Application of motivational interviewing to prenatal smoking cessation: training and implementation issues.

OBJECTIVE: Three of the Smoke-Free Families projects incorporated motivational interviewing (MI) into prenatal smoking cessation interventions. This paper describes the process involved in training healthcare providers to use MI and the issues encountered in implementing the protocols. DESIGN: Health care providers at all three sites attended local training workshops in which they learned to apply the basics of MI to their study protocol. All sites followed a similar outline and schedule for training and monitoring. SETTINGS: The MI interventions were delivered through home visits in Boston, Massachusetts; phone based counselling calls to patients' homes in Southern California; and in urban and rural prenatal clinics throughout East Texas. PARTICIPANTS: Public health nurse and social work case managers, who were already employed by health care agencies, delivered the MI interventions. MEASURES: Pre- and postintervention assessments and feedback from trainers and investigators at all three sites. RESULTS: Providers were enthusiastic about the training workshops, which they rated as effective in preparing them to deliver the intervention. Barriers to implementation included difficulty in contacting patients and competing demands on providers' time. CONCLUSIONS: Conducting initial training for providers is the first step in developing skills to deliver motivational interventions. Additional time and resources are needed for ongoing skill building and monitoring of intervention delivery.