Use of motivational interviewing by physical activity counsellors for adults with spinal cord injury


Introduction: Recently, evidence-based best practices were developed for delivering physical activity (PA) counselling to adults with spinal cord injury (SCI). One best practice is using a client-centred approach aligned with motivational interviewing (MI). Exploring counsellors' delivery of MI techniques and clients' language for and against behaviour change may provide insight for improving counsellors' adherence to the best practices. Objective: To describe the MI techniques employed by the PA counsellors and responses for and against change made by the clients. Methods: This study used recordings of PA counselling sessions with four adults with SCI enrolled in the EPIC-SCI trial (Exercise guideline Promotion and Implementation in Chronic SCI) and three counsellors. Two researchers independently coded the transcripts using the Motivational Interviewing Skill Code (MISC) manual. The MISC was used to code 19 counsellor behaviours and 15 types of responses from the client reflecting movement towards or away from behaviour change. Results: Clients were four males (age (y): 46.5±15.9), and counsellors were three females. Open questions comprised 20% of all questions asked by the counsellor, and complex reflections comprised 36% of all reflections made by the counsellor. Counsellors used an average of 49 MI consistent behaviours and 3.5 MI inconsistent behaviours each session. Clients made an average of 33 statements for change and 8.5 statements against change each session. Conclusion: Counsellors displayed good proficiency in their use of MI consistent behaviours but may require additional training to reduce their MI inconsistent behaviours to better adhere to a client-centred approach and the MI principles.

Acknowledgments: The Project Grant Program (Spring 2019) of the Canadian Institutes of Health Research (CIHR) funded this project (Grant # PJT165903)