Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study 2023 Rymenans et al

Purpose
Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI’s relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary.

Methods
Eighteen people (29–60 years; sick leave > 12 weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI’s mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis.

Results
Main mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI’s effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW).

Conclusions
These results stress the importance of self-determination theory’s support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients’ engagement regarding RTW. These mechanisms’ instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium’s social security system’s premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI’s long-term effects as well as its complex interaction with external factors.

Paywall, https://link.springer.com/article/10.1007/s10926-023-10108-4

 

This is blithely stupid. If someone asked me why I applied for disability, I'd say it's because I tried to work continuously for three years, in two career paths, and both ended in failure. I tried extremely hard, it's not like I didn't apply myself. And everyone needs some sort of income. However, people who have been on sick leave for a mere 3 months (the minimum for this study) are more likely to both have justified uncertainty as to their career prospects, and be persuaded to doubt themselves by a counselor.

 

100% this!

LOL. What does the word 'realist' even mean to the BPS folks? Almost certainly not the same as it means to everyone else... (Just like 'recovery' doesn't mean the same to them as it means to everyone else.)

I don't think any disabled people need 'motivation' to get back to work and earn a decent living instead of having to subsist on meagre benefits. What we do need is good science and treatments that work, so that we can resume normal life. All the interview pep talks in the world won't accomplish that, unfortunately.

 

Adequate accommodations would help as well.

 

Pure marketing buzzword stuff. Mental healthcare is basically becoming like life coaching, except with even more pseudoscience.

Here they're simply describing what they did and it's either buzzwords or fully generic. Entirely worthless.

 

And so has physical healthcare. It's truly scary.