title: Synchronizing clinician engagement and client motivation in telephone counseling.
abstract: Health care increasingly incorporates telephone counseling, but the interactions supporting its delivery are not well understood. The authors' clinical trial of a tailored, nurse-administered smoking cessation intervention for surgical patients included a telephone counseling component and provided an opportunity to describe the interaction dynamics of proactive telephone counseling over the course of 4 months. Tape-recorded telephone counseling calls for 56 consecutively enrolled individuals randomized to the intervention group resulted in a data set of 368 calls, which were transcribed and analyzed using constant comparative methods. The findings revealed varying interaction dynamics depending on the nurse's level of engagement with participants and participants' motivation to stop smoking. The authors identified four interaction dynamics: affirming/working, chasing/skirting, controlling/withdrawing, and avoiding commitment. Shifts in interaction dynamics were common and influenced the provision of support both positively and negatively. The findings challenge many assumptions underlying telephone counseling and suggest strategies to improve its delivery.
authors.affiliation: CIHR, Nursing and Health Behaviour Research Unit, School of Nursing, University of British Columbia, Vancouver, Canada.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Bottorff
authors.forename: Joy L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Barbara
authors.initials: B
authors.lastname: Moffat
authors.forename: Doreen
authors.initials: D
authors.lastname: Fofonoff
authors.forename: Bernice
authors.initials: B
authors.lastname: Budz
authors.forename: Marlee
authors.initials: M
authors.lastname: Groening
mesh_terms: D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009732:Nursing Care; D010045:Outpatients; D019114:Remote Consultation / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013689:Telephone; D016896:Treatment Outcome