Motivational Interviewing and Technology

Motivational interviewing (MI) was developed as a face-to-face intervention. However, increasing use of technology for mobile and electronic health approaches have adapted MI to be delivered via several technology-enabled platforms. Chapter 15 offers several examples of using MI with mobile platforms. Although these examples draw from a situated information, motivation, behavioral skills model–based approach, the use of texts, mobile phones, and computer programs to help identify potential positions on stages of change are highly generalizable. These three intervention packages detail the development and implement of technology enabled, MI-informed interventions for HIV treatment and prevention.

Learning and Experiencing Motivational Interviewing

Training in motivational interviewing (MI) has increasingly become more innovative. In this chapter, the authors review the necessary components and key requirements to learning MI. The chapter discusses the fundamental importance of feedback and coaching in the learning and practice processes. Complementary to the feedback, modeling from mentors is incredibly helpful in learning MI. The chapter emphasizes the approach of practicing MI mindfully, which requires focus and attunement toward rough areas and improvement. MI advances a skill set that draws on a certain conversational mindset and “heartset.” The authors review the stages in learning MI, which include adopting the spirit of motivational interviewing; using open-ended questions, affirmations, reflections and summarizations (OARS); encouraging “change talk”; allowing and accepting “sustain talk”; developing a change plan; consolidating commitment; and integrating MI with other modalities.

Emotional Management, Psychological Issues, and Motivational Interviewing

People living with HIV (PLWH) experience significant psychological distress and are at risk of developing psychiatric symptoms and disorders similar to those seen in the general population. This chapter summarizes and reviews the psychological issues and challenges experienced by PLWH and discusses the integration of motivational interviewing (MI) into the patient-centered multifaceted medical and psychological care of PLWH. In the closing section, the author looks at future directions for using MI to care for PLWH and suffering from depression, anxiety, and/or trauma-based disorders and argues that further studies are needed to elucidate the efficacy, advantages, and potential limitations of MI for mitigating emotional distress specifically in PLWH.

Comorbid Medical Problems and Motivational Interviewing

As HIV treatments become more effective and accessible, people living with HIV (PLWH) are achieving longer lifespans; however, this aging population also faces a greater risk of age-related co-morbidities. Many chronic diseases affect people living with HIV disproportionately, including diabetes, ischemic heart disease, and congestive heart failure. Patient-centered healthcare should aim to optimize quality and length of life while also considering the person’s value system. Motivational interviewing (MI) has been effective in helping PLWH to better manage chronic diseases requiring behavioral modification in both high- and low-resource settings. MI is a useful approach in the complex care of PLWH and medical co-morbidities. MI can promote self-management integrating HIV care as well as other co-morbidities in the context of social and cultural factors. This chapter discusses the application of MI to achieve better control of co-morbid medical conditions in PLWH.

Motivational Interviewing and the Adolescent/Young Adult HIV Care Continuum

This chapter explores the HIV care continuum specifically with youth living with HIV (YLH). The authors review relevant HIV statistics, including the trends in YLH. The authors then examine the fit of motivational interviewing (MI) with adolescent development, arguing that it is an excellent strategy to include in promoting self-management of HIV. Multiple examples are also provided for programs and interventions using MI with youth. This chapter provides specific details on how MI can be leveraged in working with YLH, although many of these insights can generalize to adult populations. In the final section, the authors examine the future direction of MI in the care of YLH. They argue that once MI has helped to motivate YLH toward change, the substitution for or addition of cognitive-behavioral therapy (CBT) may be warranted. In this way, the more action-oriented strategies of CBT strengthen the behavior changes that MI has helped to put in motion.

Motivational Interviewing and the Continuum of HIV Care in Practice

Advances in HIV treatment have transformed a nearly universally fatal disease into a manageable long-term medical condition. Treatment, however, requires long-term, active engagement and self-directed adherence to HIV medications, which can be challenging to manage. Factors influencing HIV management are multilevel and best understood from an interdisciplinary framework. This chapter reviews the interdisciplinary care model for HIV management, discusses barriers interfering with positive health outcomes in people living with HIV (PLWH), and positions motivational interviewing (MI) as particularly well suited to optimizing outcomes in an interdisciplinary context. This chapter advocates for the integration of MI into the care of PLWH throughout the HIV care continuum.

Motivational Interviewing in Global Practice Settings

Motivational interviewing (MI) in increasingly used to support people living with HIV around the world. When MI strategies represent a large departure from standard of care, learning and implementing MI can be challenging. Chapter 14 focused on experiences in Cape Town, South Africa, as counselors moved from more education/information-giving approaches to MI-informed approaches. In practice, the role of ongoing supervision and support is critically important. We emphasize the value of supervision in MI for the all MI-based interventions and particularly for these kinds of interventions in global health settings where they may be quite different from current norms.

Substance Use and Motivational Interviewing

People living with HIV (PLWH) who use drugs and alcohol are particularly likely to experience gaps across the HIV care continuum. People with co-occurring HIV and a substance use disorder face significant challenges in treatment. Substance use is well-known to be linked to important health behaviors and outcomes including adherence to antiretroviral and treatment, immunosuppression, and sexual risk behaviors. This chapter provides a review of the impact of substance use in PLWH and the role of motivational interviewing as part of an integrated approach to care of PLWH with co-occurring substance use disorders. The chapter concludes with a case example to illustrate the role that motivational interviewing can play the care of PLWH with a co-morbidity of substance use disorder.

Lifestyle Changes and Motivational Interviewing

To adequately manage and prevent HIV disease, it is important to address lifestyle behaviors such as substance use and risky sexual behaviors, which are considered as sexual behaviors that increase the risk of negative outcomes, such as condomless sex, multiple partners, sex under the influence of drug and alcohol, IV drug use, paying for sex, and untreated sexually transmitted illness, among others. Motivational interviewing (MI) has been shown to be effective in helping patients in HIV care reduce substance use and risky sexual behaviors. Using MI skills and strategies helps facilitate discussions and minimize barriers that prevent patients from having open conversations with their practitioners about stigmatized or “unhealthy” behaviors. MI is not a comprehensive intervention, but it is a tool that combines strategies and spirit to produce conversations that can help patients resolve their ambivalence in the direction of change and can be used in combination with other practical interventions approaches when addressing other areas of health promotion.

Example Interventions Using Motivational Interviewing to Enhance Engagement in HIV Care

Chapter 8 provides examples of programs developed to optimize retention in HIV care that are based on principles of motivational interviewing (MI). Two programs are highlighted: iEngage, a recently evaluated intervention to promote early retention in HIV-care as part of a multi-site clinical trial, and 60-Mintues for Health, a piloted intervention approach for patients tenuously engaged in HIV-care. These programs, their theoretical underpinnings, and use of MI offer some importance insights about mobilizing MI in the context of HIV care. Consistent with MI, both programs are founded on patients’ autonomy and self-determination, with the interventionist acting as a guide to help patients achieve tailored goals while avoiding the righting-reflex and highlighting change talk.