Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
J Occup Rehabil. 2021 Dec;31(4):785-795. doi: 10.1007/s10926-021-09964-9. Epub 2021 Mar 24.
Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for "beginning proficiency" whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.Trial registration ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).
目的 本研究旨在评估在挪威社会保险环境中实施动机性访谈（MI）作为重返工作（RTW）干预措施的潜在障碍和促进因素。
方法 一项混合方法过程评估与一项随机对照试验同时进行，该试验涉及由社会保险办事员提供的 MI 课程。研究以“可及性、有效性、采纳、实施和维持”框架为指导，通过与办事员进行焦点小组讨论来评估 MI 的实施情况。通过 MI 课程的录音和对请病假的参与者的问卷调查来评估 MI 的保真度。
结果 同事和管理层的支持不足、用于进一步发展 MI 技能的时间和地点以及高工作量使办事员难以实施 MI 干预措施。MI 方法被认为是有用的，但很难掌握。MI 保真度结果显示，技术总体得分超过了“初步熟练”的阈值，而关系总体得分低于阈值。请病假的工人报告对 MI 课程感到满意。
结论 尽管办事员有学习和在早期随访课程中使用 MI 的动机，但 MI 很难掌握和在实践中使用。确定了一些障碍和促进因素；在社会保险环境中实施 MI 之前，应解决这些因素。
试验注册 ClinicalTrials.gov：NCT03212118（2017 年 7 月 11 日注册）。
