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BACKGROUND: Community-centred care integration for older adults is a cornerstone of the WHO's Integrated Care for Older People (ICOPE) implementation framework. Realising the potential of care integration for older people requires cohesive coordination of services and interprofessional collaboration (IPC) within and across teams. There is a gap in research evidence to understand how IPC can be fostered and sustained within team-based community care integration for older people. We report on a realist evidence synthesis to identify the contextual influences and mechanisms that support IPC in interprofessional community care teams for older people. METHODS: The three phases of the realist synthesis included an exploratory scoping of research evidence and consultation with four local stakeholder groups to produce initial programme theories. The second phase involved systematic retrieval and synthesis of evidence, including peer-reviewed published empirical studies and grey literature recommended by an expert panel. The third phase involved the development of refined programme theory with stakeholder validation. The stakeholder cohorts included representatives of older people and caregivers, healthcare professionals and operational managers of community specialist older person teams, national policymakers, and programme managers. RESULTS: The resource and reasoning mechanisms that enable contexts for IPC and their associated outcomes are identified within seven programme theory areas: (1) professional identity and growth, (2) information sharing and care coordination across boundaries, (3) effective operational and clinical governance, (4) developing a team learning culture, (5) meaningful inclusion of older people and caregivers, (6) quality improvement and programme development, (7) workforce planning and retention. CONCLUSIONS: The results provide policymakers and clinicians with evidence-based programme theory that will catalyse critical dialogue on IPC implementation. This programme theory informs the prioritisation of resources to enable favourable contexts for successful IPC intervention development and implementation. This research complements and expands the work presented in the WHO ICOPE implementation framework. We encourage local realist application and evaluation of the programme theory within varying health system contexts.

The objective of this study was to evaluate the feasibility of Virtual Motivational Interviewing (VIMINT) for improving physical activity among community-dwelling older adults. A feasibility study using a mixed-method single-group pre- and post-design. Each participant received five sessions of motivational interviewing (MI) through the Zoom platform. Feasibility and acceptability were assessed through recruitment, attrition and retention rates; adherence; satisfaction; counsellors' competency; and interviews with participants and counsellors. Other outcomes including physical activity were assessed at baseline, post- and 2-month follow-up. Eight participants were recruited; the mean age was 68.9 ± 3.9 years. The retention rate was 88%, 92.5% of the sessions were attended, and the participants' satisfaction score was 24.14 ± 7.3/32. The counsellors were rated as "good" and "fair" in relational and technical components, respectively. The categories derived from qualitative analysis were session composition, acceptability of outcome measures, positive impact of the VIMINT study and suggestions to improve future studies. The findings showed that VIMINT intervention should be feasible and acceptable for older adults. Evidence from this study provides relevant information that will guide the planning of future studies investigating the effectiveness of virtual MI on physical activity among community-dwelling older adults.

The outcome of treatment for Intimate Partner Violence (IPV) is hampered by high rates of nonattendance and drop-out, low motivation or readiness to change, problems in the establishment of a therapeutic alliance, and limited engagement in treatment activities such as homework assignments. As a brief pre-treatment intervention, Motivational Interviewing (MI) has the potential to improve intervention engagement, particularly for individuals with lower motivation levels. Furthermore, MI may be particularly well suited for those mandated to attend IPV intervention programmes and those who may not yet be committed to active personal change. Previous research on MI as preparation for IPV intervention programmes has reported mixed results. Further research is required to address the limitations in past research, including measurement of and reporting data on the fidelity of the MI. Furthermore, research needs to make the distinction between MI for IPV intervention engagement and MI for IPV behaviour change. The current thesis encompasses three studies. The first study was an audit that provided information on IPV intervention commencement and completion rate at Aviva Family Violence Services (Aviva for short) and Stopping Violence Services (SVS) two of the main providers of stopping programmes in the Christchurch city of New Zealand (NZ). Additionally, this study evaluated what (if any) client characteristics predict IPV intervention commencement and completion at these agencies. The second study was an educational study that was conducted to analyse the effectiveness of MI training in developing MI skills of practitioners at Aviva and SVS. The other aim was for these practitioners to receive training in MI in preparation for the final study (Study 3). Study 3 was a quasi-experimental study that investigated the effectiveness of MI as a pre-intervention method for increasing engagement of male perpetrators in IPV programmes. The key findings from the audit Study (Study 1) were that the rate of intervention commencement at Aviva and SVS was 84.6% and 89.2% respectively. Further, it was found that the intervention commencement rate at SVS was significantly predicted by their type of referrals, suggesting that mandated clients were more likely to commence intervention. Also, IPV intervention completion was found to be lower at Aviva (46.2%) compared to SVS (82.1%). The second study found that the MI training (2-day workshop plus post-workshop feedback and coaching) produced measurable gains in the MI skills of practitioners working in IPV. Practitioners who attended the workshop training demonstrated an increase in MI skills immediately after finishing the workshop based on the results of the Video Assessment of Simulated Encounters Revised NZ version (VASE-R NZ). The average full score on the VASE-R NZ significantly increased pre-training (19.14%) to post-training (27.14%). Also, all the practitioners demonstrated at least a fair level of proficiency on the reflection-to-question ratio and the percent complex reflections based on Motivational Interviewing Treatment Integrity ratings of audio samples of their MI conversations with IPV clients. Further, 75% (3 out of 4) of them achieved at least a fair level of proficiency in their technical and relational skills. In the outcome study (Study 3), the within-group analysis found a statistically significant result for the Readiness Ruler from pre- to post-MI (time 1 to time 2), which was associated with a large effect size (p = 0.025, r = 0.64). With regards to the other primary outcomes, the results showed that the MI participants attended a significantly higher number of IPV program sessions (mean = 12.18) compared to the control participants (mean = 7) and, also completed the intervention (60%) at a higher rate than the control condition (40%). The last finding, however, was not statistically significant. Regarding the secondary outcomes, no clinically reliable changes existed between MI and control participants from time 1 to time 2 regarding the Change Questionnaire items (importance, ability, and commitment), and no discernible differences were found between MI and control groups. Taken together, the current thesis contributes to the knowledge in this area by addressing gaps in the literature, by evaluating MI as a pre-treatment intervention for increasing engagement, and including a fidelity measure. It appears that MI for engagement is appropriate for improving perpetrators’ engagement in IPV programmes. Further research, however, is required to generalise the findings to the IPV context.

PURPOSE: Early mobilization is an essential component of the Enhanced Recovery after Surgery (ERAS®)-pathway. However, a large percentage of patients fail to achieve the ERAS® recommended goal (360 min out of bed from post-operative day 1/POD1). Motivational Interviewing (MI) is an evidence-based type of patient-centered consultation to promote intrinsic motivation. This study aims to evaluate if MI can improve postoperative mobilization. METHODS: This two-arm, patient-blinded pilot randomized controlled trial included ERAS®-patients undergoing elective bowel resections. Conversations were validated by MI Treatment Integrity. Two validated motion sensors (movisens) and self-assessments were used to measure mobilization (POD1-POD3: Time out of bed, time on feet and step count). RESULTS: 97 patients were screened, 60 finally included and randomized. Cumulatively across POD1-3, the intervention group (IG) was longer out of bed than the control group (CG) (median: 685 vs. 420 min; p=0.022). The IG achieved the ERAS®-goal of 360 min/day more frequently across POD1-3 (27.4% vs. 10.61%; p=0.013). Time on feet was 131.5 min/day (median per POD) in IG vs. 95.8 min/day in the CG (p=0.212), step count was 1347 in IG vs. 754 steps/day in CG (p=0.298). CONCLUSION: MI could be conducted low threshold and was well accepted by patients. MI can improve mobilization in the context of ERAS®. Despite better performance, it should be noted that only 27.4% of the IG reached the ERAS®-compliance goal of 360 min/day. The findings of this pilot study stipulate to further test the promising perioperative effects of MI within a multicenter superiority trial. REGISTRATION: This study was registered prospectively in the German Clinical Trials Register on 25.02.2022. Trial registration number is "DRKS00027863".

BACKGROUND: Suboptimal glycaemic control in type 2 diabetes (T2D) is common and associated with psychological barriers. AIM: To investigate whether it was possible to train practice nurses in six psychological skills (Diabetes-6 [D6]) based on motivational interviewing (MI) and basic cognitive behaviour therapy (CBT), and whether integrating these with diabetes care was associated with improved glycaemic control over 18 months compared with standard care. DESIGN AND SETTING: Two-arm, single-blind, parallel cluster randomised controlled trial in primary care. METHOD: = 334) with T2D and persistent HbA1c ≥69.4 mmol/mol were randomised to receive 12 sessions of either the D6 intervention or standard care over 12 months. Practice nurses were trained in the six psychological skills and their competencies were measured by standardised rating scales. Primary outcome was a change in HbA1c level at 18 months from randomisation. Secondary outcomes were changes in systolic and diastolic blood pressure, body mass index, waist circumference, depressive symptoms, harmful alcohol intake, diabetes-specific distress, and cost-effectiveness. RESULTS: Using intention-to-treat analysis, there was no significant difference between D6 intervention and standard care in HbA1c (mean difference -0.79 mmol/mol, 95% confidence interval [CI] = -5.75 to 4.18) or for any of the secondary outcomes. The competency level of D6 nurses was below the beginner proficiency level and similar to the standard-care nurses. CONCLUSION: Training nurses in MI and basic CBT to support self-management did not lead to improvements in glycaemic control or other secondary outcomes in people with T2D at 18 months. It was also unlikely to be cost-effective. Furthermore, the increased contact with standard-care nurses did not improve glycaemic control.

INTRODUCTION: There is a high prevalence of inactive adults in the UK, and many suffer from conditions such as cardiovascular disease (CVD) or poor mental health. These coexist more frequently in areas of higher socioeconomic deprivation. There is a need to test the effectiveness, acceptability and sustainability of physical activity programmes. Active Herts uses novel evidence-based behaviour change techniques to target physical inactivity. METHODS AND ANALYSIS: Active Herts is a community physical activity programme for inactive adults aged 16+ with one or more risk factors for CVD and/or a mild to moderate mental health condition. This evaluation will follow a mixed-methods longitudinal (baseline, and 3-month, 6-month and 12-month follow-ups) design. Pragmatic considerations mean delivery of the programme differs by locality. In two areas programme users will receive a behaviour change technique booklet, regular consultations, a booster phone call, motivational text messages and signposting to 12 weeks of exercise classes. In another two areas programme users will also receive 12 weeks of free tailored exercise classes, with optional exercise 'buddies' available. An outcome evaluation will assess changes in physical activity as the primary outcome, and sporting participation, sitting, well-being, psychological capability and reflective motivation as secondary outcomes. A process evaluation will explore the views of stakeholders, delivery staff and programme leads. Economic evaluation will examine the programme costs against the benefits gained in terms of reduced risk of morbidity. ETHICS AND DISSEMINATION: This study was been approved by the Faculty of Medicine and Health Sciences Research Ethics Committee at the University of East Anglia. Informed written consent will be obtained from programme users in the evaluation. Results will be published in peer-reviewed journals, presented at conferences, and shared through the study website and local community outlets. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID number: NCT03153098.

The efficacy of Motivational Interviewing (MI), like other evidence-based counselling interventions, relies on the skills of the practitioner. Therefore, it is imperative that such practitioners receive sufficient training in order to successfully implement the method. Hence, it is important to ensure a given training programme has been effective through the use of reliable and valid measures of knowledge and skill acquisition. The Motivational Interviewing Treatment Integrity code (MITI) is one such measure of MI skill attainment; however its use is labour intensive and requires the submission of in-session trainee audio recordings. Other measures of MI skill or knowledge also exist which may be more practical for evaluating training programmes. However, these measures are under researched and are therefore rarely utilised across the MI training literature. The present research is an investigation of the psychometric properties of the Motivational Interviewing Knowledge and Attitudes Test (MIKAT), a test of MI knowledge and attitudes, and the Video Assessment of Simulated Encounters–Revised (VASE-R), a test of MI skill attainment through the use of video to simulate encounters with clients. The measures were administered during a training programme for staff of Child Youth and Family services (CYFs) New Zealand. The results suggest that the MIKAT and VASE-R are sensitive to the effects of training. However, it appeared both measures require refinement and possibly restructuring to make them more consistent with the most recent MI developments.

BACKGROUND: Community-based physical activity programs typically evolve to respond to local conditions and feedback from stakeholders. Process evaluations are essential for capturing how programs are implemented, yet often fail to capture delivery evolution over time, meaning missed opportunities for capturing lessons learned. METHODS: This research paper reports on a staged approach to a process evaluation undertaken within a community-based UK 12-month physical activity program that aimed to capture change and adaptation to program implementation. Twenty-five one-to-one interviews and 12 focus groups took place over the 3 years of program delivery. Participants included program participants, management, and service deliverers. RESULTS: Program adaptations that were captured through the ongoing process evaluation included changes to the design of promotional material, program delivery content, ongoing training in behavior change, and the addition of regular participant community events. The authors address how these strands evolved over program delivery, and how the process evaluation was able to capture them. CONCLUSION: The pragmatic evaluation approach enabled changes in response to the local context, as well as improvements in the program to be captured in a timely manner, allowing the delivery to be responsive and the evaluation flexible.

Service engagement continues to challenge providers working with individuals with serious mental illness and substance abuse disorders. Motivational Interviewing (MI), an intervention aligned with recovery-oriented principles in its emphasis on empathy, empowerment, and self-directed change, directly addresses this problem. Its effects on service engagement, however, have been inconsistent with dually diagnosed populations. To explore underlying processes that may influence engagement, the present mixed methods, single case experiment studied the effects of MI on key recovery constructs: hope, meaning, and empowerment. Participants were 6 consumers enrolled in an intensive outpatient program for co-occurring disorders. Results showed statistically significant increases for half the sample on a brief hope, meaning, and empowerment survey. Grounded theory analysis also identified positive change in identity, self-efficacy, and relationships as major recovery themes discussed in MI. It also revealed positive affect associated with spirit and method of MI. Implications for attention to personal narratives, supporting persistence in change, and satisfying psychological needs proposed by self-determination theory (SDT) are discussed.