Designing an Instrument for Measuring Motivational Interviewing Skills Acquisition in Healthcare ...

162 Pages·2011·0.5 MB·English

Designing an Instrument for Measuring Motivational Interviewing Skills Acquisition in
Healthcare Professional Trainees

by

Tatjana Petrova

A dissertation submitted to the Graduate Faculty of
Auburn University
in partial fulfillment of the
requirements for the Degree of
Doctor of Philosophy

Auburn, Alabama
May 9, 2011

Keywords: MISHCE, Motivational Interviewing, Assessment

Copyright 2011 by Tatjana Petrova

Approved by

Jan Kavookjian, Chair, Associate Professor of Pharmacy Care Systems
John C. Dagley, Associate Professor of Special Education, Rehabilitation, and Counseling
Sharon K. McDonough, Director of Office of Teaching, Learning & Assessment
Michael B. Madson, Assistant Professor of Psychology
David Shannon, Professor of Educational Foundations, Leadership, and Technology
Abstract

Motivational interviewing (MI), as a counseling approach, has been used and evaluated
extensively in the last decade. This approach has a significant impact on addiction management,
change in lifestyle, and adherence to treatment. Knowing that adherence behavior has a complex
nature and that motivational interviewing can address those complexities, proper training, and
evaluation of such training is important.
The purpose of this research project was to develop a valid, reliable, brief, and effective
assessment tool for assessing mastery of MI skills in health care provider trainees attending
training in MI. To address this purpose, specific steps were followed: developing conceptual and
operational definitions; selecting a scaling technique; selecting a response format and developing
directions for responding; preparing drafts of the instrument and conducting reviews of items;
preparing a final draft of the instrument; analyzing internal consistency; inter-rater and test-retest
reliability; and preparing a manual and examples of MI adherent and non-adherent behaviors.
The validity and reliability of the instrument were established. Face and content validity
were assured with well defined conceptual and operational definitions of the domain of the
investigation. Reliability was established through internal consistency, inter-rater reliability, and
test-retest reliability. The developed instrument is based on an analytic rubric. It is shorter and
less time consuming in comparison to already existing instruments. The instrument evaluates the
health care provider’s contribution to the interaction, but does not focus on how the patient
contributes to the interaction.
ii
Several items in the Motivational Interviewing Skills for Health Care Encounters
(MISHCE) are specifically reflective of the use of MI in health care encounters. These items
have added to the uniqueness of the MISHCE and emphasize its specificity in evaluation of MI
skills in health care encounters. The MISHCE is also unique in that while it evaluates the health
care provider’s skills and knowledge, it also has an item that evaluates the “flow” of the
interaction. The MISHCE can be used in training and supervision.

iii
Acknowledgements

The author would like to thank the chair of this dissertation, Dr. Jan Kavookjian, as well
as the committee members, Dr. John Dagley, Dr. Sharon McDonough, Dr. Michael Madson, and
Dr. David Shannon for their support, patience, and assistance with this project. The author would
also like to thank Dr. Bruce Berger, professor emeritus in the Department of Pharmacy Care
Systems.
The author would like to express gratitude to the doctoral students and friends Michelle
Breland, Abishek Krishna Pillai, Saranrat Wittayanukorn, Qian Ding, Dr. Linda Byrd, and
Batsirai Bvunzawabaya, as well as the entire staff at the Department of Pharmacy Care Systems
for their unconditional support during the course of this investigation and their creative ideas for
timely and successful completion of this investigation. The author would like to thank the
following faculty and professionals for their support and expertise: Dr. Elena Petrova, Dr.
William Villaume, Dr. Joe Abhold, Dr. Heather Whitley, and Dr. Kimberly Plake.
Also, the author would like to thank family members Elena, Nada, and Aleksandar
Petrovi for their emotional and financial support and encouragement during this investigation.
Finally, the author would like to thank family members and friends, Vera Hristova, Harshal
Pandya, and Dr. Minov Jordan, for their ongoing emotional support.

iv
Table of Contents

Abstract ..................................................................................................................................... ii
Acknowledgements ....................................................................................................................... iv
List of Tables ................................................................................................................................. ix
Introduction ......................................................................................................................................1
Purpose .......................................................................................................................................1
Background of MI ......................................................................................................................1
Motivational Interviewing from a theoretical standpoint ...................................................1
Motivational Interviewing as an approach ...........................................................................2
The spirit and skills of Motivational Interviewing .............................................................5
Significance of Motivational Interviewing .........................................................................6
Current Instruments ...................................................................................................................7
Significance of the Development of a New Assessment Tool .................................................12
Research Questions ..................................................................................................................14
Literature Review...........................................................................................................................15
Origins of Motivational Interviewing ......................................................................................15
The Person-Centered Approach ...............................................................................................16
Motivational Interviewing and Person-Centered Theory .......................................................18
Links with Other Theories .......................................................................................................19
Motivational Interviewing Principles ......................................................................................20
v
Motivational Interviewing Microskills ....................................................................................25
Menu of Motivational Interviewing Strategies ........................................................................26
The Helping Relationship ........................................................................................................27
Measuring Knowledge and Skills in Motivational Interviewing .............................................28
Measuring Interpersonal Skills and Competence ....................................................................29
Assessment of Performance .....................................................................................................31
Existing Assessment Tools ......................................................................................................34
Motivational Interviewing Skills Code (MISC) ................................................................34
Measure description .....................................................................................................34
Psychometric properties ...............................................................................................36
Conclusions regarding the MISC .................................................................................36
Motivational Interviewing Treatment Integrity Scale (MITI) ...........................................37
Measure description .....................................................................................................37
Psychometric properties ...............................................................................................37
Conclusions regarding the MITI ..................................................................................38
Behavioral Change Counseling Index (BECCI) ................................................................38
Measure description .....................................................................................................38
Psychometric properties ...............................................................................................39
Conclusions regarding the BECCI ...............................................................................41
Motivational Interviewing Process Code (MIPC) .............................................................41
Measure description .....................................................................................................41
Psychometric properties ...............................................................................................42
Conclusions regarding the MIPC .................................................................................42
vi
Motivation Interviewing Supervision & Training Scale (MISTS) ....................................42
Measure description .....................................................................................................43
Psychometric properties ...............................................................................................43
Conclusions regarding the MIPC .............................................................................…44
Summary ..................................................................................................................................44
Methodology ..................................................................................................................................46
Participants ...............................................................................................................................46
Procedure .................................................................................................................................47
Patient-trainee interaction ..................................................................................................47
Instrument development .....................................................................................................47
The Motivational Interviewing Skills for Health Care Encounters (MISHCE) ......................51
Validity ..............................................................................................................................54
Expert panel .................................................................................................................55
Reliability ...........................................................................................................................56
Results…………………………………………………………………………………………... 59
Validity ....................................................................................................................................59
Reliability .................................................................................................................................61
Internal consistency reliability ...........................................................................................61
Inter-rater reliability ...........................................................................................................63
Test-retest reliability ..........................................................................................................66
Discussion. .....................................................................................................................................72
Interpretation of the Results ....................................................................................................72
Validity ....................................................................................................................................72
vii
Reliability .................................................................................................................................73
Internal consistency reliability ...........................................................................................73
Inter-rater reliability ..........................................................................................................75
Test-retest reliability ..........................................................................................................75
Limitations and Considerations ...............................................................................................76
Significance of the MISHCE .............................................................................................79
The MISHCE vs. Existing Instruments .............................................................................82
Current and Future Use of the MISHCE............................................................................83
References .....................................................................................................................................86
Appendix A: Table 1 ......................................................................................................................93
Appendix B: Panel of Experts Review Form .................................................................................96
Appendix C: The MISHCE ..........................................................................................................101
Appendix D: The Manual ............................................................................................................104
Appendix E: Examples of MI Adherent and MI Non-Adherent Behaviors ................................150

viii
List of Tables

Table 1: Characteristics of the Included Studies…………………………………………………93
Table 2: Internal Consistency Reliability-Cronbach’s Alpha if Item Deleted...............................62

Table 3: Internal Consistency Reliability-Cronbach’s Alpha per Domain………………………63
Table 4: Inter-rater Reliability-ICCs for Individual Items……………………………… ………65

Table 5: Test-retest Reliability-Intraclass Correlation (ICC) Per Item, For the Five Raters.........67

Table 6: Test-retest Reliability-SEM per Item for the Five Raters………………………………69

Table 7: Pearson r for Test-retest Reliability……………………………………………….........71

ix
Introduction
Purpose
There are several existing instruments that measure knowledge and skills acquisition in
motivational interviewing (MI). Revising existing instruments or developing new instruments
that would measure the skills and spirit of MI accurately is challenging. Development of
instruments requires much knowledge about the measured concept and knowledge in the process
of instrument development. The purpose of this research project was to create an instrument that
measures skills and knowledge in MI that is less complex than existing instruments, less time
consuming, more cost effective, and is appropriate for use with health care providers who are
trainees in MI. The goal of this research project was to develop a valid, reliable, brief, and
effective assessment tool for assessing mastery of MI skills in health care provider trainees
attending training in MI. There is hope that the developed assessment tool will be used in future
research on the effectiveness of brief MI training in acquisition of MI skills and principles, as
well as in future evaluation of performance of MI trainees.
Background of Motivational Interviewing
Motivational Interviewing from a theoretical standpoint. Motivational interviewing is
based on the person-centered approach of helping. The person-centered approach of helping
people comes from humanistic psychology. Its principles were posed by Carl Rogers.
Motivational interviewing also incorporates elements from social psychology, applying
processes like attribution, cognitive dissonance, and self efficacy. Motivational interviewing has
1