Fidelity of a prenatal motivational counseling intervention: Baby Smiles study

Objectives: To describe study counselors’ adherence and competence (fidelity) with delivering a prenatal motivational interviewing intervention to pregnant women enrolled in a randomized controlled trial.  The overall aim of the study is to test a two-part (prenatal and/or postnatal ) brief motivational intervention to increase preventive dental care utilization among rural low-income women and their children.  These data report on prenatal intervention fidelity.

Methods: Study counselors in four rural Oregon counties delivered either a motivational interviewing (MI) or health education (HE) session to pregnant participants.   Prenatal interview sessions were digitally recorded and uploaded to a secure database. Counselor’s sessions (~ 20%) were each rated by two previously trained fidelity coders (ICC (CI upper, lower) =0.88 (0.62,0.96).  Frequency of an MI element was the number of times the element occurred during the session.  Competency of an MI element was rated on a scale from 1 (very poor) to 5 (excellent). MI elements coded within the session included support affirmations, change talk, reflective listening, discrepancy, and open-ended questions.  The average of the two coder’s ratings was used to assess the intervention fidelity. For training, a competence rating of three was deemed an adequate delivery of the intervention.

Results:   Sixty-four interview sessions were coded; 32 were a motivational interviewing session.  Within the MI sessions, counselors used a mean (standard deviation; SD) frequency of MI elements ranging from 20 (5.0) to 33 (5.3).  In contrast, their mean frequency of MI elements in the HE sessions ranged from 0.2 (0.3) to 1.6 (0.8). The mean overall competency rating for delivering MI elements for all counselors was 3.0 (SD < 0.1).  MI elements that were most frequently used and rated as being competently delivered by all the counselors were change talk and open-ended questions.

Conclusions:   Study counselors delivered the prenatal motivational interviewing intervention consistently and competently.