The challenge of learning motivational interviewing (MI) for pulmonary rehabilitation (PR): clinician perspectives

Background: MI is a potential method for enhancing adherence to PR. We observed variable skill acquisition amongst PR clinicians following intensive MI training. This study provides insights into their challenges. Aim: To explore PR clinicians’ experiences whilst learning and implementing MI. Method: Nine PR clinicians (7 physiotherapists, 1 physiotherapy technician, 1 nurse) completed a 2-day workshop and on-going supervision. Each undertook a semi-structured follow-up interview that was audio-recorded, transcribed verbatim and analysed with framework analysis. Results: Five themes were identified: 1) Burden: Participants described a high level of psychological effort involved in using MI. Trying novel skills and suppressing behaviours that are antithetical to MI demands much attentional resource and detracted from other key tasks such as maintaining empathy. 2) Destabilising: Recognising the limitations of existing practice, yet feeling underprepared to deliver MI effectively was stressful for some and led to performance anxiety. 3) Committing to uncertainty: Using MI required participants to accept sessions may take longer, cover unanticipated topics and may not result in change. 4) Difficult feelings: concern that MI may reveal emotive issues that are uncomfortable for patients and clinicians. 5) Additional support: Training was viewed positively, but more supervision was perceived necessary. Extending consultations would help integration efforts particularly while skills are novel and inefficient. Conclusion: MI is a complex method that is challenging to do well. These findings have been used to optimise training to promote higher skill levels in a future study.