Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis

BMC Public Health

Carmen Cabezas⁵  Gemma Fanlo¹  José L Ballvé³  Silvia Granollers⁶  Javier González-Bonilla⁴  Margarida Pla²  Enriqueta Pujol-Ribera⁴  Núria Codern-Bové⁷ 

[1] Equip d’Atenció Primària L’Hospitalet de Llobregat - 11 Gornal, C/Carmen Amaya, 37-39, 08902 Hospitalet de Llobregat, Spain;Cátedra de recerca qualitativa, Fundació Dr Robert, Universitat Autònoma de Barcelona, C/St. Antoni Maria Claret, 171, 08041 Barcelona, Spain;Equip d’Atenció Primària L’Hospitalet de Llobregat - 7 Florida Nord, C/Parc dels Ocellets, s/n, 08905 Hospitalet de Llobregat, Spain;Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Àmbit d’Atenció Primària de Barcelona, Institut Català de la Salut, C/Gran Via Corts Catalanes, 587, àtic, 08007 Barcelona, Spain;Departament de Salut. Subdirecció de Prevenció i Promoció de Salut, C/de Roc Boronat, 81-95, 08005 Barcelona, Spain;Equip d’Atenció Primària Sant Just Desvern. SAP Baix Llobregat Centre, Av. Indústria, Sant Just Desvern, 08960 Barcelona, Spain;Escola Universitària d’Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma de Barcelona, C/De la Riba, 90, 08221 Terrassa, Spain

关键词: Social interaction;    Smoking cessation;    Qualitative research;    Primary health care;    Motivational interviewing;    Communication;    Conversation analysis;   

Others  :  1122887
DOI  :  10.1186/1471-2458-14-1225

 received in 2013-09-26, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS).

Methods

Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction.

Results

Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed.

Conclusions

Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.

【 授权许可】

   
2014 Codern-Bové et al.; licensee BioMed Central Ltd.

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