Training Oral Health Providers in Brief Motivational Interviewing: Pilot Study

Objective: To evaluate a brief motivational interviewing-informed educational module developed for oral health providers(OHP).

Method: A four-hour training module was developed by one author (AK) and presented in two group sessions to 34 participants. OHPs were recruited via mail/email from our practice-based research network CROWN or the Cleveland Dental Hygiene Society.   Session components included lecture, role-playing, and small group interactions.  Co-investigators facilitated small group discussions.  Participants completed pre-and 1-month post-session surveys; items were compared using a Wilcoxen signed rank test.   Written responses to a patient counseling scenario were reviewed for MI-adherent and non-adherent wording, guided by the MITI scoring system.  

Result: OHPs averaged 20.6 years (±13, range 2-45) in practice and worked 30 hours (±10, range 8-40) per week.  Thirty-two OHPs worked in private general dental offices. Ten subjects did not complete a follow-up survey; there were no differences in baseline characteristics between these 10 and those who completed the post-session survey.   Participants estimated their patient populations as 20% children, 20% elderly and 60% between 18 and 65 years old.  Nineteen participants (57%) cited lack of reimbursement for counseling time as a moderate/strong barrier to changing communication style; time to learn new skills posed a moderate barrier for 65% of OHPs.  Confidence in recognizing readiness to change, facilitating patient behavior change, and documenting change plans increased significantly from pre to post-session (Z=-3.94, p<.001).  Of 6 MI knowledge questions on the post-survey, participants averaged 4.5 correct (±1.4, range 1-6).  Twelve of 21 participants included MI-adherent wording in the patient scenario post-session compared to pre-session.

Conclusion: OHPs interested in learning and implementing brief, MI-informed communication skills in practice face several barriers.  Inclusion of MI-based techniques must not appreciably extend patient visit time. Despite increased confidence, MI-adherent responses were difficult for many participants to write. Additional training and opportunities to hone MI skills are needed.