Background: Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which\nis increasingly being used in public health settings, either as a stand-alone approach or in combination with other\nstructured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed,\npreventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are\nadditionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing\neffectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites\nin England. The aim of this process evaluation component of the trial is to determine the extent to which\nMotivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with\nclients.\nMethods: Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected\nduring the ââ?¬Ë?pregnancyââ?¬â?¢ and ââ?¬Ë?infancyââ?¬â?¢ phases of the FNP programme. They were analysed using The Motivational\nInterviewing Treatment Integrity (MITI) coding system.\nResults: A competent level of overall MI adherent practice according to the MITI criteria for ââ?¬Ë?global clinician ratingsââ?¬â?¢\nwas apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner\ncompetency variables, there was a large variation in the percentage of recordings in which ââ?¬Å?beginner proficiencyââ?¬Â\nlevels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the ââ?¬Ë?MI adherent behaviourââ?¬â?¢\nvariable in the pregnancy phase to 6.7 % for ââ?¬Ë?percentage of questions coded as openââ?¬â?¢ in the infancy phase.\nConclusions: The results suggest that it is possible to deliver a structured programme in an MI-consistent way.\nHowever, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as\nopen can be more difficult to achieve in such a context. This is an important consideration for those involved in\ndesigning effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both\nMI and the structured programme
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