Abstract
This Mixed-method research design aimed to evaluate Motivational Interviewing utilization on health behavior changes in chronic non-communicable disease patients at regional health 2, during May 2016 to April 2017. The explanatory design was performed with consisted of two phases. The first phrase was quantitative data collection by surveying the use of MI techniques to alter health behavior. There were 579 health care units in 5 provinces including Uttaradit, Phitsanulok, Tak, Sukhothai and Phetchabun provinces. Moreover, MI competence was also evaluated in this period. Four hundred and thirty personnel who using MI technique were purposive sampled. The second phrase was qualitative data collection following CIPP model evaluation. Health care unit visiting
was conducted in five provinces; focus group and in-depth interview were performed in 380 staffs. Ten health care units were purposing selected with five units achieved versus not achieved goals. The in-depth interviewees in each unit were 3-5 persons including administrator and personnel responsible for health behavior change and used MI technique. Five research tools were developed by researcher team, that were questionnaires including MI service survey, MI performance evaluation, MI competence evaluation, In-depth interview question and MI using outcome record. Determination the reliability of MI performance evaluation and MI competence evaluation questionnaires by alpha coefficients that were 0.97 and 0.99, respectively. The quantitative data were analyzed by percentage, mean, standard deviation, Chi-square, Pearson Product Moment
Correlation and Multiple regression analysis. Content analysis was also used for qualitative data and verify correctness by reflecting the summary data to personnel to agree on the correctness. The results were as follows. 1. The MI techniques utilization to modify health behavior was collected from 579 health care units. Numbers of diabetes and hypertension patients in their responsibilities were 112,867 and 238,607 respectively. They were 47,316 (41.9%) of diabetes patients and 91,636 (38.4%) of hypertension patients that received behavior change. 73.2% of health care units were using MI technique for behavior change. The average length of MI was 1.18 years. The personnel were trained to improve MI skill with 1,529, but only 686 people used MI technique (44.9%). They were 293 of MI mentor or counselor. Moreover, community volunteers (VHV.) were also trained to develop MI skills (13,363). The amount of overall budget was 1,583,826 baths for MI support in all 5 provinces. 2. The overall MI performance was at low level (Mean 2.30, SD 1.1). The overall MI adherence was considered at moderate level (Mean 2.27, SD 1.3). The overall MI competence was at novice level (Mean 1.71, SD 1.1). The important thing, advanced and expert competence level were indicated 3.8 % and 1.2 %, respectively. MI competence of personnel from different province was different statistically significant at 0.001, however, different types of health care units and staff positions were not significantly different (p>0.05). Personal factors, MI skill training factors and MI using experience factors were significantly correlated with MI competence (p <0.001). The MI performance factor was correlated with MI competence at medium level statistically significant (r=0.654, p <0.001). Interestingly, MI adherence was associated with a high level of MI competence
statistically significance (r=0.767, p <0.001). Factors that could predict the MI competence statistically significant (p <0.001) including, MI Adherence (b=0.493), MI using performance (b=0.346), MI skill training (b=0.187) and duration of work time (b=0.007). Consequently, all factors were cooperatively predict MI competence at 67.0 percents (r2 = 0.67). 3. Consideration an outcome of MI implementation for altering health behavior in chronic non-communicable diseases, 412 (71.2%) and 399 (38.8%) of health care units were using MI in diabetes and hypertension group respectively. 34,101 of diabetes group received MI technique for behavior change, with 13,994 persons (41.0%) were achieving goals. In 2016 period outcome, people at the risk of diabetes were achievement higher than those with diabetes patients. It was found that the percentage of patients with glycemic control were 49.1% and 69.1%, respectively. The percentages of Hb1Ac below 6.5% were 43.0% and 69.6%, respectively. Behaviors changes were also detected at 56.1% and 70.7% respectively. Furthermore, 62,725 persons of hypertensive group received MI technique for behavior change, and 34,665 people (55.3%) achieved the goals. In 2016 period outcome, people at the risk of hypertension achieved goals the same as those with hypertension patients. The percentages of blood pressure control were 63.4% and 67% respectively. Behaviors changes were also indicated at 67.0% and 71.6%, respectively. 4. The results of qualitative data that evaluation using the MI technique based on the CIPP Concept Framework Model. Policy and Indicators, it founded that regional health 2 had announced a policy; however, personnel perception did not cover all areas. The policy was appropriate to be practical. Four types of MI techniques were conducted including: 1) No clear pattern, 2) 7-colors ping pong, 3) Clinical setting and 4) Particular project. Health care units were supported not only administrators but also budget. However, in all areas lack of information systems for MI tracking and evaluation. MI data were recorded through Excel, HosXp and JHCIS formats. Remarkably, factors and barriers to using MI techniques were including lack of budget support, personnel have a lot of workload, lack of MI skills and experience, lack of MI learning and share and service recipients do not cooperate. Therefore, requirement to encourage support are including: 1) Regional health 2 defined as the main MI policy; 2) Construct pattern of using MI
techniques; 3) the development of MI skills; 4) Consultant team; 5) Provide manuals and tools for MI operation. 6) Support staffing, 7) Motivation support and 8) Support operating budget. Notably, the patterns and factors supporting that different between achieve versus not achieve MI goals health care unit, in conclusion, that administrators should be promote including Inner inspiration, MI commitment, Relationship, Self study learning, MI home visit, and MI Dynamic improvement.
