From a “Terrifying Challenge” to a “Professional Revelation” - Implementing Motivational Interviewing through Participatory Action Research

Abstract BackgroundMotivational Interviewing (MI) is a humanistic and evidence-based counseling approach within primary care. However, MI rarely translates to clinical practice that follows the usual introductory training programs; a lack of evidence regarding its implementation persists today. A participatory action research was conducted to (1) facilitate and describe the clinicians’ professional transformation through interprofessional communities of practice on motivational interviewing (ICP-MI), and (2) explore the contribution of ICP-MI in transforming their daily practices. This article addresses the first objective. MethodsData collection involved the principal investigator’s research journal, participant observation of four ICP-MIs (76 hours, 16 clinicians), and four appraisal focus groups. A general inductive approach was used for qualitative data analysis. ResultsFindings describe the four processes of MI implementation in primary care as motivational endeavors: ambivalence, introspection, experimentation, and mobilization. The clinicians were initially ambivalent with respect to MI implementation, taking into consideration the significant challenges involved. After introspecting previous practices, they realized the limits of their clinician-centered counseling approach, which consolidated their engagement in ICP-MI. Thus, the experimentation of MI implementation initiatives in the workplace followed and enabled clinicians to witness the feasibility and effectiveness of MI. Finally, the clinicians were intrinsically mobilized to ensure MI sustainability in their practices. Two categories of influencing factors were reported. Intrinsic factors included personal traits, and perception about MI as a clinical priority. Extrinsic factors related to organizational support that was crucial in providing the appropriate resources and supporting the clinicians’ implementation efforts. Results are discussed according to the Consolidated Framework for Implementation Research (CFIR).ConclusionsAs described in a fragmented manner in previous studies, MI implementation processes and influencing factors are presented in our study as integrated findings; we also suggest innovative avenues for future research projects. Considerations in elaborating effective training programs are highlighted, especially when it comes to providing motivational and organizational support to succeed at MI implementation within primary care.