Fidelity of Motivational Interviewing for smokers who are not ready to quit

Motivational Interviewing (MI) and behavioral interventions are effective treatments for smoking cessation, and MI is increasingly being integrated into behavioral interventions in smoking cessation programs—especially with smokers who are not ready to quit. Moreover, these programs often utilize bachelor’s-level counselors with minimal training in MI or counseling in general, which may lead to concerns about fidelity of MI. The current study examined whether 15 bachelor’s-level counselors adhered to MI principles and techniques while delivering three smoking cessation interventions: MI, BI, and MI plus BI. Smoker participants were 344 individuals recruited through primary care clinics and enrolled in a larger clinical trial of counseling and nicotine replacement therapies for smokers who were not ready to quit. For each smoker participant, one randomly selected counseling session was coded using the Motivational Interviewing Treatment Integrity Scale (Moyers et al., 2010), a coding system that assesses for global ratings of MI quality (e.g., evocativeness) and specific MI-related counseling behaviors (e.g., complex reflections). Compared to MI only, MI plus BI was associated with lower levels of empathy, but was not associated with lower levels of evocation, collaboration, or support of autonomy, other core characteristics of MI. MI plus BI was also associated with a smaller proportion of complex-to-simple reflections, and a smaller percentage of open-ended (compared to closed-ended) questions, compared to MI only. Lastly, greater empathy and MI fidelity were associated with smoker participants being more likely to report during follow-up that they intend to quit in the future. Limitations and future directions are discussed.