Fidelity of motivational interviewing in an oral health intervention with caregivers of young children

Ripplinger, Tamara; Cascaes, Andreia Morales

doi:10.1590/1807-3107bor-2022.vol36.0045

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Original Research, Pediatric Dentistry • Braz. oral. res. 36 • 2022 • https://doi.org/10.1590/1807-3107bor-2022.vol36.0045 copy

Fidelity of motivational interviewing in an oral health intervention with caregivers of young children

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

The aim of this study was to assess the fidelity of a motivational interviewing (MI) intervention with caregivers of young children in primary healthcare in Southern Brazil. Seven trained interventionists conducted one MI session with each caregiver at their home. The sessions were audio-recorded and a randomly selected subset (n = 109) was coded by a single reviewer using the Motivational Interviewing Treatment Integrity 3.1.1. criteria (MITI 3.1.1.). This instrument establishes parameters of MI proficiency for beginners and experts measuring the global ratings of five MI principles (evocation, collaboration, autonomy/support, direction and empathy), the global MI spirit score, and the behavior counts of MI basic skills: to inform, to ask, and to listen. The mean global MI spirit rating was 4.0 (95%CI 3.9–4.1). Mean MI principle scores ranged from 3.8 (95%CI 3.7–3.9) to 4.3 (95%CI 4.2–4.4). The overall reflection-to-question ratio was 0.9 (95 CI 0.8–1.0), % open questions was 76.3 (95%CI 73.1–79.6), % complex reflections was 66.1 (95%CI 63.1–69.1), and % MI-adherent information was 94.1 (95%CI 93.5–94.5). Interventionists with higher scores conducted more and longer sessions than those with lower scores (p = 0.012). Those with beginner proficiency had a higher proportion of caregivers changing their oral health knowledge (p = 0.005). In conclusion, a good degree of MI fidelity was found, with higher fidelity among interventionists who conducted more interviews and spent more time talking with caregivers.

Keywords:
Motivational Interviewing; Oral Health; Primary Health Care; Child

Variables		Sample distribution
Child
	Female, n (%)	57 (52.3)
	White, n (%)	92 (84.4)
	Age (months), mean (SD)	22.3 (1.1)
	Has private health insurance, n (%)	39 (35.8)
Caregiver and family
	Mother is the primary caregiver, n (%)	96 (88.1)
	Caregiver age (years), mean (SD)	30.5 (0.9)
	Caregiver education (years), mean (SD)	8.8 (0.3)
	Caregiver is married or lives with a partner	100 (91.7)
	Family per capita income (in Brazilian reals)	399.4 (21.2)
	Family covered by conditional cash transfer program, n (%)	21 (19.4)

MITI 3.3.1 measures	All	Staff 1	Staff 2	Staff 3	Staff 4	Staff 5	Staff 6	Staff 7
MITI 3.3.1 measures	n = 109	n = 31	n = 19	n = 16	n = 6	n = 7	n = 19	n = 11
Evocation, mean (95%CI)	4.0 (3.9–4.2)	4.1 (3.9–4.2)	4.2 (3.9–4.4)	4.6 (4.3–4.9)	3.1 (2.8–3.4)	3.5 (3.1–3.9)	3.8 (3.6–4.0)	3.8 (3.5–4.0)
Collaboration, mean (95%CI)	3.8 (3.7–3.9)	3.9 (3.9–4.0)	4.0 (3.9–4.1)	4.0 (3.8–4.2)	3.3 (2.9–3.7)	3.7 (3.3–4.0)	3.7 (3.5–3.9)	3.5 (3.2–3.8)
Autonomy, mean (95%CI)	4.0 (4.0–4.2)	4.1 (4.0–4.3)	4.3 (4.0–4.5)	4.2 (3.9–4.2)	3.8 (3.5–4.1)	3.7 (3.3–4.0)	4.0 (3.8–4.1)	3.8 (3.5–4.0)
Direction, mean (95%CI)	4.2 (4.1–4.3)	4.4 (4.2–4.5)	4.3 (4.0–4.6)	4.8 (4.6–5.0)	3.5 (3.0–3.9)	3.7 (3.1–4.2)	3.9 (3.6–4.2)	4.2 (3.9–4.4)
Empathy, mean (95%CI)	4.3 (4.2–4.4)	4.6 (4.5–4.8)	4.6 (4.4–4.8)	4.5 (4.2–4.8)	3.3 (2.9–3.7)	3.8 (3.3–4.3)	4.3 (4.0–4.5)	3.9 (3.7–4.0)
Global MI spirit, mean (95%CI)	4.0 (3.9–4.1)	4.1 (4.0–4.2)	4.2 (4.0–4.3)	4.3 (4.1–4.4)	3.4 (3.3–3.6)	3.7 (3.5–3.8)	3.9 (3.8–4.1)	3.8 (3.6–3.9)
MI–adherent statements, % (95%CI)	94.1 (93.5–94.5)	92 (91.3–92.8)	95 (94–96)	95.4 (94.2–96.9)	96.5 (94.8–98.2)	93.6 (92.5–94.7)	93.5 (92.0–95.0)	95.8 (94.5–97.0)
Open–ended questions, % (95%CI)	76.3 (73.1–79.6)	76.0 (69.7–82.3)	77.6 (70.2–85)	78.3 (70.5–86.2)	78.1 (66.9–89.3)	82.3 (77.1–87.5)	76.8 (69.1–84.5)	66.5 (52.4–80.6)
Complex reflections, % (95%CI)	66.1 (63.1–69.1)	66.6 (63.5–69.7)	65.2 (60.4–70)	76.5 (65.8–87.2)	44.4 (26.0–62.8)	60.9 (55.0–66.8)	64.1 (59.6–68.5)	69.8 (55.2–84.4)
Reflection–to–question ratio	0.9 (0.8–1.0)	1.0 (0.8–1.2)	0.9 (0.7–1.1)	1.0 (0.8–1.1)	0.5 (0.3–0.8)	0.7 (0.6–0.8)	0.9 (0.7–1.1)	1.1 (0.9–1.4)

MI characteristics	Expert level^a a staff 1, 2, 3 and 6 (n = 85);	Beginner level^b b staff 4, 5 and 7 (n = 24).	p-value
Session duration in minutes, mean (SD)	39.8 (8.4)	32.7 (8.2)	< 0.001^c c p–value of T–test.
Participation of another adult, n (%)	30 (36.2)	9 (39.1)	0.793^d d p–value of Pearson's Qui–square.
Child was present at the session, n (%)	46 (55.4)	11 (47.8)	0.518^d d p–value of Pearson's Qui–square.
Caregiver motivation assessed as good/very good, n (%)	68 (81.9)	22 (95.6)	0.104^d d p–value of Pearson's Qui–square.
Interventionist self-performance evaluated as good/very good, n (%)	68 (81.9)	21 (91.3)	0.278^d d p–value of Pearson's Qui–square.

Outcomes	Expert level^a a Staff 1, 2, 3 and 6 (n = 85);	Beginner level^b b staff 4, 5 and 7 (n = 24).	p-value^c c p–value of Pearson's Qui–square;
Outcomes	n (%)	n (%)	p-value^c c p–value of Pearson's Qui–square;
Caregiver oral health knowledge increased	53 (67.1)	23 (95.8)	0.005
Child improved oral hygiene^d db rushing twice a day with fluoride toothpaste + brushing always before sleeping + using adequate amount of toothpaste for age.	55 (71.4)	18 (78.3)	0.517
Child stopped drinking sugar-sweetened baby bottle before bed	14 (17.7)	4 (16.7)	0.905
Child reduced frequency of sweet food and sugar-sweetened beverages consumption to less than 4 times/day	16 (20.5)	1 (4.2)	0.063
Child visited the dentist for routine / prevention	45 (57.7)	15 (62.5)	0.676
Child visited the dentist at PHC	50 (64.1)	13 (54.2)	0.381

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[1] Corresponding Author: Andreia Morales Cascaes. E-mail: andreiacascaes@gmail.com