| Abstract |
This proposed collaboration among a social scientist (Dr. Laws), a physician (Dr. Wilson) and a psychologist
(Dr. Rose) will consist of formative research to support the development of an R34 proposal to NIMH, led by
Dr. Laws, for the development and evaluation of an intervention to train physicians in HIV care in
motivational interviewing (MI) techniques. In HIV care, the need to motivate and support behavior change in
patients is highly salient. Antiretroviral therapy (ART) requires very strict adherence to medication regimens,
which can be challenging to patients. Previous research by Drs. Laws and Wilson has found that providing
physicians with information about their patients’ ART adherence can result in more physician-patient
discussion about adherence, but that this does not result in improved adherence. Analysis using a coding
system developed for the study found that the physicians’ communication style tended to be highly directive,
and that patients expressed few goals, opinions, or commitments to behavioral change. Research into
counseling about behavior change, conducted principally in the field of substance abuse treatment, has
established that MI -- a facilitative style in which clients are encouraged to explore their own motivations and
to engage in talk about behavioral change – is effective. To develop the intervention, we first need to
determine how physicians perceive their ability to counsel patients about ART adherence and other
behavioral issues, the kinds of skills they would like to acquire, and the format and structure of a training and
ongoing supportive intervention that will be most acceptable to them and likely to be used. We also need to
better understand the patient’s point of view on physician-patient dialogue about ART adherence and other
behaviors, including how they respond to examples of Dr-Pt dialogue which are MI consistent and
inconsistent, because it is after all the patients who need to carry out the desired behaviors. Using principles
of participatory research, we will conduct a focus group of physicians and in-depth interviews and focus
groups with patients, and invite patients to participate in interpretation of the data and the findings. The
results will inform the development of the training intervention and evaluation tools for the R34 grant.
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