Mental health counselors who counsel adolescents suffering from substance abuse and obesity issues have successfully used motivational interviewing with their clients; however there is little data that has explored motivational interviewing when it has been used to address academic concerns in schools. The purpose of this study was to explore the experiences of school counselors who have used motivational interviewing to improve student academic performance. This heuristic phenomenological qualitative study examined the perceptions and experiences of professional school counselors who had used motivational interviewing in their schools. Criterion sampling was used to recruit 9 middle and high schools counselors from across the United States. Interview data was analyzed using NVivo software and provisional coding, which revealed four specific themes: defining motivational interviewing in schools, explaining specific techniques, combining motivational interviewing with other theories, and training opportunities for school counselors. The themes that emerged from this study strengthen existing research and provide current and future school counselors with insight into the potential that motivational interviewing could bring to their school counseling programs.

Dual diagnosis clients continue to have low treatment completion rates. The purpose of the current study was to understand if motivational interviewing helped to increase completion rates for clients receiving cognitive behavioral therapy (CBT). Studying the problem was necessary for identifying an evidenced-based model for mental health counselors to help clients with dual diagnoses complete CBT treatment. There were no studies available for understanding the effectiveness of motivational interviewing as a tool for improving treatment completion rates for dual diagnoses clients in intensive outpatient programs. The research question examined if motivational interviewing was effective for improving treatment completion rates for the dual diagnosis population. A quantitative methodology with a quasi-experimental design used for this study and included a paired samples t test, a chi-square test, and a logistic regression analysis. The results showed a statistically significant association between receiving the motivational interviewing techniques and completing CBT. Clients who received motivational interviewing were 4 times more likely to complete CBT treatment compared to clients who did not receive the technique. Clients with increased self-efficacy levels were 2 times more likely to complete treatment, thus addressing the problem of dual diagnosis clients having low treatment completion rates. The overall results demonstrated that clients reduced substance use relapse and recidivism improved. Completing treatment helped to reduce crimes related to drug use; it also prepared substance users for return to society as productive citizens, which promoted positive social change.

Adolescents with acting-out behavior have an increased risk of dropping out of high school, incarceration, and early mortality. Researchers have indicated the need for studies using motivational interviewing (MI) to promote behavioral change. There is a gap in the literature about the efficacy of MI with adolescents and clinicians' knowledge of, and attitude toward, MI. Using self-determination theory as the grounding theory, this study examined the knowledge and attitudes of 73 clinicians on the island of St. Croix, Virgin Islands, about knowledge and attitudes of MI and whether it predicted the use of MI as a therapeutic intervention for adolescents who exhibit acting-out behavior. A cross-sectional survey was used to collect data using an adapted version of Leffingwell's Motivational Interviewing Knowledge and Attitudes Test (MIKAT). Two phases were required: a pilot study and a full study. A pilot study of 10 clinicians was used to establish the reliability of the revised MIKAT. In total a purposive sample of 73 clinicians participated in the full study, which includes the 10 from the pilot study. Results of the multiple linear regression test indicated that knowledge about MI and attitudes towards MI were not significant predictors of likelihood to use MI (p = .875). The results of this study may contribute to positive social change by supporting the development of effective training for clinicians who work with adolescents on St. Croix, where adolescent behavior is of great concern.

Medication nonadherence is a healthcare problem that costs the United States billions of dollars annually. The purpose of this project was to propose an evidence-based program for healthcare personnel to increase the rate of medication adherence in hypertensive Black adults who require daily, oral medication. The transtheoretical model of change was used to explain the process of change and to identify approaches to changing non-adherent behaviors related to medications. Motivational interviewing was used to explain the process that nurse-educators would use to guide patients through the stages of change. In the initial step of this quality improvement program, a convenience sample of 9 healthcare personnel were given an overview of the proposed program and asked to provide feedback on the relevance and meaningfulness of the proposed program using a program development evaluation form. Numerical data collected from the evaluation form were gathered using a 5-point Likert-type, scale. The data results were analyzed to determine the relevance and meaningfulness of the proposed program. The analyzed data were reported in frequency and percentages. Descriptive statistics were used. According to the findings, all 9 healthcare personnel supported the use of the proposed program and believed that its content was relevant and meaningful to clinical practice. The findings also revealed that 8 out of the 9 healthcare personnel believed that patients who qualified for the proposed program would be likely to participate. Adoption of this evidence-based program would facilitate social change by improving the rate of medication adherence in hypertensive Black adults and potentially improving their overall health.

Managers spend 75% of their time actively communicating with employees. Effective leadership communication is fundamental to employee job satisfaction. The purpose of this phenomenological study was to explore how communication strategies that government agency leaders use may motivate greater employee job satisfaction. Twenty employees of a government office in Florida were the general population sample. The motivational language theory helped explore the nature of job satisfaction by focusing on leadership and employee communication strategies. Leadership communication influences employee motivation through incorporating 3 categories of utterances: empathetic (illocutionary) language, direction-giving (perlocutionary) language, and meaning-making (locutionary) language. The Van Manen selective approach helped code and the Stevick-Colaizzi-Keen method helped analyze the participants' transcribed face-to-face interviews. Member checks and data saturation ensured the findings trustworthiness. The findings developed from coding and analyzing data led to the discovery of 4 themes: empathetic language, direction-giving language, meaning-making language, and job satisfaction. The 2 most important themes, direction-giving language and meaning-making language, help motivate job satisfaction by explaining how leadership advice, clear instructions, and leadership stories pertaining to primary events from the agency's past provide direction and a feeling of job satisfaction. Social implications of this study include creating and improving organizational communication best practices and guidelines to help leaders communicate information effectively and to motivate regional governmental organization employee job satisfaction.

This thesis tested an appraisal, coping and adaptation model of job insecurity and organisational change with a sample of police officers. The model integrated key aspects of Lazarus' (1991a, 1999) cognitive-motivational-relational theory of emotion (personal coping resources, appraisal questions, emotion, coping and adaptation outcomes) with the ten job characteristics (opportunity for control, opportunity for skill use, externally generated goals, variety, environmental clarity, availability of money, physical security, opportunity for interpersonal contact, valued social position and supportive supervision) from Warr's (1987, 1999) vitamin model. The ten job characteristics were viewed as valued aspects of the environment that may potentially be lost or threatened during organisational crisis or change. The service within which the police officers worked underwent a large scale organisational restructuring from late 2001 to July 2002. Three research studies were conducted for this thesis. The first study developed a psychometrically sound, 40-item job characteristics scale, based on the ten dimensions of Warr's vitamin model. This scale assessed participants' worries about changes to aspects in their work environment. The development of this scale met a need within the job insecurity literature for a theoretically-derived measure of valued job features, and enabled the investigation of the appraisal, coping and adaptation model. This measure was included in the questionnaire for the cross-sectional and longitudinal studies that formed the second and third major research projects of this thesis. The main aim of the second study was to test a proposed model of appraisal, emotion, coping and adaptation following the experience of organisational change. The model proposed that person variables and personal coping resources (e.g., personal control and coping self-efficacy) would have indirect associations with the adaptational outcomes of Psychological Distress, Life Satisfaction and Job Withdrawal Behaviour. The personal coping resources were proposed to have indirect relationships with coping strategies through job characteristics, appraisal and emotion as well as direct associations with levels of distress, Life Satisfaction and Job Withdrawal Behaviour. The ten job characteristics were expected to have a direct relationship with Psychological Distress, and indirect associations with the three adaptational outcomes through appraisal, emotion and coping. Primary and secondary appraisal was proposed to precede and directly influence emotion. In turn, emotions were expected to directly relate to the coping strategies that were used, with coping strategies mediating the association between emotion and the three adaptational outcomes. An additional focus of this study was to determine whether there were mean differences for males and females on the variables examined. The second study was conducted in November 2002, three months after the restructuring. Two thousand two hundred and eighteen police officers were invited to participate in the study, with a total sample of 303 police officers responding. The antecedent variables (personal resources, job characteristics, perception of global job insecurity, appraisal components, feelings, coping strategies) and the indicators of employee adjustment (Psychological Distress, Life Satisfaction and Job Withdrawal Behaviour) were collected via a self-report questionnaire. Collateral data were also obtained from a friend, spouse/partner or work colleague of the police officer for the dependent variables of Psychological Distress and Life Satisfaction. Hierarchical multiple regression analyses were applied to investigate the aims of this study. Some support for a partial mediating model was obtained, mainly with the work specific adaptational outcomes of Psychological Distress and Job Withdrawal Behaviour. The antecedent variables in the model explained a substantial amount of variance for each of the adaptation outcomes. Notably, the antecedents of the model to uniquely account for variance in Life Satisfaction, a non-work contextual outcome, were person variables and personal coping resources. The third research study used a two-wave longitudinal panel design. The principle aim of this study was to test the proposed model of appraisal, coping and adaptation, longitudinally. Specifically, the aim was to examine whether initial levels, and changes in levels over time in aspects of the proposed model predicted later levels, and changes across time in the adaptational outcomes of Psychological Distress, Life Satisfaction and Job Withdrawal Behaviour. The study was conducted in April and May, four to five months after the T1 data had been collected, and seven months after the restructuring. A total of 158 police officers responded from the 303 that participated in Study 2. Difference scores were calculated to examine change across time within hierarchical multiple regression analyses. Three longitudinal regression models (Basic, Change-in-Outcome and Change/Change) were examined to test for robust effects. The model explained considerably more variance in Psychological Distress across all three longitudinal models tested, compared to Life Satisfaction and Job Withdrawal Behaviour. Generally the work related antecedents (T1) had no or minimal association with change in Life Satisfaction. However, change in physical safety was associated with change in Life Satisfaction across the two points in time. Some robust associations were found for emotion coping strategies with Psychological Distress; personal control with Life Satisfaction; and negative feelings with Job Withdrawal Behaviour. The findings from the three studies are discussed with reference to Lazarus' (1991a, 1999) cognitive-motivational-relational theory and Warr's (1987, 1999) vitamin model. The findings from the cross-sectional and longitudinal research studies support partial mediating relationships among the antecedents with the adaptational outcomes. There is debate within the job insecurity literature as to whether potential loss of job features should be included in the definition and operationalisation of this construct. Based on the results of the research, it is recommended that the definition and operationalisation of job insecurity include potential loss of job features and potential loss of the job. The model tested accounted for more variance in the work specific outcomes of Psychological Distress and Job Withdrawal Behaviour than Life Satisfaction. Thus, the organisational restructuring appeared to have a greater association with work-specific outcomes rather than non-work outcomes. Some limitations of the research are noted. For example, the small sample size limited the ability to use latent variable model testing procedures. Second, the conclusions from the research studies are applicable to a police service organisation and thus may be limited in their application to employees in other organisations. Third, the model focused quite heavily on the individual within the organisation, examining personal resources and characteristics. Nonetheless, this research has contributed to the literature in several ways by: (a) developing a theoretically founded measure of valued job characteristics, (b) demonstrating the importance of evaluating changes to these features of the work environment and the potential loss of the job during organisational instability, and (c) testing an appraisal, coping and adaptation model that shows much promise for use within organisations undergoing crisis or change. This newly developed and tested model appears especially useful in understanding the impact of organisation changes on work related outcomes.

In the 21st century drug and alcohol abuse presents one of the most serious problems worldwide. Of particular concern is the strong relationship between drug use and crime. While law enforcement strategies, including incarceration, have been revealed to contribute little to break the vicious cycle of drug use and crime, substance abuse treatment has been shown to represent an effective form of intervention. Substantial research on the effectiveness of drug treatment has demonstrated the importance of motivation in predicting treatment retention and success. However, substance users are frequently coerced into therapy by external sources, including the criminal justice system, therefore, typically exhibiting little motivation to enter and remain in treatment long enough to overcome their substance addiction. Although past research investigating the effects of treatment-entry coercion indicates positive treatment results, the vast majority of these studies are seriously impeded by extensive conceptual and methodological problems, questioning the postulated value of coercion in substance abuse treatment. Following the call for a shift in the methodological focus of future studies made by some researchers, the author of the present study tested three models that were based on well-established theories. The first model was based on Self Determination Theory (SDT), a motivational theory, while the second model was based on the Theory of Planned Behaviour (TPB), an expectancy-value theory. The third model consisted of a combination of the two theories, which was argued to provide a more complete and comprehensive model than each theory on its own. The testing of the models allowed the exploration of the dynamic interplay and relationships between a number of variables including perceptions of coercion, motivation, perceived autonomy support, and behavioural intentions in an effort to explain and predict retention and treatment outcomes amongst drug and alcohol abusers. The study was conducted in two phases. Phase 1 involved the development of a 29-item instrument called the Perceived Coercion Questionnaire, which was designed to assess participants' perceptions of coercion to enter drug and alcohol treatment originating from six different sources. The scale was shown to be a valid and reliable measure of the coercion construct. Phase 2 involved the testing of the three models longitudinally by using a sample of 350 substance abusers from six therapeutic communities across Australia. Participants were asked to complete a battery of standardised measures within the first two weeks of treatment admission (Time 1), two months into treatment (Time 2), and at completion of the treatment program (Time 3). The models were tested cross-sectionally and longitudinally employing hierarchical multiple regression analysis. In addition, change scores were calculated to test whether changes in predictor variables would predict outcomes and changes in outcomes cross-sectionally and longitudinally. Analyses of Time 1 and Time 2 cross-sectional data revealed that the SDT model, compared to the TPB and the combined model, provided a better and more parsimonious account of the factors that influence outcomes in therapeutic community treatment. Given the complexity of the study, it was decided to resume the analysis by focusing on the investigation of the SDT model alone. To highlight some of the most important findings, results demonstrated that motivation was a key factor in the treatment and rehabilitation of substance users. As anticipated, intrinsic motivation was consistently predictive of retention and more positive treatment outcomes, while external motivation and amotivation were associated with more negative outcomes. Results also revealed that clients who entered treatment as the result of a legal mandate experienced substantially higher levels of legal coercion compared to clients who entered treatment voluntarily. Legal coercion, in turn, was found to exert a negative impact on substance users' motivation for treatment, thereby indirectly resulting in more negative treatment outcomes. In contrast, self coercion (i.e., feelings of pain and suffering) and health-related pressures seemed to facilitate the development of a more intrinsic motivational attitude towards treatment. Besides, perceptions of competence and control in relation to the therapeutic regime emerged as consistent and important predictors of motivation and treatment outcomes. Finally, findings suggested that treatment staff who employed more autonomous and non-coercive strategies that guided substance users through the change process directly influenced individuals' treatment motivation and thereby facilitated more positive treatment outcomes. In sum, findings provided support for the usefulness of the SDT model in predicting dropout as well as processes and outcomes in therapeutic community drug and alcohol treatment. Implications for residential substance abuse treatment were discussed, as well as the strengths and limitations of the study. The discussion concludes with implications for practice and suggestions for future research.

<p><strong>Background:</strong> The past three decades have seen a growth in health promotion research and practice, stimulated by the epidemiologic transition of the leading causes of death from infectious to chronic diseases. An estimated 50% of mortality from the 10 leading causes of death is due to behaviour, which suggests individuals can make important contributions to their own health by adopting some health-related behaviours and avoiding others. Motivational interviewing (MI) has emerged as a brief counselling approach for behavioural modification that builds on a patient empowerment perspective by supporting self-esteem and self-efficacy. MI has become increasingly popular in a variety of health care settings as well as non-health care settings.</p><p><strong>Aims:</strong> The overall aim of this thesis is to contribute to improved understanding of the different factors that impact on the learning and practice of MI. The aim of study I was to identify barriers and facilitators to use MI with overweight and obese children in child welfare and school health services. The aim of study II was to identify barriers, facilitators and modifiers to use MI with pharmacy clients in community pharmacies.</p><p><strong>Methods:</strong> Participants in study I were five child welfare centre nurses from the county council and six municipally-employed school health service nurses, all from Östergötland, Sweden. Participants in study II were 15 community pharmacy pharmacists in Östergötland Sweden. Data for both studies were obtained through focus group interviews with the participants, using interview guides containing open-ended questions related to the aims of the studies. Study II also included five individual interviews. Interview data were interpreted from a phenomenological perspective.</p><p><strong>Results:</strong> In study I, important barriers were nurses’ lack of recognition that overweight and obesity among children constitutes a health problem, problem ambivalence among nurses who felt that children’s weight might be a problem although there was no immediate motivation to do anything, and parents who the nurses believed were unmotivated to deal with their children’s weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem, and working with obese children rather than those who were overweight. In study II, pharmacists who had previously participated in education that included elements similar to MI felt this facilitated their use of MI. The opportunity to decide on appropriate clients and/or healthrelated behaviours for counselling was also an important facilitator. The pharmacists believed the physical environment of the pharmacies was favourable for MI use, but they experienced time limitations when there were many clients on the premises. They also experienced many difficulties associated with the practical application of MI, including initiating and concluding client conversations.</p><p><strong>Conclusions:</strong> Learning and practicing MI effectively is difficult for many practitioners as it requires a new way of thinking and acting. Practitioners’ use of MI is not effective unless there is recognition that there is an important health-related problem to be solved. Practitioners feel more confident using MI with clients who have health-compromising behaviours and/or risks in which the practitioners feel they have expertise. Possessing considerable MI counselling skills does not compensate for insufficient knowledge about a targeted health-related behaviour and/or risk. Feedback from clients plays an important role for the quality and quantity of practitioners’ MI use.</p>

<p>The purpose of this study was to describe how nurses, working in primary health care and responsible for diabetes care, reflected on patient information and education, its’ content and experiences of providing it. The study had a descriptive design and seven nurses from seven health care units in the middle of Sweden participated in the study. Data were analyzed with qualitative content analysis. The results are presented in two main categories; <em>“The information”</em> and<em> “The procedure”.</em> The two subcategories; Adjusting information and Bring about knowledge and to live with the disease<em> </em>emerged from <em>“The information”</em>. The five subcategories; Specific situation information, Increased insight about lifestyle changes, Developed dialogues, Nurses’ and patients’ perspective of responsibility and Supporting and follow ups<em> </em>were formulated from <em>“The procedure”</em>. Individual adjusted information within dialogues was highlighted. The motivational interview technique was considered as contributing to possibilities for more successful treatment and lifestyle changes. The main result showed that nurses responsible for diabetes care in primary health care empathized the need of individual adjusted information and the procedure providing it, in order to support the patients’ daily life.</p>

<p>We wanted to study if and how students become motivated and stimulated towards a permanent interest for regular physical activity, from a pedagogical perspective. Our goal was to examine how physical education teachers create motivation for the students and how you, as a physical education teacher, can motivate those students who are physically inactive due to obesity or other various kinds of problems. In the theoretical background, we have made a summary of sports and development of the physical education subject over the years. We also describe society´s perspective on public health. The motivation concept is definded and we explain different motivational theories. The study shows how teachers can help motivate their students and we discuss earlier research concerning motivation. The examination consisted of semi-structured interviews interpreted on the basis of research questions. When it comes to creating motivation for physical activity among students, the result shows that physical education teachers are of utmost importance. The students´ motivation can be influenced in a positive way if teachers encourage and praise all children and vary the education, adapting it to needs of the students.</p>