level of empathy that is expressed by a HCP during a consultation, which is considered to be a defining characteristic of MI. Four hundred eleven questionnaires were completed and each item was scored on a 1 to 5 Likert scale (1 = poor, 2 = fair, 3 = good, 4 = very good, 5 = excellent). In addition, 5 patient consultations were randomly selected and the patients gave permission for their consultations to be confidentially audiotaped and analyzed by a MI coding expert. The Motivational Interviewing Treatment Integrity 3.0 (MITI 3.0) Coding Instrument was used to score the consultations on global ratings that used a 1 to 5 scale, and an objective behavioral count that determines MI proficiency.
Results: The overall mean score for the CARE Measure was 47.6 (SD = 4.4) out of a possible maximum of 50. The overall mean global rating score for the MITI 3.0 was 4.2 (SD = 0.5) out of a possible maximum of 5. The mean global rating score for MI spirit was 4.1 (SD = 0.5) and the mean global rating score for empathy was 4, where all consultations were scored the same. On the behavioral count, reflections outweighed questions with a mean reflection-to question ratio of 1.4. The mean percentage for MI adherence was 100%.
Conclusions: In this study, the health educator demonstrated MI consistent behavior. It appears that the CARE Measure and the MITI 3.0 are assessment tools that can be used in CR to provide feedback on MI proficiency. Further investigation is needed to determine the relationship between MI proficiency and patient outcomes in CR.