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参与奶牛群健康管理的瑞典兽医的沟通方式:从动机式访谈的角度来看。

Communication styles of Swedish veterinarians involved in dairy herd health management: A motivational interviewing perspective.

机构信息

Department of Clinical Sciences, Swedish University of Agricultural Sciences, PO Box 7054, SE-750 07 Uppsala, Sweden.

Department of Clinical Sciences, Swedish University of Agricultural Sciences, PO Box 7054, SE-750 07 Uppsala, Sweden.

出版信息

J Dairy Sci. 2019 Nov;102(11):10173-10185. doi: 10.3168/jds.2018-15731. Epub 2019 Sep 11.

DOI:10.3168/jds.2018-15731
PMID:31521349
Abstract

Veterinary communication has evolved in the context of traditional veterinary tasks, such as diagnosing and treating sick animals, and this may encourage a directive communication style, in which the veterinarian acts as an expert, directing the client in what to do and how to do it. This type of communication style has been shown to evoke resistance to change in clients who are experiencing psychological ambivalence, a well-known aspect of farmers' herd health decisions. Veterinary herd health management (VHHM) constitutes an increasing proportion of the work of cattle veterinarians and often focuses on behavior change. The present study aimed to characterize communication styles of Swedish dairy cattle veterinarians involved in VHHM in relation to their skills in facilitating behavior change. A secondary aim was to investigate whether these skills differed among veterinarians depending on their experience in the veterinary profession or in VHHM. Audio-recorded role-play conversations (n = 123; reflecting VHHM telephone consultations) with 42 veterinarians involved in VHHM in Swedish dairy herds and audio-recorded on-farm consultations (n = 86) with 18 of those veterinarians were coded using a system developed to evaluate motivational interviewing (MI) skills. Motivational interviewing is a communication methodology aimed at facilitating clients' internal motivation to change. The MI Treatment Integrity (MITI) code identifies frequency counts of 10 verbal behaviors, and assesses 4 global variables on a Likert scale, based on 20 min of conversation. It also suggests 6 summary measurements of MI competency based on these 14 original variables. Of the 42 veterinarians, 39 also responded to a web questionnaire about their age, continuing education, and experience in the profession, in dairy herds and in VHHM. We analyzed associations between the 6 summary MITI variables from the role-play conversations and characteristics of the 39 veterinarians using logistic and linear multivariable regression models. Veterinarians in the role-play and on-farm conversations relied predominantly on giving information, questions, and persuasion in their consultation approaches. They generally did not explore the client's expectations or wishes regarding the agenda for the consultation, or acknowledge the client's right to make decisions about actions. Veterinarians gave advice without exploring the client's need for the advice or how the information was perceived. We found a significant reduction in so-called relational scores (Empathy plus Partnership) and an increase in MI-nonadherent behaviors (Persuasion plus Confront) as years of veterinary experience increased. Results showed that there is room for improvement in the communication style of veterinarians involved in VHHM. Wider literature suggests that training veterinarians in a client-centered communication methodology such as MI may increase the demand for and success of VHHM.

摘要

兽医沟通在传统的兽医任务背景下发展而来,例如诊断和治疗患病动物,这可能鼓励一种指令式的沟通风格,其中兽医充当专家,指导客户该做什么以及如何做。这种沟通风格已被证明会引起客户对变革的抵制,而这些客户正经历着心理矛盾,这是农民群体健康决策的一个众所周知的方面。兽医群体健康管理(VHHM)构成了奶牛兽医工作的越来越大的比例,并且通常侧重于行为改变。本研究旨在描述参与 VHHM 的瑞典奶牛兽医的沟通风格与他们促进行为改变的技能之间的关系。次要目的是调查这些技能是否因兽医在兽医职业或 VHHM 中的经验而异。对 42 名参与瑞典奶牛养殖场 VHHM 的兽医进行了音频角色扮演对话(n = 123;反映 VHHM 电话咨询),并对其中 18 名兽医进行了音频农场咨询(n = 86),使用开发的系统对其进行了编码评估促进动机访谈(MI)技能。动机访谈是一种沟通方法,旨在促进客户改变的内在动机。MI 治疗完整性(MITI)代码确定 10 种口头行为的频率计数,并根据 20 分钟的对话,在李克特量表上评估 4 个全局变量。它还根据这 14 个原始变量建议 6 个 MI 能力的综合测量。在 42 名兽医中,有 39 名兽医还回答了关于他们的年龄、继续教育以及在该行业、奶牛养殖场和 VHHM 中的经验的网络问卷。我们使用逻辑和线性多变量回归模型分析了角色扮演对话中的 6 个综合 MITI 变量与 39 名兽医特征之间的关系。角色扮演和实地谈话中的兽医在咨询方法中主要依赖于提供信息、提问和说服。他们通常没有探讨客户对咨询议程的期望或愿望,也没有承认客户对行动做出决定的权利。兽医在没有探讨客户对建议的需求或信息感知的情况下提供建议。我们发现,随着兽医经验的增加,所谓的关系得分(同理心加合作伙伴关系)显著降低,而 MI 不遵守行为(说服加对抗)增加。结果表明,参与 VHHM 的兽医的沟通风格还有改进的空间。更广泛的文献表明,培训兽医使用以客户为中心的沟通方法(如 MI)可能会增加 VHHM 的需求和成功。

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