Summary
This study evaluated the fidelity of motivational interviewing delivery by 11 oral health coaches in the Toddler Oral Health Intervention programme across nine Dutch well-baby clinics. Using standardised MITI coding of audio-recorded counselling sessions, the authors found that despite intensive training, less than half of coaches achieved fair or good technical MI integrity, and only 24% met the threshold for an adequate reflection-to-question ratio. The findings underscore the need for ongoing supervision and quality assurance to sustain MI implementation fidelity in routine clinical practice.
UK applicability
These findings are relevant to UK oral health and health visitor services, which increasingly adopt motivational interviewing for behaviour change support in early childhood. The study suggests that MI fidelity cannot be assumed after initial training alone, implying that UK programmes incorporating MI would benefit from similar quality-assurance auditing and ongoing coach supervision.
Key measures
MITI 4.2.1 technical and relational component ratings (0–5 scale); percentage of complex reflections; reflection-to-question ratio; counts of MI-adherent and non-adherent statements; proportion of recordings meeting fair or good MI integrity thresholds
Outcomes reported
The study evaluated the integrity of motivational interviewing (MI) delivery by oral health coaches using the MITI 4.2.1 coding scale across audio-recorded counselling sessions. Key metrics included MI component ratings, reflection-to-question ratios, complex reflection percentages, and MI-adherent versus non-adherent statement counts.
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