title: Unintended effects of training on clinicians' interest, confidence, and commitment in using motivational interviewing.
abstract: BACKGROUND
  Improving clinicians' interest, confidence, and commitment in using evidence-based treatment (EBT) is often an aim of training clinicians in EBT. However, the degree to which these areas actually improve through training and what their relationship is to treatment integrity is unknown.
  
  
  METHODS
  Using data from a multi-site study (Martino et al., 2010) comparing three methods of clinician training in motivational interviewing (MI), changes in interest, confidence, and commitment over time and their relationship to MI adherence and competence were assessed using mixed-effects regression models. Individual patterns of change were examined through cluster analysis.
  
  
  RESULTS
  Interest, confidence, and commitment declined over time across training conditions with two distinct patterns: 76% clinicians largely maintained strong interest in MI over time with only slight decreases in confidence and commitment (the "maintainers"), while 24% began with lower initial interest, confidence, and commitment, which subsequently declined over time (the "decliners"). Interest and commitment were not associated with MI adherence and competence; confidence was associated with increased competence in the use of advanced MI strategies. However, decliners demonstrated greater use of MI-inconsistent techniques than maintainers overall (d=0.28).
  
  
  CONCLUSIONS
  Training in MI may have an unintended consequence of diminishing clinicians' interest, confidence, or commitment in using MI in practice. While attitudinal variables in this study show mixed relationships to MI integrity, they may have some utility in identifying less enthusiastic participants, better preparing them for training, or tailoring training approaches to meet individual training needs.
authors.affiliation: New England Mental Illness Research Education and Clinical Centers, VA Connecticut Healthcare System, Yale School of Medicine, United States. Electronic address: suzanne.e.decker@gmail.com.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Decker
authors.forename: Steve
authors.initials: S
authors.lastname: Martino
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods / Q000706:statistics & numerical data*; D010820:Physicians / Q000592:standards*; D016320:Substance Abuse Treatment Centers / Q000379:methods / Q000592:standards
keywords: Adherence; Clinician training; Dissemination; Implementation; Motivational interviewing; Treatment integrity