Assessing fidelity in Motivational Interviewing interventions; an overview

Abstract

(MI), a counselling approach designed to promote positive change with our clients, is based on four processes: engaging with the patient, focusing on a target behaviour, evoking perspectives from the patient and planning for change. The most important component of MI is the MI ‘spirit’. MI spirit is concerned with enhancing client-centred collaboration, evoking from the client, compassion, as well as acknowledging client autonomy. Despite evidence of MI efficacy and increasing use of MI in a range of oral health settings, little attention has been paid to documenting the integrity of MI delivery (fidelity). In the second of four manuscripts regarding challenges in testing fidelity in MI oral health interventions, this paper aims to define fidelity, its importance, and how to assess the fidelity of MI interventions. Methods: A thorough description of the internationally recognised and research based Motivational Interviewing Treatment Integrity (MITI) code, specifically developed to test MI fidelity, will be provided. Attention will be given to the global ratings of ‘empathy/understanding’ and ‘evocation’, as well as behaviour counts for ‘MI adherent’, ‘MI non-adherent’, ‘closed and open questions’ and ‘simple and complex reflections’. Results: The psychometric properties of the MITI codes have been consistently shown to be robust, with inter-rater reliability demonstrated across a range of disciplines and population groups. Demonstrating fidelity is at the heart of efficacy research to improve oral health. Thus, planning the fidelity assessment component of oral health research involving motivation interviewing is crucial. Conclusions: There is an opportunity for communication among oral health researchers with an interest in MI to explore pathways through which fidelity assessment in MI-based interventions may be facilitated.