The Patient's Experience with Motivational Interviewing (MI) during Medication Adherence Conversations by MI Trained Nurses

Monday, 18 November 2013: 3:55 PM

Kristiina Hyrkas, PhD, LicNSc, MNSc, RN
Center for Nursing Research and Quality Outcomes, Maine Medical Center, Portland, ME

Learning Objective 1: Explain the use of the Patientís Experience Scale (PES) to assess the patientís Motivational Interviewing (MI) experience during medication adherence conversations by MI trained nurses.

Learning Objective 2: Compare the PES with a measure of therapeutic alliance to assess the MI experience during medication adherence conversations from a patientís perspective.

Aims:

(1) To compare the Kim Alliance Scale (KAS) with a new tool to measure the patient’s experience with Motivational Interviewing (MI).

(2) To examine a new tool, the Patient’s Experience Scale (PES) during medication adherence conversations by MI trained nurses.

Background: MI is a patient-centered, evidence-based method of communication. Therapeutic alliance conceptualizes patient-provider relationships focused on shared goal setting. Although therapeutic alliance captures one aspect of the MI relationship, a method for assessing the patient’s experience with MI was needed. 

Methods: The sample was a subset of 205 adult patients enrolled in a medication adherence study at a large north-eastern medical center. Twenty-two nurses received MI education. Prior to hospital discharge, 68 patients received medication education from MI trained nurses. Thirty-five percent (n=24) of the conversations were recorded and examined for MI proficiency. The 9-item PES was adapted from the Behavior Change Counseling Index. Patients completed the PES and the KAS during a phone call at 30 days. 

Results: The 30-item KAS had good reliability (Cronbach’s alpha .797) and showed adequate therapeutic alliance. However, the 16-item revised KAS-R had poor to adequate subscale reliability alphas for integration (.149), communication (.630), collaboration (.659), and empowerment (.555). Significant Spearman’s rho correlations between the PES and KAS were found, except for one PES item. Factor analysis of the PES resulted in three components: Support, Dialogue, and Acceptance. 

Conclusions: The KAS-R may not be adequate to measure therapeutic alliance in this setting. The PES item indicating that the nurse acknowledged that there may be challenges to taking medication was the only item without any significant association with therapeutic alliance. The PES showed promise to elicit the patient’s experience to medication adherence conversations by MI trained nurses. Further research comparing the KAS and the PES in acute care settings is warranted.