Application of motivational interviewing to prenatal smoking cessation: training and implementation issues
Mary M Velasqueza, Jacklyn Hechtb, Virginia P Quinnc, Karen M Emmonsd, Carlo C DiClementee, Patricia Dolan-Mullenf
a Department
of Family Practice and Community Medicine, University of Texas-Houston
Medical School, Houston, Texas, USA, b Center for Behavioral and Preventive Medicine,
Miriam Hospital, c Kaiser
Permanente Southern California, Pasadena, California, USA, d Dana
Farber Cancer Institute and Harvard School of Public Health, Boston,
Massachusetts, USA, e Department
of Psychology, University of Maryland-Baltimore County, Baltimore,
Maryland, USA, f Center for
Health Promotion Research and Prevention, University of Texas-Houston
Health Science Center, School of Public Health
Correspondence to: Mary M Velasquez, PhD, Department of Family Practice and Community Medicine, University of Texas-Houston Medical School, 6431 Fannin, Suite 2.112, Houston, TX 77030-1501, USA; mvelasquez{at}fpcm.med.uth.tmc.edu
Received 8 December
1999; Revision received 27 March 2000;
Accepted 5 April 2000
OBJECTIVE
Three of the
Smoke-Free Families projects incorporated motivational interviewing
(MI) into prenatal smoking cessation interventions. This paper
describes the process involved in training healthcare providers to use
MI and the issues encountered in implementing the protocols.
DESIGNHealth care
providers at all three sites attended local training workshops in which
they learned to apply the basics of MI to their study protocol. All
sites followed a similar outline and schedule for training and monitoring.
SETTINGSThe MI
interventions were delivered through home visits in Boston,
Massachusetts; phone based counselling calls to patients' homes in
Southern California; and in urban and rural prenatal clinics throughout
East Texas.
PARTICIPANTSPublic
health nurse and social work case managers, who were already employed
by health care agencies, delivered the MI interventions.
MEASURESPre- and
postintervention assessments and feedback from trainers and
investigators at all three sites.
RESULTSProviders were
enthusiastic about the training workshops, which they rated as
effective in preparing them to deliver the intervention. Barriers to
implementation included difficulty in contacting patients and competing
demands on providers' time.
CONCLUSIONSConducting
initial training for providers is the first step in developing skills
to deliver motivational interventions. Additional time and resources
are needed for ongoing skill building and monitoring of intervention delivery.
Keywords: pregnancy; smoking; motivational interviewing
© 2000 by Tobacco Control
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Dolan-Mullen, P., DiClemente, C. C, Velasquez, M. M, Timpson, S. C, Groff, J. Y, Carbonari, J. P, Nicol, L.
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