An Initial Validation of a Two Dimensional Theory of Motivational Interviewing

Abstract

Patient non-adherence to treatment regimen is a major cause for increased healthcare utilization costs associated with emergency room visits, outpatient services and hospitalizations. The need to improve patient adherence calls for a counseling approach that increases the probability of patients’ engaging in constructive health behavior change. Motivational interviewing (MI) is a patient-centered approach to counseling that enhances the patient’s intrinsic motivation for behavior change by addressing the patient’s ambivalence and resistance. Several systematic reviews of MI studies have supported the effectiveness of MI while also calling for a more adequate theoretical account of the effectiveness of MI. This study is the first attempt to validate a two dimensional model of MI proposing that the effectiveness of MI varies along two synergistic dimensions, namely addressing relational resistance and addressing issue resistance. Addressing relational resistance refers to respecting the patient’s face and addressing issue resistance refers to providing information directly responsive to the patient’s core concerns/issues. Message effects research was used as the primary methodology in this study. 12 videotaped physician-patient counseling sessions operationalized the crossed design for relational resistance (two levels) by issue resistance (three levels). The study participants were 162 students from Auburn University who watched all the stimulus videotaped counseling interactions running from 90 to 150 seconds in length. After each video the participants provided judgments about these interactions using a 15 item Likert-type scale whose scores were summated to form five reliable dependent measures. The results of this study supported that the perceived effectiveness of MI varies along the two synergistic dimensions of addressing resistance in the patient. Two major patterns were observed in the dependent variables. Two relationally oriented variables were accounted for solely by the main effects for relational resistance and issue resistance. Three outcome oriented dependent variables (including likelihood of patient behavior change) were accounted for by the main effects plus a significant interaction effect. This study concluded that it is crucial to consider the two dimensions of resistance in a theory of MI. Finally, the limitations of the study and directions for future research are discussed.