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When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour

When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour
When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour
Aims In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. Design Experimental manipulation of levels of patient resistance in a role play. Setting The study was conducted at the start of a 2-day health behaviour change workshop. Participants Thirty-two practitioners who had registered for the workshop. Intervention The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. Measurements Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. Findings Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. Conclusions Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.
Health behaviour change, motivational interviewing, resistance, smoking cessation.
0965-2140
1175-1182
Francis, Nicholas
9b610883-605c-4fee-871d-defaa86ccf8e
Rollnick, Stephen
09154e57-b7c3-4904-bd43-fd18e0365257
McCambridge, Jim
6e38f35a-fd0d-46f6-817d-61f6c33cfc4f
Butler, Christopher Collett
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Lane, Claire
809aea0d-05a0-4292-b2b6-5c541691209d
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32
Francis, Nicholas
9b610883-605c-4fee-871d-defaa86ccf8e
Rollnick, Stephen
09154e57-b7c3-4904-bd43-fd18e0365257
McCambridge, Jim
6e38f35a-fd0d-46f6-817d-61f6c33cfc4f
Butler, Christopher Collett
d2f9102c-54c2-4570-be4e-32324c8c8f1d
Lane, Claire
809aea0d-05a0-4292-b2b6-5c541691209d
Hood, Kerenza
af7cf839-ca85-4ea9-83c3-3dd31be88b32

Francis, Nicholas, Rollnick, Stephen, McCambridge, Jim, Butler, Christopher Collett, Lane, Claire and Hood, Kerenza (2005) When smokers are resistant to change: experimental analysis of the effect of patient resistance on practitioner behaviour. Addiction, 100 (8), 1175-1182. (doi:10.1111/j.1360-0443.2005.01124.x).

Record type: Article

Abstract

Aims In the field of motivational interviewing, practitioner confrontational behaviour has been associated with lower levels of patient behaviour change. We set out to explore whether resistance to change among smokers affects practitioner confrontational and other behaviours. Design Experimental manipulation of levels of patient resistance in a role play. Setting The study was conducted at the start of a 2-day health behaviour change workshop. Participants Thirty-two practitioners who had registered for the workshop. Intervention The practitioners were assigned randomly to interview a standardized patient (actor) who portrayed a smoker who had been briefed to display either high or low levels of resistance to change. Measurements Interviews were audiotaped and transcribed. Practitioners and standardized patients completed interview ratings at the end of each interview. After listening to each taped interview practitioners were assigned a global score for confrontation, empathy and expert instructional style. Interviews were then submitted to a qualitative analysis. Findings Higher levels of practitioner confrontational behaviour were observed in the high resistance group. This was evident both from the global scores (median 2 versus 0, P = 0.001) and the qualitative analysis. Global scores for empathy and expert instruction were not significantly different. Qualitative analysis also suggests a pervasive negative impact on other practitioner behaviours. Conclusions Higher patient resistance probably leads to an increase in confrontational and other negative behaviours in health professionals attempting to promote behaviour change. This challenges important assumptions about the influence of practitioner behaviour on patient behaviour and subsequent health-related outcomes.

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More information

e-pub ahead of print date: 15 June 2005
Published date: 1 August 2005
Keywords: Health behaviour change, motivational interviewing, resistance, smoking cessation.

Identifiers

Local EPrints ID: 436258
URI: http://eprints.soton.ac.uk/id/eprint/436258
ISSN: 0965-2140
PURE UUID: 27fbe22a-bada-457f-9dc3-5b087ed7311d
ORCID for Nicholas Francis: ORCID iD orcid.org/0000-0001-8939-7312

Catalogue record

Date deposited: 05 Dec 2019 17:30
Last modified: 09 Jan 2022 04:08

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Contributors

Author: Stephen Rollnick
Author: Jim McCambridge
Author: Christopher Collett Butler
Author: Claire Lane
Author: Kerenza Hood

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