Fidelidade ao protocolo de entrevistas motivacionais com famílias de crianças em idade pré-escolar: avaliação em um estudo de intervenção para promoção da saúde bucal na atenção primária à saúde

Abstract

Motivational Interviewing (MS) is a guideline counseling method used to improve intrinsic motivation and strengthen commitment to changes in patient health behaviors. With the use of this method, the capacity and decision to promote change are entirely under the control of the patient, because the approach is centered in the exploration of the space of this, so that they themselves are able to classify their conflicting and contradictory problems finding solutions. For this method to gain positive results the monitoring of protocol fidelity is crucial. Thus, the objective of the present study is to evaluate the degree of fidelity of the implementation of Motivational Interviews (MS) applied to parents / caregivers participating in a randomized controlled community intervention study aimed at promoting the oral health of children from zero to five years old, enrolled in Basic Health Units of Pelotas, RS, in the years 2015 to 2017. After training, the interviewers made home visits to implement the MS, which were recorded and stored in computers. MS was auditioned for evaluation of protocol fidelity, based on the criteria established by the instrument "Motivational Interviewing Treatment Integrity 3.1.1. (MITI 3.1.1.) ". This instrument has specific domains for evaluating MS delivery strategies, based on its principles (motivation / evocation, collaboration, respect for autonomy, orientation for change and empathy) and skills (listening, informing and asking). The mean values for each domain was be calculated for both the interviewer group and the individual interviewers. These scores was compared to parameters recommended by the authors of MITI 3.1.1. for interviewers at the beginner and experienced level. The mean global MI spirit rating score was 4.0 (95% CI 3.9–4.1). Mean MI principles scores ranged from 3.8 (95% CI 3.7– 3.9) to 4.3 (95% CI 4.2– 4.4). The overall reflection to question ratio was 0.9 (95% CI 0.8– 1.0), % open-ended questions was 76.3 (95% CI 73.1-79.6), % complex reflections was 66.1 (95% CI 63.1-69.1) and % MI- adherent information was 94.1 (95% CI 93.5–94.5). Intervencionists with higher scores implemented more sessions with longer duration compared to those with lower scores (p=0.012). Conclusions: the interventionists achieved beginner and experient competence on MI. Expert performance was observe in those who have conducted more interviews and spent more time talking with the caregivers.