title: Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency.
abstract: OBJECTIVE
  Motivational Interviewing (MI) consistent talk by a counselor is thought to produce "change talk" in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior.
  
  
  METHODS
  We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit ("episodes"), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system.
  
  
  RESULTS
  Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second.
  
  
  CONCLUSIONS
  Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency.
  
  
  CONCLUSIONS
  Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients.
authors: Dept of Health Services, Policy and Practice, Brown University School of Public Health, Providence, USA. Electronic address: Michael_Barton_Laws@brown.edu.
authors: Michael Barton
authors: MB
authors: Laws
authors: Massachusetts School of Professional Psychology, Boston, USA.
authors: Gary S
authors: GS
authors: Rose
authors: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
authors: Mary Catherine
authors: MC
authors: Beach
authors: Dept of Health Services, Policy and Practice, Brown University School of Public Health, Providence, USA.
authors: Yoojin
authors: Y
authors: Lee
authors: Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, USA.
authors: William S
authors: WS
authors: Rogers
authors: Dept of Health Services, Policy and Practice, Brown University School of Public Health, Providence, USA.
authors: Alyssa Bianca
authors: AB
authors: Velasco
authors: Dept of Health Services, Policy and Practice, Brown University School of Public Health, Providence, USA.
authors: Ira B
authors: IB
authors: Wilson
mesh_terms: D005260:Female; D006040:Goals; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology*; D006293:Health Promotion / Q000379:methods; D006801:Humans; D033182:Intention; D007802:Language; D008297:Male; D009042:Motivation; D062405:Motivational Interviewing; D010349:Patient Compliance; D010817:Physician-Patient Relations; D013637:Tape Recording
keywords: Behavioral counseling; HIV care; Motivational interviewing