Aim: The overall aim of the present thesis was to describe and examine primary care nurses´ self-reports on training, use and performance as well as experiences and actual performance of MI. Method: One qualitative and three quantitative studies were conducted among primary care nurses. A study-specific questionnaire was sent to 980 primary care nurses and 673 (69%) responded (Study I). Semi-structured interviews were conducted with 20 MI trained primary care nurses (Study II). MI sessions between 12 (Study III) respective 23 (Study IV) primary care nurses and patients (total 32 respective 50 sessions) were audio-recorded. Data were analyzed using qualitative content analysis, Motivational Interviewing Integrity Code, Motivational Interviewing Sequential Code for Observing Process Exchanges and statistical analysis. Results: The findings showed that primary care nurses reported and experienced lack of training in MI and lack of prerequisites for using MI (Study I-II), while training, knowledge, prerequisites and time were associated with use of MI. They also reported and experienced that MI facilitated their work with patients (Study I-II) as well as elicited their own ability to motivate and be empathetic (Study II). About half of the primary care nurses reported that they used MI (Study I), and none of the nurses (Study III) achieved the approved skill levels in MI in their recorded sessions. They overestimated their performance on six of eight aspects of MI (Study III). The most frequently used nurse talk in the recorded sessions was neutral, which is not consistent with MI. Questions and reflections directed toward change were most likely to be followed by change talk among patients (Study IV). Conclusions: Self-reported knowledge about MI and personal as well as workplace prerequisites for using it were associated with self-reported use of MI. Participating nurses´ experienced that MI requires openness, practice, support, feedback and willingness. The participating primary care nurses did not achieve approved levels of MI skills in their recorded MI sessions. Patients´ change talk is more likely to occur after open questions, complex reflections as well as after questions and reflections directed toward change. / <p>Finansisärer: Högskolan i Gävle, STROKE-Riksförbundet, Hjärt-lung fonden och Erik, Karin and Gösta Selander Stiftelse</p>

This Doctorate of Nursing Practice (DNP) Project is a program evaluation of a Motivational Interviewing (MI) Training Program provided by Southeast Arizona Health Education Center (SEAHEC). MI is a counseling style that focuses on exploring and resolving ambivalence to elicit behavior change. The purpose of this DNP Project was to: 1) describe the Motivational Interviewing Training Program provided by SEAHEC for ¡Vivir Mejor! healthcare providers; and 2) evaluate the long-term effectiveness of the MI training program by assessing: a) if program participants have retained the MI skills they learned in the training program, and b) if program participants apply these learned MI skills one-year post intervention in their encounters with patients diagnosed with T2DM. The Centers for Disease Control (CDC) Framework for Program Evaluation was used to guide this program evaluation. An online survey was administered to the ¡Vivir Mejor! healthcare providers to evaluate the MI program. Overall, based on the survey results, there was a positive response to the SEAHEC MI Training Program. The results of this program evaluation are limited due to a low response rate. However, these results will be shared with key stakeholders to inform the development of future MI training programs for rural healthcare providers.

Bakgrund: Antalet personer med diabetes i världen ökar ständigt. Dåliga levnadsvanor ökar risken för diabeteskomplikationer. Vården har ett ansvar att stärka patientens motivation och förmåga till egenvård.  Syfte: Undersöka effekten av MI som behandlingsmetod för att hjälpa diabetespatienter till förbättrad egenvård.    Metod: Litteraturstudie. Artikelsökningar gjordes i de medicinska databaserna Pubmed, Cinahl och Scopus. I studien inkluderades 10 originalartiklar varav fem var av medelkvalitet och fem av hög kvalitet. Dessa delades in i två grupper vilka var effekt på HbA1c och blodfetter samt effekt på egenvård.    Resultat: Utifrån inkluderade studier kunde ingen signifikant effekt påvisas i HbA1c och blodfetter eller gällande kost, fysisk aktivitet eller medicinsk följsamhet. Däremot sågs positiv effekt vid mätningar av upplevd kompetens, kunskap och egenkontroll. En studie visade positiv effekt på HbA1c av MI i kombination med KBT.  De effekter som kunde påvisas avtog kort tid efter behandlingssessionerna upphört. Studiernas utformning och mätmetoder ifrågasattes.    Slutsats: I nuläget finns få studier inom området därför är det för tidigt att rekommendera MI som metod inom diabetesvården. Mer forskning behövs om MI med tydligare fokus på personalens relation med patienten och personalens MI-färdigheter om man syftar till att mäta effekten av MI-samtalet. / Background: The number of people with diabetes in the world is constantly increasing. Bad food habits increase the risk of diabetes complications. Healthcare has a responsibility to enhance the patient's motivation and ability for self-care. Objective: Investigate the impact of MI as a treatment to help patients with diabetes to better self-care. Method: Literature review. The search for articles were made in the medical databases Pubmed , Cinahl and Scopus. The study included 10 original articles of which five were medium and five high quality. These were divided into two groups, effect on HbA1c and blood lipids and effect on self-care. Results: Based on the included studies, no significant effect is demonstrated in HbA1c and blood lipids or current diet, physical activity or medical adherence. There was however a positive effect in measurements of perceived competence, knowledge and self-control. One study demonstrates a positive effect on HbA1c of MI in combination with CBT. The effects found subsided shortly after the treatment sessions ended. Study design and measurement methods were questioned. Conclusion: Few studies exist in the field, therefore, it is too early to yet recommend the MI-method in diabetes care. More research is needed on MI with a clearer focus on the interviewers relationship with the patient and the MI skills of the interviewers if one aims to measure the effect of the MI-sessions.

Hjärt- och kärlsjukdom är den främsta dödsorsaken i Sverige. Majoriteten av dem kan förebyggas med hjälp av en livsstilsförändring, men för att göra det krävs motivation. En evidensbaserad metod som används för att främja motivation och livsstilsförändringar är motiverande samtal (MI). Syftet med litteraturstudien var att utforska vilka effekter MI kunde ha i sjuksköterskans prevention av hjärt- och kärlsjukdom. Resultatet visade att MI hade en varierande, men genomgående positiv effekt i att förbättra de levnadsvanor som är kopplade till hjärt- och kärlsjukdom. Bland patienterna som hade deltagit i MI visades främst positiva effekter på fysisk aktivitet, kroppsmått och blodtryck. Kostvanorna hade kortsiktigt förbättrats, men långsiktigt varierade det hur länge de goda vanorna kunde behållas. Den hälsorelaterade livskvaliteten förbättrades, men patienterna upplevde dessutom en ökad ångest. Resultatet visade att MI är en effektiv metod i att främja livsstilsförändringar, däremot är val av utformandet av hur MI ska föras, i kombination med andra metoder och vilken patientgrupp som skulle gynnas mest oklart och implicerar vidare forskning i ämnet. / Cardiovascular disease (CVD) is the leading cause of death in Sweden. The majority of all CVDs can be prevented with the help of a lifestyle change, but to do so it requires motivation. An evidence-based approach used to promote motivation and lifestyle changes is motivational interviewing (MI). The aim of this literature review was to explore the effects that MI may have in the nurse’s preventive work against CVD. The results showed that MI had a varied but mainly positive effect in improving lifestyles that are associated with CVD. Among the patients who had participated in MI improvements were shown mainly in physical activity, body size and blood pressure. Dietary habits had improved in the short term, but in the long term it varied how long the good habits could be maintained. The health related quality of life had improved, but the patients also experienced an increase in anxiety. The results showed that MI is an effective method in promoting lifestyle changes, however, it is unclear which design of MI should be chosen, in combination with other methods, and what patient group would benefit the most, which implies further research on the subject.

Bakgrund: Socialstyrelsens nationella riktlinjer ger rekommendationer om metoder för att förebygga sjukdom genom att stödja människors förändring av sina levnadsvanor. Alla kvinnor ska erbjudas ett tidigt hälsosamtal vilket är av stor vikt för att identifiera ohälsosamma levnadsvanor. I arbetet med att motivera patienten till förändring är motiverande samtal (MI) en beprövad samtalsmetod som barnmorskan kan använda i samtalet med den gravida kvinnan. Effekterna av motiverande samtal har visat sig ha en gynnsam verkan på flera hälsorelaterade beteenden såsom bruk av alkohol, tobak och andra droger, kost och fysisk aktivitet. Syfte: Syftet med studien var att undersöka barnmorskors erfarenheter av och inställning till hälsosamtal i tidig graviditet. Metod: Studien var empirisk och har en kvalitativ ansats och bygger på åtta enskilda intervjuer. Datamaterialet analyserades med innehållsanalys enligt Graneheim och Lundman (2004). Resultat: I resultatet framkom sex kategorier som besvarade studiens syfte.  Kategorierna heter; tidig flexibel handläggning, intresserade och positiva till hälsosamtal, tidigt hälsosamtal är en vinst, barnmorskorna hade olika åsiketer om behov av utbildning, stor variation i genomförande av hälsosamtal och resurstillgång påverkar hälsosamtalets kvalitet. Slutsats: Det som framkom av studien var att tidsbristen är en avgörande faktor för  arbetet med hälsosamtal. Barnmorskorna hade delade uppfattningar om utbildningen som gavs var tillräcklig eller inte. En stor vinst sågs med tidigt hälsosamtal för både barnmorskan och den gravida kvinnan. Mer specifika riktlinjer och utbildningar bör därför finnas eftersom övervikt är ett växande hälsoproblem idag. / Background: The guidelines of the National Board of Health and Welfare provides recommendations on methods on how to prevent illness by supporting people to change their lifestyles. All women should be offered an early health dialogue which is of great importance to identify unhealthy habits. Motivational interviewing is a proven method that the midwife can use in the effort to motivate the pregnant woman. The effects of motivational interviewing has been shown to have a beneficial effect on several health-related behaviors such as use of alcohol, tobacco and other drugs, diet and physical activity. Objective: The aim of this study was to explore midwives' experiences of and attitudes towards health interviews in early pregnancy. Method: The study was empirical and has a qualitative approach and is based on eight single interviews. The data were analyzed by content analysis according Graneheim and Lundman (2004). Results: The results revealed six categories that answered the purpose of the study. The categories are called: early flexible handling, interested and supportive of health interviews, early health consultation is a benefit, the midwives had different opinions about the need for training, considerable variation in the implementation of health consultations and resource availability affects the quality of health discussions. Conclusion: The findings of the study was that lack of time is a crucial factor in the work of health consultations. The midwives had different views on the training given was adequate or not. A large gain was seen with early health consultations for both the midwife and the pregnant woman. More specific guidelines and training should therefore be implemented because obesity is a growing health problem today.

Bakgrund: Övervikt ökar idag bland svenska barn och skolsköterskor inom elevhälsan har en viktig del i arbetet för att få ner barns övervikt.   Syfte: Beskriva skolsköterskors erfarenheter av hälsofrämjande arbete med övervikt hos elever i högstadiet och gymnasiet. Metod: Nio skolsköterskor har intervjuats individuellt med hjälp av semistrukturerade intervjuer. Intervjuerna analyserades utifrån en innehållsanalys. Kategorier och subkategorier utformades sedan för att få en överblick av skolsköterskornas erfarenheter. Resultat: Skolsköterskorna möter vanligtvis eleverna vid hälsosamtalet och detta samtal är ofta grunden till hälsoarbetet när de har identifierat övervikt hos eleven. Skolsköterskorna eftersträvar att individualisera hjälpen eleverna får och de använder sig ofta av metoden motiverande samtal för att motivera eleverna till att genomföra en förändring.  De utgör även en rådgivande funktion då de kan bistå med olika kost- och motionsråd.  Skolsköterskorna förklarar att det även behövs ett samarbete för att få eleverna att bli aktiva och gå ner i vikt. Dels inom den egna professionen men framförallt interprofessionellt samarbete i skolmiljön. Föräldrarna involveras i detta arbete av några skolsköterskor samtidigt som andra anser att eleven måste få känna sig självständig i detta arbete. Konklusion: Skolsköterskornas arbetssätt har både likheter och skillnader. Att utveckla gemensamma strategier och riktlinjer för deras arbete kan därför vara en del av att förbättra det hälsofrämjande arbetet med övervikt hos elever. / Background: Overweight increases among Swedish children and school nurses have an important part to reduce overweight among children. Aim: Describe school nurses experiences of their health promotion for overweight in students. Method: Nine school nurses were interviewed individually by semi-structured interviews. The interviews were analyzed based on a content analysis, categories and subcategories were designed to provide an overview of the school nurses experiences. Results: School nurses usually meet students during a health conversation, this meeting is usually the foundation of their health work. The school nurses strive to individualize the support they give the students and they often use the method of motivational interviewing to motivate students to make a change. They can also assist with various diet and exercise advice. The school nurses explain that there is often a need for collaboration in order to get students to become active and lose weight. Both within their own profession but especially inter professional collaboration in the school environment. The parents get involved in this work by some of the school nurses while others believe that the student needs to feel independent. Conclusion: This study thus suggests both differences and similarities in health promotion for overweight among student. To develop a united strategy and guidelines for their work can therefore be a part of the improvement of their health promotion against overweight among students.

Motivational Interviewing (MI) is an evidence-based, directive, client-centered therapy designed to develop discrepancy and resolve ambivalence by eliciting and reinforcing client Change Talk. However, the exact link between the process engaged in during MI and outcome is only starting to be uncovered. The present thesis has replicated and expanded on the current knowledge of the relationship between Therapist and Client Behaviours during a MI-based intervention (Motivational Enhancement Therapy; MET) and outcome, and has provided support for the emergent theory of the inner workings of MI. This was achieved by coding 106 audiotaped MET sessions primarily by the methods outlined in the Motivational Interviewing Skill Code Version 2.0. Data was drawn from 28 participants who received 3-4 sessions of MET within the context of a randomised controlled trial for mild-moderate alcohol dependence at the Community Alcohol and Drug Service of Christchurch. Therapist and Client Behaviours were analysed within sessions (categorised into Early, Mid, or End Intervals) and across sessions, and compared with whether the client had drank within national drinking guidelines during the 6-months after MET (Controlled Drinkers). In terms of Client Behaviours during MET it was found that Uncontrolled Drinkers (compared with Controlled Drinkers) uttered a significantly higher frequency of Sustain Talk, lower Ability Language strength (over all MET and during End Intervals), and lower Commitment Language strength (during Session 2 and 4, and change over MET). Giving Information was the only Therapist Behaviour where significant differences were observed over all MET, with a higher frequency given to the Uncontrolled Drinkers. However, during End Intervals within MET Sessions, Controlled Drinkers received a significantly higher frequency of Advise without Permission and a lower frequency of Emphasise Control statements. In most instances MI-Consistent Therapist Behaviours were associated with higher strength of Ability and Commitment Language, and a lower frequency of Sustain Talk. MI-Inconsistent Therapist Behaviour, Direct, was associated with lower Client Language strength. Limitations to these results include small sample, limited ability to make inferences about causality, coder biases, and uneven reliability. However, this exploratory study was unique in investigating the relationship between Therapist Behaviours and the strength of Client Language, and in examining these factors within and across multiple sessions, and has produced a number of potentially valuable findings that warrant further investigation.

Thesis (Ph.D.)--Ohio University, August, 2008. / Title from PDF t.p. Includes bibliographical references.

Thesis (Ph.D.)--University of Wyoming, 2007. / Title from PDF title page (viewed on June 17, 2009). Includes bibliographical references (p. 42-52).

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