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Motiverande samtal (Motivational Interviewing, MI) är en utbredd metod som används vid exempelvis drogberoende, viktminskning och diabetes för att uppnå varaktiga beteendeförändringar. Sådana här beteendeförändringar är önskvärda även inom tandvården, och syftet med denna litteraturstudie var därför att undersöka om motiverande samtal kan användas inom vårt område. Sökning i databaserna PubMed, PsycINFO via CSA och Cochrane library resulterade i sex relevanta artiklar: tre av dessa redogjorde för kariesprevention hos små barn, två behandlade rökavvänjning och en av artiklarna studerade tandvårdsutnyttjande. Analys av artiklarna indikerar att MI kan ha en ökad kariespreventiv effekt jämfört med traditionell munhälsoinformation, men angående metodens effekt på rökavvänjning och tandvårdsutnyttjande kan dock inga slutsatser dras. Vår litteraturstudie visar en tendens mot att MI kan fungera bättre än traditionell munhälsoinformation men fler studier behövs inom ämnet oral hälsa.

Bakgrund: Rökning skapar både ett fysiskt och ett psykologiskt beroende vilket gör vanan svår att bryta. En del av sjuksköterskans ansvarsområde är att arbeta hälsofrämjande och att använda sig av kunskapsbaserade metoder. En av dessa är Motivational Interviewing (MI) som är en patientcentrerad samtalsmetod som kan användas inom omvårdnad i syfte att hjälpa patienter till hälsofrämjande livsstilsförändringar. Inga tydliga riktlinjer finns dock för metodens effektivitet vid rökavvänjning. Syfte: Att undersöka forskningsresultat som stödjer eller avfärdar MI som rökavvänjningsmetod. Design: En litteraturöversikt användes i denna uppsats. Resultat: Resultatet sammanställdes utifrån den vetenskapliga litteraturen. Stöd framkom gällande rökstopp, minskat bruk av cigaretter, motivation, minskat röksug samt kostnadseffektivitet vid återfallsprevention. Avfärdande resultat framkom gällande rökstopp och kostnadseffektivitet vid rökstopp. Slutsats: Resultaten indikerar att metoden kan användas framgångsrikt om den anpassas efter de förutsättningar som ges gällande exempelvis patientens rökvanor och aktuella motivation. Mer forskning behövs dock. / Background: Smoking creates a physiological and psychological dependence which makes the habit difficult to break. Nurses are responsible, as part of their professional duty, to work with lifestyle prevention using evidence-based methods. One of them is Motivational Interviewing, MI, a patient-centered technique, which aims to help patients with health-promoting lifestyle changes. There are no clear guidelines regarding this method's efficiency on smoking cessation. Aim: To study the research findings that support or reject MI on smoking cessation. Design: A literature review was used to perform this study. Results: The results were extracted from the scientific literature. Support were found in relation to smoking cessation, reduced smoking, motivation, reduced temptation to smoke and cost-effectiveness on relapse prevention. However, rejection emerged regarding smoking cessation and cost-effectiveness on smoking cessation. Conclusion: The results indicate that the method can be successfully used if adjusted for the conditions given, for example the patient´s smoking history and current motivation. Further research is needed.

Bakgrund: Antalet personer med diabetes i världen ökar. Det har blivit en global epidemi. Risken för dödsfall bland människor med diabetes, är ungefär dubbelt så stor, som för människor i samma ålder utan diabetes. Diabetes typ 2 (DT2) är den vanligaste typen av diabetes. Inom hälso- och sjukvården används alltmer motiverande samtal (MI) som behandlingsmetod för livsstilsrelaterade problem som till exempel: kost, motion alkohol och tobak. Syfte: Syftet med studien var att beskriva hur sjuksköterskans användning av MI påverkar livsstilsförändringar hos personer med DT2 och deras upplevelse av behandlingen. Metod: En litteraturöversikt. Resultat: MI som behandlingsmetod gav flera positiva hälsoeffekter. Det framgick bland annat genom en sänkning av HbA1c. Även kunskapsnivån gällande livsstilsförändringar ökade efter MI-behandling. Vid användning av MI stärktes personens inneboende motivation till förändring. Slutsats: MI är en relativt ny metod som ännu inte fått stor genomslag inom diabetesvården. MI ger positiva hälsoeffekter som till exempel sänkt HbA1c. Deltagarna blev mer motiverade och medvetna om sitt eget ansvar för att göra livsstilsförändringar. Mer forskning om MI för personer med DT2 behövs. / Background: The number of people in the world with diabetes is on the rise. It has become a global epidemic. The mortality risk among people suffering from diabetes is about twice as large, then for people in the same age without diabetes. Diabetes type 2 (DT2) is the most common form of diabetes. Motivational interviewing (MI) as a method of treatment, has a growing use within the health care sector and is applied to lifestyle related issues such as alcohol, tobacco, diet and exercise. Aim: The aim of the study was to describe how the nurse’s use of MI affect life-style changes in people with DT2 and their experience of the treatment. Method: A literature review. Result: MI, used as a treatment gave several positive health benefits. It showed among other things that HbA1c was lowered. Also the level of knowledge regarding lifestyle changes increased after MI treatment. The use of MI strengthened the person’s intrinsic motivation of change. Conclusion: MI is a relatively new treatment method that still hasn’t received a greater impact within the diabetic health care. MI shows positive health benefits such as a lowered HbA1c. The participants became more motivated and aware of their own responsibility to make life-style changes. More research is needed concerning MI for people with DT2.

Ohälsosamma levnadsvanor så som dålig kost och brist på fysisk aktivitet leder till övervikt och fetma hos barn och ungdomar idag. För att inte de ohälsosamma levnadsvanorna ska ge framtida komplikationer är det viktigt att se till att barn och ungdomar får den hjälp de behöver för att motiveras till en beteendeförändring så tidigt som möjligt. Motiverande samtal (MI) är en samtalsmetod för att få individer motiverade till en förändring. Denna studie kommer att fokusera på just hälsosamma levnadsvanor. Olika hälso- och sjukvårds professioners använder motiverande samtal som metod för att stödja en beteendeförändring hos överviktiga ungdomar. Därutifrån har syftet till denna studie skapats vilket är att undersöka professionernas upplevelser av hur metoden fungerar på barn och ungdomar med övervikt. Studien har en kvalitativ insats som inkluderade intervjuer med sex stycken professioner. Intervjuerna spelades in och analyserades. Resultatet av studien visade att professionerna upplevde MI som en mycket positiv och användbar samtalsmetod och att kontinuitet behövdes för att upprätthålla kunskapen. Möjligheterna med att använda MI menar de professionella är att de ofta kan se en positiv förändring hos patientens beteende samt att de ser positivt på användningen av MI i framtiden. Författaren anser att det är viktigt att fortsätta utbilda personal som jobbar med människor inom MI då samhället troligtvis kan “spara” både pengar och tid hos personalen genom att använda MI i exempelvis primärvården. / The unhealthy lifestyles such as poor diets and lack of physical activity can lead to overweight and obesity for children and adolescents today. To not have the unhealthy lifestyles lead to future complications it’s important to give them the help and support they need to get motivated to change theirs behavior. Motivational interviewing (MI) is a method to help people change their behavior, this study will focus on a healthy lifestyle changes. A profession in healthcare uses the MI as a method to support the lifestyle change for children and adolescents with obesity. The purpose of this study is to examine what the professions experiences is concerning how the method works with children and adolescents with overweight. This study has used a qualitative method with six interviews. The interviews were recorded and analyzed. The result of this study showed that professions experiences MI as a very positive and useful method, also that the professions needed to use the method continuity to maintain the knowledge. The potential of MI as a method was that the professions often could see a positive change in the patient and the respondent had a positive view in using MI in the future. The author of this study believes that it’s incredibly important to keep working with MI as it probably can "save" money both for society and the work hours for professions in healthcare.

Preliminary research exists indicating the importance of counselor attitudes and organizational features as influencing use of evidence-based practices (EBPs). Conceptual models of evidence-based practice implementation posit relationships among factors theoretically associated with use of an EBP, yet little research exists that explores how a constellation of counselor characteristics relate to counselors’ use of evidence-based practices. Research is also lacking on the role of counselor characteristics in use of motivational interviewing, a specific evidence-based practice. In addition to identifying counselor characteristics associated with use of MI, this study explores how counselor characteristics directly and indirectly affect implementation relationships for MI. The study sample comes from a larger study testing how organizational facilitation influences outpatient substance abuse counselors’ use of MI, and client outcomes. Multiple regression was used to explore the contribution of counselor characteristics (amount of MI training, MI skill level, motivation to use MI, supportive attitudes toward MI, perception of organizational climate and MI skill level) on reported use of MI. Analyses with each dependent variable had different sample sizes: N=76 for relationships tested between counselor characteristics and use of MI and N=46 for relationships tested between counselor characteristics and MI skill level. Results suggest that among these characteristics, supportive attitudes related to MI and motivation to use MI significantly contribute to counselors’ use of MI with clients. Further, supportive attitudes related to MI and motivation to use MI each partially mediates the relationship between amount of MI training and counselor use of MI. But, findings are tempered by a sample comprised of relatively low levels of training and low MI skill level. Despite having very little training, and low skill levels, high usage of MI was reported by counselors. More empirical research utilizing larger samples with higher training levels is needed to better understand how counselor characteristics may affect EBPs implementation in order to promote the effective use of evidence-based practices. / text

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.