Respiratory clinicians' views of motivational interviewing (MI) for enhancing engagement and adherence as part of pulmonary rehabilitation (PR)

Background: MI has been recommended as a potential method for improving outcomes of PR, however there is a paucity of research exploring its feasibility in this context. Aim: To explore respiratory clinicians9 views of MI used as an adjunct to PR. Specifically: Is it useful? Can it be integrated into practice? What training is required? Methods: Nine respiratory clinicians (3 physiotherapists, 4 nurses, 1 occupational therapist and 1 rehabilitation assistant) attended a 1-day MI workshop and a semi-structured interview 2 weeks later. Interviews were audio-recorded and subjected to thematic analysis. Results: Three themes were identified: 1) Difference: Most participants felt MI was fundamentally 9different9 to their current style of working, with its emphasis on counselling skills and resolving ambivalence. 2) Motivational: They saw potential in using MI to motivate patients. Those who experimented with skills post-workshop were encouraged by patient responsiveness and overall effectiveness. 3) Implementation issues: Participants sensed the complexity of MI would make it difficult to learn and it would take time to become competent. On-going supervision was perceived necessary. Suppressing behaviours that are antithetical to MI was highlighted as a challenge. PR structures would need revising, with additional time made available to enable an appropriate depth of conversation. Conclusion: These results lend support to the feasibility of MI used as an adjunct to PR, but highlight implementation issues. The insights have informed the development of a study testing the effect of a training package on MI skill for clinicians delivering PR.