Adoption of motivational interviewing/motivational enhancement therapy.
The National Institute on Drug Abuse (NIDA) Clinical Trials Network is intended to test promising drug abuse treatment models in multi-site clinical trials, and to support adoption of effective interventions into clinical practice. Using qualitative research methods we studied adoption of Motivational Interviewing and Motivational Enhancement Therapy (MI/MET) in five clinics where these interventions were tested. Through participation in the clinical trials, participating clinics all had knowledge of the intervention, were exposed to the intervention through training, and had the opportunity to practice the intervention so that they could evaluate it in their own setting. In this presentation we report on adoption outcomes in the wake of the MI and MET multi-site clinical trials, describe the range of outcomes observed, and consider adoption as a continuum rather than as a dichotomous outcome.
Twenty-nine participants, representing 8 organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and whether MI and MET were adopted after the clinical trial. Among the five clinics studied, and based on respondent interviews, we observed a spectrum of adoption outcomes including adoption, partial adoption, intention to adopt, and no adoption of the tested intervention. Clinic level factors related to adoption or non-adoption in this study included having MI training available locally, active MI supervision capability in the post-study period, and having a champion of the intervention in the clinic. In the case of non-adoption, respondents expressed difficulties implementing the clinical trial and lack of support to continue MI at the clinic leadership level. In one instance, changes in state policy for drug treatment supported adoption of MI. Findings are relevant to clinical staff, program directors, and administrators and policy makers concerned with improving drug abuse treatment through adoption of evidence based practices.
Related protocols: CTN-0004, CTN-0005