Barriers and Facilitators for Implementing Motivational Interviewing as a Return to Work Intervention in a Norwegian Social Insurance Setting: A Mixed Methods Process Evaluation.
Vegard Stolsmo Foldal, Marit Solbjør, Martin Inge Standal and 10 others
PMID 33761083WHAT IT FOUND
Caseworkers found motivational interviewing hard to master and resource-intensive, with fidelity scores below proficiency for empathy.
However, 99% of sick-listed workers reported satisfaction with the sessions, and caseworkers valued the early one-on-one contact for building trust.
Key findings
01Caseworkers struggled to maintain MI skills due to lack of practice time, workload, and insufficient organizational support.
02Treatment fidelity assessments showed technical skills met the threshold for beginning proficiency, but relational skills (empathy/partnership) did not.
03Despite implementation barriers, the vast majority of participants reported satisfaction with the intervention and its timing.
STILL TO COME
How it was doneWhat they found
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What it does not show
All caseworkers in the study were female, which may limit generalizability to male practitioners. The project was externally funded and better resourced for training and supervision than typical social insurance settings, so the barriers reported may be understated. Caseworkers were volunteers motivated to learn MI, which may have biased them to overestimate its benefits. The study did not include the managerial perspective on structural barriers. Fidelity data was collected from a small sample of 20 sessions during the early phase of the trial, which may not represent the full range of practice. The RCT was ongoing, so effectiveness data was not available for this process evaluation.
Declared interests
The study was funded by the Research Council of Norway (Norges Forskningsråd) and NTNU Norwegian University of Science and Technology.
The easy way to misread this
Do not interpret the high participant satisfaction as evidence that motivational interviewing was delivered with high fidelity. The study found that caseworkers' relational skills, including empathy, scored below the threshold for beginning proficiency, suggesting that the quality of the counseling may have been compromised by workload and training gaps despite positive client feedback.