Ten training study practitioners were randomly selected and stratified based on group intensity assignment, discipline, and site to participate in in-depth interviews. The interviews lasted about 30 minutes, and Minneapolis study investigators conducted in-person interviews with local participants and telephone interviews with Denver participants. The interviews focused on experiences with both high- and moderate-intensity MI training programs, how MI was used in their practice, barriers to implementing MI, impressions of the MI training program, and their interactions with MI champions.
Focus group leaders were experienced interviewers who had not previously interacted with MI champions in the context of this study. Investigators conducting study practitioner interviews were blinded to group assignment. All interviews were audio-recorded and transcribed verbatim. Study investigators reviewed the focus group notes and interview transcripts, identified themes independently, and then discussed group themes. The most salient themes were selected to inform implementation of a larger scale MI training program.
Results
Nine MI champions participated in the focus groups, and 8 study practitioners from both sites representing all clinical disciplines completed in-depth interviews. Table 2 identifies the characteristics of each population.
MI Champion Focus Group Themes
The champions were asked to discuss all aspects of the program, including their training as champions, role as trainers, attitudes about using MI during patient encounters, and participation in the training program. Themes from the MI champion focus groups were placed in the following categories based on the authors’ analytic approach: training MI champions, training study practitioners, and attitudes about MI.
Training MI champions. The champions identified role-play exercises and receiving feedback as strengths of the training program. The champions also expressed the desire for more hands-on practice, especially in small groups. They wanted additional training on teaching MI and facilitating the booster sessions. The champions wanted an expert to train them on how to give feedback and how to best coach practitioners in their use of MI. Champions expressed a desire to have follow-up training sessions with the standardized patient to help them hone their newly acquired coaching skills.
Training study practitioners. The champions’ key role was to train local practitioners and lead the booster sessions for the high-intensity MI training group. Champions felt ill-prepared to fully cover the training materials during the initial half-day workshop and 6 booster sessions. Champions identified difficulty coordinating schedules with the practitioners and lack of compensation for participation as significant barriers to implementing the booster sessions. Champions felt that using a standardized patient during the booster sessions was a strength of the program and that making the cases more realistic could have further enhanced the program.
Attitudes about MI. Champions from both sites perceived MI to have a positive impact on patient care. However, all champions noted there were challenges in using MI in practice. Champions felt MI takes time, energy, and practice to gain proficiency. The current primary care system is not set up to support the use of MI. The appointment time slots are fixed, and VHA goals and the spirit of MI are not always compatible. VHA performance measures encourage providers to achieve performance targets with each patient, often requiring use of directives for patients on what to do. In contrast, MI encourages the patient to take the lead on goal setting and prioritizing.
Study Practitioner Interview Themes
The practitioners were asked to discuss MI skills training, using MI skills with patients, integrating MI into daily practice, getting other PACT members involved, booster sessions, interactions with champions, and suggestions for improving the MI program. Themes from the study practitioner interviews were grouped into the following categories: MI skills training, using MI skills, integrating MI into practice, and suggestions for improving MI training (Table 3).
MI skills training. Overall, the MI high-intensity participants stated they learned useful skills. They reported asking more questions that are open-ended and were more aware of the patient’s perspective. Practitioners reported that booster sessions provided a way to reinforce, refine, and practice their MI skills. Practitioners reported that having the champion located in their own PACT was critical for connecting with their champion between sessions. Nurses and doctors reported that not having time to meet with champions was a barrier, while pharmacists reported more flexibility.