Unintended effects of training on clinicians' interest, confidence, and commitment in using motivational interviewing.
Unintended effects of training on clinicians' interest, confidence, and commitment in using motivational interviewing.
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DOI：
10.1016/j.drugalcdep.2013.04.022
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发表时间：
2013-10-01
影响因子：
4.2
通讯作者：
Martino S
中科院分区：
文献类型：
--
作者：
Decker SE;Martino S
提高临床医生对使用循证治疗（EBT）的兴趣、信心和承诺通常是EBT临床医生培训的目标。然而，这些领域通过培训实际改善的程度及其与治疗完整性的关系尚不清楚。使用多中心研究的数据，比较三种方法的临床医生培训的动机访谈（MI），兴趣，信心和承诺的变化，随着时间的推移和他们的关系MI坚持和能力进行了评估，使用混合效应回归模型。通过聚类分析对个体变化模式进行了研究。兴趣，信心和承诺随着时间的推移在培训条件下下降，有两种不同的模式：76%的临床医生随着时间的推移在很大程度上保持了对MI的浓厚兴趣，只有轻微的信心和承诺下降（“维持者”），而24%的人开始时的初始兴趣，信心和承诺较低，随后随着时间的推移下降（“下降者”）。兴趣和承诺与MI依从性和能力无关;信心与使用高级MI策略的能力增加相关。然而，下降表现出更多的使用MI不一致的技术比维护者整体（d = 0.28）。MI培训可能会产生非预期的后果，即降低临床医生在实践中使用MI的兴趣、信心或承诺。虽然在这项研究中的态度变量表现出混合的关系，MI的完整性，他们可能有一些效用，在确定不太热情的参与者，更好地为他们准备培训，或定制培训方法，以满足个人的培训需求。
Improving clinicians' interest, confidence, and commitment in using evidence-based treatment (EBT) is often an aim of training clinicians in EBT. However, the degree to which these areas actually improve through training and what their relationship is to treatment integrity is unknown. Using data from a multi-site study comparing three methods of clinician training in motivational interviewing (MI), changes in interest, confidence, and commitment over time and their relationship to MI adherence and competence were assessed using mixed-effects regression models. Individual patterns of change were examined through cluster analysis. Interest, confidence, and commitment declined over time across training conditions with two distinct patterns: 76% clinicians largely maintained strong interest in MI over time with only slight decreases in confidence and commitment (the “maintainers”), while 24% began with lower initial interest, confidence, and commitment, which subsequently declined over time (the “decliners”). Interest and commitment were not associated with MI adherence and competence; confidence was associated with increased competence in the use of advanced MI strategies. However, decliners demonstrated greater use of MI-inconsistent techniques than maintainers overall (d = 0.28). Training in MI may have an unintended consequence of diminishing clinicians' interest, confidence, or commitment in using MI in practice. While attitudinal variables in this study show mixed relationships to MI integrity, they may have some utility in identifying less enthusiastic participants, better preparing them for training, or tailoring training approaches to meet individual training needs.
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