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Table 1 Characteristics of included papers

From: Embedding and sustaining motivational interviewing in clinical environments: a concurrent iterative mixed methods study

Author Type of study & setting Research aim Intervention/methods Results Implications
Horn et al. (2008) [25] Randomised controlled trial (n = 75), emergency department, USA To determine the reach, implementation fidelity, and acceptability of a brief tobacco intervention for teens who had treatment in a hospital emergency department A 15–30 min motivational interviewing session together with an educational handout, a postcard after the visit and 3 follow-up phone calls (1,3 and 6 months) Low levels of reach, high levels of implementation fidelity, and high levels of acceptability for teen patients, their parents, and emergency department personnel. It is possible to implement a motivational tobacco intervention that includes an interview session in an acute, busy and unpredictable setting. Enabler: structure, time, resource, staff buy-in
Jansink et al. (2010) [28] Qualitative interview (n = 12), nurses in general practice, the Netherlands To examine barriers nurses encounter in lifestyle counselling to patients with type 2 diabetes to inform the development of an implementation strategy to improve lifestyle behaviour change in general practice Broad questions on perceived barriers encountered by nurses at three levels (nurse, patient, practice) on management of type 2 diabetes Nurses reported lack of counselling skills and insufficient time as barriers in effective lifestyle counselling (since patients had limited knowledge of a healthy lifestyle and insight into own behaviour, and lacked motivation to modify lifestyles or the discipline to maintain an improved lifestyle). An implementation strategy based on motivational interviewing can help to overcome ‘jumping ahead of the patient’ and promotes skills in lifestyle behavioural change. Agenda setting and prioritizing the behaviour change will assist to develop social maps that contain information on local exercise programs. Barrier at patient level: knowledge, attitude, skills and compliance. Barrier at practice level: organisation processes, staff, capacity, resources and structure
Amodeo et al. (2011) [26] Phone interview (n = 172), providers in community-based addiction treatment organisations, USA To explore barriers to implementing evidence-based practices (including motivational interviewing) in community-based addiction treatment organisations Comparing staff descriptions of barriers for motivational interviewing, adolescent community reinforcement approach, assertive community treatment, and cognitive-behavioural therapy Staff described different types of barriers. For motivational interviewing, the majority of barriers involved insufficient training, variance in training and perspective, staff resistance, client resistance and organizational factors such as philosophy, time, space, process and structure Need to include explicit strategies to address such barriers, and consider whether their programs have the organisational capacity and community capacity to meet the demands
van Eijk-Hustings et al. (2011) [30] Concurrent mixed methods, primary and secondary care setting, the Netherlands To examine the uptake of motivational interviewing in daily practice by health care professionals in a care management initiative for patients with diabetes in the region of Maastricht, the Netherlands Directly and six months after the staff training (n = 2 practice nurses, 4 diabetes specialist nurses, 4 dieticians) the application of motivational interviewing was measured objectively using the Motivational Interviewing Treatment Integrity Scale coupled with patient clinical data (n = 91 intervention vs. 50 control). Interviews with the 10 trained and another 10 untrained professionals were conducted to understand barriers and enablers The applicability of motivational interviewing in daily practice was found feasible, with various degrees of uptake. Mostly uncomplicated techniques were applied. Professionals stated the need for training and practice to be able to apply more complicated techniques In daily practice, a phased training in motivational interviewing is recommended, with sufficient time and support by colleagues as essential conditions to profit most from the training sessions
Rosseel et al. (2011) [29] Embedded interviews (n = 62) in a controlled study, primary dental care centre, the Netherlands To encourage primary care dental professionals to use a stage-based motivational protocol to provide more smoking cessation advice and support for all smoking patients in the Netherlands A smoking cessation protocol was introduced in 23 primary care dental practices in the Netherlands in 2008. Practices could choose between a minimal or optimal version of the protocol, including motivational interviewing training. Patients were asked whether they had received smoking cessation advice and support as part of their treatment. Lack of practice time and anticipated resistance on the part of the patient were cited as barriers by over 50% of the dental professionals in the first interviews. Periodontal treatment and the presence of smoking-related diseases were mentioned as the most important stimuli Education on the associations between smoking and oral health, vocational training on motivational interviewing and the offering of structured advice protocols were identified as promising components for an implementation strategy to promote the involvement of dental professionals in the primary and secondary prevention of tobacco addiction
Lundgren et al. (2011) [33] Phone interviews (n = 100 program directors), community-based addiction treatment organisations, USA To explore implementation of evidence-based practices including motivational interviewing in community-based addiction treatment organisations Describes community based addiction program director attitudes on: (1) satisfaction with program they were mandated to implement; (2) the extent to which their organisation modified the program; (3) reasons for modifications; and, (4) the standards they used for modifications Program directors were highly positive about program implemented and modifications made. Most common modifications were adding or deleting intervention sessions to serve the needs of a specific client population Government funders require community based addiction treatment organisations to implement and maintains standards. Conflict between providing evidence-based practices and culturally appropriate services
Rosseel et al. (2012) [35] Review (n = 8), smoking cessation in dental care To summarise evidence regarding the effectiveness of various implementation strategies to stimulate the delivery of smoking cessation advice and support during daily dental care Search of online medical and psychological databases, correspondence with authors and checking of reference lists. Eight studies or were included with four deemed to be at sufficient quality Professional education may enhance motivation for smoking cessation activities and advice giving together with organisational interventions (e.g., protocols, involvement of the whole team, referral possibilities) and incorporation of patient-oriented tools Multifaceted support strategies positively influence dental professionals’ knowledge of smoking and smoking cessation, their motivation to give advice and their performance
Lundgren et al. (2012) [34] Phone interviews and web survey of staffs working in community-based addiction treatment program, USA To examine the relationship between clinical staff (n = 510) and director (n = 296) perceptions of organisational capacity and lever of barriers experienced when implementing new intervention Organisational readiness for change and phone interview to understand barriers Barriers: stress, low level of program needs, working in a program that had been in existence for a short period, Staff who implemented motivational interviewing techniques as compared to other interventions and in program in existence for short period experienced lower level of barriers
Lundgren et al. (2013) [32] Phone interviews and web survey, staffs working in community-based addiction treatment program, USA To explore whether staff perceptions about the organisational capacity of their treatment unit are associated with staff experience of barriers to implementing evidence-based addiction treatment practices Prior studies have identified that working in an addiction treatment unit with higher levels of organisational capacity is a factor associated with positive staff attitudes Barriers identified from bivariate analysis: clinical staff who had five or more years of addiction counselling experience and less frequently implemented new counselling interventions, staff who reported a less level of influence in the organisation Government funders of community addiction programs must take organisational capacity into account, continued funding is needed to promote adoption and adherence, ongoing training opportunities to promote implementation
Guerrero and Kim (2013) [27] Multi-methods evaluation, USA To explore the extent to which pressure from funding and regulation, leadership and readiness for change impact on organisational implementation Online survey, review of program, qualitative interviews and review of printed material available at 122 addiction programs Public funding and regulation associated with greater implementation; leadership capacity associated with outreach to minority and development of diverse staff; programs with more graduate staff were associated with less involvement from communities Investment in funding, leadership skills and strategic climate are importance enablers
Aboueid et al. (2019) [31] Qualitative interviews (n = 14), dietitians, Canada Clinicians’ perspectives on barriers and enablers Naturalistic inquiry approach of 14 dietitians Individual levels enablers: financial resources, education, self awareness. Relationship-level enablers: supportive networks. Community-level enablers: community program, workplace norm, supportive interdisciplinary teams. Macro system barrier such as socioeconomic status, discrimination, lack of communication between providers can impede sustainability.
  1. Abbreviation: USA = United States of America