Abstract
Abstract
Background
Motivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person’s behaviors.
Methods
We developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment.
Results
Participants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not “allow” it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone’s motivations and align those with the patient’s needs.
Conclusions
MI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient’s autonomy and their role as a member of a complex social fabric to facilitate behavior change.
Funder
National Institute of Mental Health
Publisher
Springer Science and Business Media LLC
Subject
General Psychology,General Medicine
Reference32 articles.
1. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract J R Coll Gen Pract. 2005 Apr;55(513):305–12.
2. William Miller R., Stephen Rollnick. Motivational Interviewing Third Edition: Helping People Change By Miller R. William. 3rd ed. The Guilford Press; 3rd edition; 2012. 482 p. (Applications of Motivational Interviewing).
3. DiClemente CC, Corno CM, Graydon MM, Wiprovnick AE, Knoblach DJ. Motivational interviewing, enhancement, and brief interventions over the last decade: a review of reviews of efficacy and effectiveness. Psychol Addict Behav J Soc Psychol Addict Behav. 2017;31(8):862–87.
4. Lukaschek K, Schneider N, Schelle M, Kirk UB, Eriksson T, Kunnamo I, et al. Applicability of motivational interviewing for chronic disease management in primary care following a web-based e-learning course: cross-sectional study. JMIR Ment Health. 2019;6(4):e12540.
5. What Is the Heart of Health Care? Advocating for and Defining the Clinical Relationship in Patient-Centered Care [Internet]. Journal of Participatory Medicine. 2012 [cited 2019 Oct 2]. Available from: https://participatorymedicine.org/journal/evidence/reviews/2012/04/25/what-is-the-heart-of-health-care-advocating-for-and-defining-the-clinical-relationship-in-patient-centered-care/
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