Motivational interviewing and health coaching: A quantitative and qualitative exploration of integration

Motivational Interviewing (MI) has demonstrated efficacy in changing difficult behavior problems that contribute to the rising health care costs associated with chronic diseases and disability. Health care systems employ methods such as MI-based health coaching in service of behavior change. Fifty nurses conducting telephone health coaching with members of a large, national health insurer in the U.S. were recruited to participate in a study designed to examine the role of MI in health coaching. It was hypothesized that the skills of the nurses would predict patient self-exploration and the intensity and slope of patient change talk during the session. The nurses were given MI training and ongoing supervision. Up to four recorded sessions per nurse (199 total sessions) were randomly selected and transcribed for analysis. The sessions were coded with the Motivational Interviewing Skill Code (MISC). Initial coding suggested that the calls were complex, most often not about behavior change, and that MI was infrequently used. Patient self-exploration was predicted by the nurse means of the sum of the global ratings, the percent complex reflections, the number of support statements, and the length of the individual session (p=.0361, accounting for 57% of the nurse level variance). There were inadequate data to examine a hypothesis about change talk. A coding system was developed to be used with a random sample of 50 sessions, one per nurse. Each turn-of-talk in the transcript was coded for content, indicating a mean of 22% of total turns-of-talk in a session were about potential target behavior, 20% about medical issues, and 42% about personal issues. Patient responses were rated on the depth of self-exploration and those high in self-exploration (4% of total) analyzed. The results suggested that nurses were not promoting self-exploration. Three calls that included extensive self-exploration are described. A thematic analysis was also conducted on the 50 sessions. Results include discussion of the patient types, the nature of the relationship, structural elements of the calls, and missed opportunities to use MI. Recommendations are made about development of health coaching programs training and supervision of health coaches, and advancements in the MISC. (PsycINFO Database Record (c) 2010 APA, all rights reserved)