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Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients

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Abstract

Purpose Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI’s relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary. Methods Eighteen people (29–60 years; sick leave > 12 weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI’s mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis. Results Main mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI’s effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW). Conclusions These results stress the importance of self-determination theory’s support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients’ engagement regarding RTW. These mechanisms’ instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium’s social security system’s premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI’s long-term effects as well as its complex interaction with external factors.

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Data Availability

The codebook which resulted from the data analysis process can be found in the supplementary material. Interview guide and interview data can be made available upon reasonable request by contacting the corresponding author.

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Acknowledgements

We want to thank the Industrial Research Fund of KU Leuven for providing funding for this study. We also would like to thank the Alliance of Christian Sickness Funds for their cooperation in the data collection as the interviewed participants were members of them. Phebe Raman and Lies Vankerckhove, Master students of UGent, also deserve mentioning as they conducted the semi-structured interviews with the participants and thus contributed to the data collection. Finally, we want to thank the participants for sharing their experiences with us.

Funding

This work was supported and funded by the Industrial Research Fund of KU Leuven (Grant Nos. C2/20/050 and C3/20/050).

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Author notes

  1. I. Rymenans and C. Vanovenberghe have contributed equally to this work and should be both considered as first authors.

Authors and Affiliations

  1. Department of Work and Organization Studies, KU Leuven, Brussels, Belgium

    I. Rymenans & A. Van den Broeck

  2. Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium

    C. Vanovenberghe & M. Du Bois

  3. Department of Experimental-Clinical and Health Psychology, UGent, Ghent, Belgium

    C. Vanovenberghe & E. Lauwerier

  4. North-West University, Vanderbijlpark, South Africa

    A. Van den Broeck

  5. Department of Public Health and Primary Care, UGent, Ghent, Belgium

    E. Lauwerier

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  1. I. Rymenans
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  4. A. Van den Broeck
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Contributions

CV, EL, AVdB and MDB: contributed to the conception of the study. CV: managed the data collection and EL: provided feedback on the interview guide and the data collection process. CV: conducted the data analysis with the undergraduate students, which was supervised by EL. IR: mainly contributed to reviewing the coding process, the reporting of the data and writing the manuscript, together with CV. The manuscript was regularly revised and finally approved by the other co-authors.

Corresponding author

Correspondence to C. Vanovenberghe.

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Conflict of interest

The authors have no relevant conflicts of interest to disclose.

Ethical Approval

The Medical Ethics Committee of UZ Gent (2019/1248) and the Research Ethics Committee of KU/UZ Leuven (Belgian registration number B322201941009) granted ethical approval for the conduct of this study. The ClinicalTrials.gov registration number of the RCT pilot trial regarding the MI intervention is NCT05412537.

Consent to Participate and Publish

Interested participants received an information letter concerning their rights to look into their own interview data and also to stop the interview and/or enrolment in the study at any time without consequences. The letter also stated that their data would be processed and published anonymously, so that their privacy would be guaranteed. After reading this information, all participants signed an informed consent to agree with the data collection and analysis, and publication of the findings.

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Rymenans, I., Vanovenberghe, C., Du Bois, M. et al. Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients. J Occup Rehabil 34, 141–156 (2024). https://doi.org/10.1007/s10926-023-10108-4

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