Codern-Bové Núria, Pujol-Ribera Enriqueta, Pla Margarida, González-Bonilla Javier, Granollers Silvia, Ballvé José L, Fanlo Gemma, Cabezas Carmen
Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma de Barcelona, C/De la Riba, 90, 08221 Terrassa, Spain.
BMC Public Health. 2014 Nov 26;14:1225. doi: 10.1186/1471-2458-14-1225.
Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS).
Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction.
Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed.
Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.
研究表明，三分之一的吸烟者戒烟动力不足。本研究的目的是运用会话分析来加深对初级保健医生和护士进行动机性访谈以激励患者戒烟过程的理解。本研究是初级卫生保健项目中吸烟习惯系统干预项目（西班牙语缩写：ISTAPS）的子研究。
对ISTAPS研究中九名当前吸烟者且在测量戒烟动力的里士满测试中得分低于5分的参与者（对其中两人进行了两次访谈）进行动机性访谈，并录像和转录。对西班牙巴塞罗那的五名初级卫生保健专业人员进行的总共11次访谈进行了分析。运用定性内容分析法制定了用于对转录内容进行编码的分析指南。会话分析允许对互动过程中的言语交流进行详细研究。
动机性访谈有三个阶段：评估、对改变意愿的反思和总结。互动是在门诊就诊期间构建的，在此期间会出现互动困境，并且可以通过多种方式解决。专业人员的一些行为（使用重复、声明、开放式问题）有助于构建共享关系框架；其他行为则抑制了这种关系（关注吸烟风险、拘泥于方案以及过早强调改变）。一些专业人员倾向于通过对抗性或指导性风格来解决互动困境（例如，抵触情绪）。在所分析的11次访谈中，有7次互动未遵循动机性访谈原则。
会话分析表明，当卫生专业人员遇到改变动力不足的个体时，干预的复杂性会增加，并且可能会出现互动困境，从而难以遵循动机性访谈原则。在动机性访谈中纳入不同形式的表达有助于建立以患者为中心的医疗保健关系，并且对于戒烟动力不足的患者，在门诊就诊期间提供了一个反思烟草使用的机会。研究结果可纳入专业培训，以提高动机性访谈的质量。
