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.

Bakgrund: Motiverande samtal (MI) är en metod för att behandla främst alkoholmissbruk, men har allt mer integrerats i behandlingen av andra substansmissbruk. Det flesta studier gällande MI har genomförts på vuxna varför effekten av MI på denna grupp är mest belagd. Antalet ungdomar med substansmissbruk ökar, vilket medför att en undersökning rörande studier om MI som riktas mot denna åldersgrupp (14-24 år) förefaller både relevant och nödvändig. Syfte: Syftet med denna litteraturstudie var att belysa vilken effekt MI har vid arbetet med ungdomar med substansmissbruk. Metod: Allmän litteraturstudie. Resultat: Interventioner med MI ledde till en konsumtionssänkning, en ökad motivation samt minskade substansrelaterade problem. Slutsats: MI har en positiv behandlingseffekt hos ungdomar med substansmissbruk. Resultaten stämmer överens med tidigare forskning och stödjer nyttan av en kort MI intervention hos ungdomar med en missbruksproblematik. Dock visades en ökad abstinens vid användning av tyngre droger. / Background: Motivational Interviewing (MI) is a method to treat primarily alcohol abuse, but has been increasingly integrated into the treatment of other substance abuse. Most studies of MI have been conducted in adults why the effects of MI in this group are mostly paved. The number of adolescents with substance abuse is increasing, leading to why an investigation concerning the studies on MI focused on this age group (14-24 years) seems both relevant and necessary. Aim: The aim of this study was to elucidate the effect of MI in the work with adolescents who hold a substance abuse. Method: A literature review. Results: The intervention with MI led to a consumption reduction, increased motivation, and reduced drug-related problems. Conclusions: MI has a therapeutic effect in adolescents with substance abuse. The results are consistent with previous research and support the utility of a brief MI intervention in adolescents with substance abuse problems. However, there was an expansion in abstinence from the use of heavier drugs.

Bakgrund: Sedan mitten av 1990-talet har alkoholkonsumtionen i Sverige ökat från drygt 8 liter ren alkohol per person och år till cirka 10,5 liter per person och år. Varje år dör minst 6000 människor i Sverige av orsaker relaterade till alkohol. Majoriteten av den svenska befolkningen konsumerar i måttlig mängd men en del hamnar i ett riskbruk eller missbruk som kan leda till ett beroende. Idag beräknas mellan 10-15 % av befolkningen i Sverige ha ett skadligt alkoholkonsumtionsmönster. MI (Motivational interviewing) är en metod som används av bland annat vårdpersonal för att motivera personer till förändring i sitt liv genom egen motivationshöjning. Syfte: Syftet med denna studie är att beskriva MI-metodens effekter på människors alkoholkonsumtion. Design: Denna uppsats är en litteraturöversikt. Resultat: MI hade en minskande effekt på alkoholkonsumtionen bland alla målgrupper som testats. MI har även positiva effekter såsom minskade alkoholrelaterade skador och upphörd alkoholkonsumtion. Vårt resultat visade dock att det inte nödvändigtvis måste vara så att MI-metoden är bättre än någon annan jämförande metod. Slutsats: Resultaten indikerar att MI är en effektiv metod att använda för att förändra livsstilen hos individer med skadlig alkoholkonsumtion. / Background: Since the mid-1990s alcohol consumption in Sweden has increased from eight liter pure alcohol per person and year, to approximately 10,5 liter per person and year. Each year in Sweden 6000 persons die from causes that relates to alcohol consumption. A majority of the Swedish population consumes alcohol moderately. However, some persons develop a destructive drinking habit that can result in addiction. Today 10-15% of the Swedish population estimates having developed an unhealthy consumption of alcohol. MI (Motivational interviewing) is a method that is used to motivate persons to change their lives by individual motivational improvement. Aim: The purpose of this study is to describe the effects of MI (Motivational interviewing) on people's alcohol consumption. Design: This study is a literature review. Result: MI had a positive effect that decreased alcohol consumption among all target groups. MI has positive effects on decreasing negative consequences of alcohol and cease alcohol consumption. Nonetheless, our results show that MI is not necessarily better than any other research method of comparison. Conclusion: The results indicate that MI is an effective method to be used to change lifestyles of individuals with dangerous alcohol consumption.

Bakgrund: Ohälsosamma matvanor är ett stort problem och är det som idag orsakar flest sjukdomar i Sverige. Kosten har en stor inverkan på insjuknande i olika sjukdomar och en god hälsofrämjande omvårdnad är därför av stor vikt för en friskare befolkning. Inom hälsofrämjande omvårdnad används Motiverande Samtal (MI) som en metod för att öka motivationen till en förändring. Syfte: Var att beskriva patientens erfarenheter och förändring efter en MI baserad kostrådgivning utförd av sjuksköterskan. Metod: Allmän litteraturstudie med innehållsanalys. Resultat: Litteraturstudien baserades på nio vetenskapliga artiklar som resulterade i tre huvudkategorier med respektive subkategorier. Resultatet visade att MI rådgivning kan hjälpa människor att förändra sin kost med hjälp av motivation och stöd från sjuksköterskan, men även hinder mot genomförandet av en förändring inom kosthållning identifierades. Resultatet tog också upp den fysiska och kognitiva förändringen som inträffade efter MI – samtalet med sjuksköterskan. Konklusion: För att genomföra en förändring krävs motivation. Motivationen kan påverkas positivt eller negativt beroendes på olika aspekter så som sjuksköterskans genomförande av samtalet och den egna viljan att förändras. Resultatet indikerade på att patientens förändring påverkas av kvalitén på det motiverande samtalet. / Background: Unhealthy eating habits are a major problem that causes most diseases in Sweden today. Diet has a major impact on becoming ill and good healthcare is of high importance for av healthier population. Within healthcare Motivational Interviewing is used as a method to increase motivation to make a change. Aim: To describe the patient's experience and change following a MI-based dietary counseling performed by the nurse. Method: General literature study with content analysis. Result: The literature study is based on nine scientific articles that resulted in three main categories with respective subcategories. The result showed that MI counseling can help people change their diet with the help of motivation and support from the nurse, but it also showed barriers to the implementation of a change in diet. The result also took on the physical and cognitive changes that occurred after the MI interview with the nurse. Conclusion: To make a change, motivation is required. Motivation can be positively or negatively affected by various aspects such as the caregiver's implementation of the conversation and the patients own will to change. The result indicated that the patient's change is affected by the quality of the motivational interview.

Bakgrund: Inom primärvården möter läkare och distriktssköterskor dagligen patienter som söker hjälp för symtom som är direkt relaterade till rökning. Att arbeta sjukdomsförebyggande genom livsstilsförändringar är en viktig del av distriktssköterskans ansvarsområde. Enligt Socialstyrelsens (2011) nationella riktlinjer finns tydliga rekommendationer för hur distriktssköterskor ska gå till väga med patienter som söker hjälp för att sluta röka. Syfte: Syftet var att belysa distriktssköterskans erfarenheter av arbetet med rökavvänjning för patienter samt vilka arbetsmetoder de använder för detta. Metod: En kvalitativ metod användes och 14 semistrukturerade intervjuer utfördes med distriktssköterskor som arbetar med rökavvänjning inom primärvård i ett län i södra Sverige. Vid dataanalysen användes manifest kvalitativ innehållsanalys. Resultat: Analysen av data resulterade i två kategorier: Distriktsköterskans tillvägagångssätt och Faktorer som påverkar rökavvänjning med fem underkategorier under vardera kategori. Resultatet i studien visar att distriktssköterskornas arbetsmetoder vid rökavvänjning består av Motiverande samtal MI (Motivational Interviewing) och kvalificerade rådgivande samtal med patienter. Distriktssköterskornas erfarenhet är att dessa två arbetsmetoder är de mest effektiva att använda för att kunna finna ut hur beslutsam samt hur motiverad patient är till rökstopp och hur de tillsammans kan planera vägen dit. Distriktssköterskornas erfarenhet av rökavvänjningsarbetet är att det ger positiv energi när patienten lyckas bli rökfri.  Det ger också ny energi till att fortsätta med motivationsarbetet. En generell svaghet som konstaterats är bristerna i uppföljning av om patienternas rökfrihet varit varaktig efter avslutad behandling. Slutsats:  Motiverande samtal i kombination med nikotinersättningsmedel beskrevs av distriktssköterskorna som betydelsefullt i strävan efter att stödja patienter till rökfrihet. Stöd av kollegor i form av nätverksträffar, utbildning inom samtalsmetod samt arbetslivserfarenhet var viktiga delar för distriktssköterskorna och underlättade för dem i arbete med att försöka stödja patienter till varaktig rökfrihet. / Background: In primary care physicians and district nurses faces on a daily basis patients seeking help for symptoms that are directly related to smoking. Working disease prevention through lifestyle changes is an important part of the district nurse's responsibility. According to the National Board of Health (2011) National guidelines there are clear recommendations for district nurses to proceed with patients seeking help to quit smoking. Objective: The objective was to highlight the district nurse practice and experience of working with smoking cessation for patients in primary care. Method: A qualitative method was used, and 14 semi-structured interviews were conducted with district nurses in Southern Sweden. The data was analyzed according to the method manifest qualitative content analysis. Results: The analysis of the data resulted in two categories: The primary nurse approaches and factors affecting smoking cessationwith five sub-categories in each category. The results of the study show that the district nurses working methods consists of Motivational Interviewing, MI and qualified advisory conversations with patients and smoking cessation. District nurses common experience that these two methods are the two most effective to use to find out how determined and how motivated the patient is to quit smoking and how they together can plan the way to quit smoking. District nurses experience from smoking cessation is that it gives them positive feedback when they manage to get the patient non-smoking and it gives positive energy to continue with the motivational work. An identified general weakness are shortcomings in monitoring whether patients' abstinence has been sustained after the treatment is finished.  Conclusion: Motivational interviewing and nicotine replacement medicine was described by the district nurses as important in the quest for supporting patients to quit smoking. Support of colleagues, training in communication technique in the form of network meetings and work were important parts of the districts nurses and facilitating them in their work is often very difficult and important task to try to support patients to smoke.

Syftet med studien var att undersöka klienternas och socialarbetarnas upplevelse av metoden motiverande samtal (motivational interviewing, MI), vilket besvaras genom frågeställningarna; hur upplever klienten kontakten med socialarbetaren som använder MI och vad är socialarbetarens upplevelse av MI metoden. Studien är genomförd med en triangulerande kvalitativ metod där studiens syfte blir belyst från tre olika perspektiv. Empirin baseras därför på två stycken intervjuer med klienter, två stycken intervjuer med socialarbetare och två stycken inspelade verkliga MI-sessioner mellan klient och handläggare. Som teoretisk referensram har resultatet analyserats utifrån begreppet empowerment. Resultatet visar att relationen mellan socialarbetare och klient är en avgörande faktor för att kunna bryta ett destruktivt beteende. Att formulera delmål på vägen mot ett större mål anser samtliga informanter vara av stor vikt i förändringsarbetet. Klienten har ett egenansvar om att förändra sin livssituation, där den ena klienten ställer sig negativ till eget ansvar. Båda klienterna berättar att, när de befunnit sig i ett aktivt missbruk har kontakten med socialtjänsten endast handlat om att få pengar eller utnyttja systemet på något sätt. I denna fas finns inte någon motivation att förändras, vilket leder till svårigheter. Resultatet visar att klienterna har upplevt sin handläggare som stöttande och en trygghet i processen att bli fri från sitt missbruk. / The aim of the study was to investigate the clients 'and the social workers' experience of the method of motivational interviewing, which is answered by the questions; how do clients experience the contact with social workers who use MI as a method and what is the social worker's experience of MI as a method. The study was conducted with a triangulation qualitative method where the purpose of the study was illuminated from three different perspectives. The empirical data is therefore based on two interviews with clients, two interviews with social workers and two MI-recorded real-sections between the client and the social worker. As a theoretical framework, the result has been analyzed based on the concept of empowerment. The result shows that the relationship between social worker and client is an essential factor to break destructive behavior. All of the informants believes that formulating partial goals is an important part in the changing process. The client has a personal responsibility to change their situation, one client is negative to that responsibility. Both of the clients report that, when in an active addiction, the contact with the social services only were about gain money or use the system. In this phase there is no motivation to change, which leads to difficulties. The results show that clients have experienced their administrators as supportive and secure in the process of becoming free from their addiction.

The effectiveness of drug abuse treatment for clients coerced into care remains controversial. Some studies find clients with legal pressure do better than those without legal pressure, while others report the exact opposite. Opposing views are often fueled by the wide-ranging models that guide delivery of addiction treatment. The present study examined how participants with and without legal pressure to attend treatment responded to a motivational (MET) vs. traditional (TAU) form of addiction treatment. Additionally, the predictive value of the Readiness to Change (RTC) score, from the URICA, was assessed across days of substance use and treatment retention. Legal status was shown to have a significant effect on days of primary substance use per week and treatment retention, regardless of intervention condition. The RTC score was shown not to be predictive of days of primary substance use or treatment retention. Research and clinical implications and future directions are discussed.

Purpose: To assess a caregiver’s oral health attitudes, habits, and behaviors pre and post intervention, and to determine whether a particular delivery-style (verbal-only or with visual supplementation) of a motivational interviewing session is more effective in improving oral health behaviors as well as improving success of a chosen preventive goal. Methods: N=140 caregivers of pediatric dental patients were given questionnaires to assess readiness to change and current preventive oral health behaviors. Oral health education was communicated in a MI style (verbal-only or with visual supplementation). One preventive oral health goal was selected to focus on. The home preventive behavior survey was re-administered at follow-up. Results: Preventive home behaviors improved, with no significant difference between interventions. There was significance in the amount of change in items specified as a goal. Conclusions: Behaviors improved significantly after a MI educational intervention. Goal setting and providing oral health education in a MI style can improve home preventive behaviors.

Purpose: The purpose of this study is to examine infant oral health knowledge and readiness of expectant mothers to incorporate preventive oral health behaviors for their infants. Methods: The study used a prospective cohort design to examine the effect of prenatal education and motivational counseling with expectant mothers about infant oral health care readiness. Participants were all enrolled in a prenatal care program called Centering Pregnancy offered by VCU’s Department of Obstetrics and Gynecology. They all completed a pre-survey questionnaire, followed by a motivational counseling intervention, and then completed a post-survey questionnaire. Results: A sample of 30 pregnant women completed the pre- and post-survey. The participants were predominantly white (60%) who had finished college (67%) with an average age of 28.8 years. Based on the analysis of the readiness (RAPIDD scale) responses, the participants showed an improvement in their value for dental health with a p-value illustrating a significant overall change between the pre and post surveys (p < .02). The results for the knowledge portion of the survey demonstrated an increase in their infant oral health education, showing a significant change across time (p < .0001). The results to the last portion of the pre and post survey illustrated that the participants learned at what age to establish a dental home for their infant. Conclusion: This study has shown that with the proper educational tools parents are able to accept and improve their knowledge related to infant oral health and the prevention of early childhood caries.

THE EFFECTS OF MOTIVATIONAL INTERVIEWING IN PREGNANCY ON KNOWLEDGE AND RETENTION OF INFANT ORAL HEALTH INFORMATION By Andrew D. Zima, Jr., B.S., M.S., D.D.S. A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Major Director: Tegwyn H. Brickhouse, D.D.S., Ph.D Associate Professor, Department of Pediatric Dentistry Purpose: The purpose was to examine the effect of motivational counseling in pregnancy with readiness and acceptance of infant oral health information. Methods: The study used a prospective cohort design to examine the effect of prenatal education and motivational counseling with expectant mothers about infant oral health care readiness. Participants were all enrolled in a prenatal care program called Centering Pregnancy offered by VCU’s Department of Obstetrics and Gynecology. They all completed a pre-survey questionnaire, followed by a motivational counseling intervention, and then completed a post-survey questionnaire. A third survey was sent out 1 year post-partum. The participants were evaluated for their willingness to accept v vi information, their knowledge about infant oral health, and the retention and implementation of infant oral health information. Results: A sample of 87 pregnant women completed the pre- and post-survey and 11 of these participants completed and mailed back the 1 year post-partum survey. Based on the analysis of the readiness (RAPIDD scale) responses, the participants showed statistically significant overall improvements in their pre versus post survey openness to health information (p < .0039) and value for dental health (p < .001). The results for the knowledge portion of the survey demonstrated an increase in their infant oral health education, showing a significant change across time (p < .0001) from the pre survey to both the post and 1 year post partum surveys. The results to the last portion of the pre, post, and 1 year survey illustrated that the participants learned at what age to establish a dental home for their infant. Conclusion: This study has shown that with the proper educational tools parents are able to accept and improve their knowledge related to infant oral health and the prevention of early childhood caries. Data suggests that parents are implementing routine home infant oral health measures, but fewer have established a dental home by age 1.