Assessing fidelity of motivational interviewing-based ‘treatment support’ delivered by rheumatology practitioners within the TITRATE trial

Introduction: To investigate treatment fidelity of selected motivational interviewing (MI) techniques applied by trained rheumatology practitioners (who were mostly nurses) in the TITRATE randomised controlled trial (N=335), and to understand their potential contribution to reductions in rheumatoid arthritis pain and fatigue observed in the trial. Methods: Analysis of fidelity data collected across 39 NHS rheumatology outpatient clinics participating in the experimental ‘intensive management’ arm of TITRATE trial. A 10% sample of audio-recorded intensive management participant consultations (N=126) was assessed by four investigators. The dataset represented 19 NHS rheumatology outpatient clinics. Evaluation was conducted using a bespoke, piloted, intervention fidelity assessment tool, and focused on the application of taught MI techniques. Results: Over half (56%) the consultations achieved moderate or high fidelity ratings across the taught MI techniques. Practitioners demonstrated skilled rapport building during 60% of consultations, and 42% included agreement on appointment agenda and the skilled use of affirmations. Practitioners demonstrated higher skill levels at providing emotionally-supportive care and lower skill levels at supporting behaviourally-focused discussion. Practitioners demonstrating MI skills in the earlier consultations maintained these. Those initially demonstrating fewer techniques did not improve over time. Discussion: Findings evidence rheumatology practitioners learnt, and implemented, most of the MI techniques. Future research needs to examine if focusing on a person’s emotions and behaviours during a consultation facilitate behavioural changes, for example pacing and medication concordance, which may result in reduced pain and fatigue.