Engaging people in services: An introduction to the MotivATE approach
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Engaging people in services: An introduction to the MotivATE approach Dr Sarah Muir and James Day [email protected] [email protected]
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Transcript of Engaging people in services: An introduction to the MotivATE approach
Engaging people in services: An introduction to the MotivATE
approach
Dr Sarah Muir and James Day
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The problem of non-attendance
Around 35% of people referred to an eating disorder
service never make it to an assessment appointment
(Waller et al., 2009)
16.4% of patients decline to attend
Our 2014 survey of 4 UK services show that the number
of those who do not attend ranges from 10-32% (Muir
et al., Under review)
Large variation across services e.g. some use an opt-in
system and others give appointments
Sarah Muir and James Day ([email protected]; [email protected] )
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Why the high number?
Leavey et al. (2011)- audited 100 new referrals to an eating
disorder service in London
26% did not attend
23% attended only once
Qualitative interviews with 13 non-attenders identified
the following reasons
The functional role of the eating disorder
Ambivalence about engagement (health issues vs. giving up
identity)
Other reasons included: perceived conflict between
patient/clinician beliefs, long waiting lists, unhelpful
expectations of service and stigma about mental health services
Sarah Muir ([email protected])
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Motivation in eating disorders
Williams and Reid (2010) – Motivation to maintain an
eating disorder
Online focus groups with those who use pro-anorexia websites
AMBIVALENCE!! – Main overarching theme
Functional tool vs. disease
Friend vs. enemy
But also low self-efficacy for recovery
“I didn’t know what they were
going to do to me!”
I don´t want to die, but I don´t want
to recover, though-not yet...mostly
because of fear, and a small bit of
me wants to get better sometimes,
but I wouldn´t know how.” (Maria)
Sarah Muir ([email protected])
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Current interventions to increase attendance in mental health
Intervention Type Beneficial?
Opt-in system No significant benefit
Telephone reminder No benefit - may decrease
attendance
Orientation and reminder letters Beneficial - shows promise – 3
studies show sig. benefit
Accelerated intake Possible benefit - some increase but
not statistically sig.
Pre-appointment completion of
questionnaires
No benefit
Patient encouraged to make plans about
attending
Beneficial - A third increase in
attendance
Giving choice about therapist style Possible benefit
Schauman et al., (2013) systematic review of 21 studies
Sarah Muir ([email protected])
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Current interventions to increase attendance in mental health…
…. Could be criticised for:
a) Being relatively passive
b) Giving people more options to cancel/not attend
We believe that …
… Interventions that utilise motivation-enhancement theories
could address patient ambivalence and enhance choice to
attend
…. Web-based interventions could provide people with a way
to engage in intervention prior to formal care
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Motivation Enhancement
People are more likely to perform a behaviour if they have
high intrinsic motivation to do so (e.g. behaviour is valued
and seen as personally relevant (Deci & Ryan, 2000)
Giving people choice in ED treatment reduced treatment
drop-out (Vandereycken & Vansteenkiste, 2009)
Higher stage of change at start of treatment means
improved symptoms (Clausen et al., 2013)
Lower stage of change means higher chance of
hospitalisation, drop-out and relapse (Clausen et al., 2013)
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Day, J. et al. (in preparation)Improving Motivation to Change Amongst Individuals With Eating Disorders: A Systematic Review
(contact: [email protected] for questions)
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• Waller (2012)
• Identified nine papers - mixed evidence for enhancing motivation to
change and no evidence for improving treatment engagement.
• Criticised the current views of motivation to change in eating
disorders.
• Knowles, Anokhina and Serpell (2013)
• Also identified nine (slightly different) papers - mixed evidence that
motivational interventions were effective at increasing motivation to
change.
• Suggested they are effective at treating binge eating, but not
compensatory or restrictive behaviours.
• Why do a systematic review? – Using motivational
approaches in the treatment of eating disorders is
well supported (included in NICE guidelines) BUT
has come under criticism.
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• Why the different opinions?
• Reviews used different criteria and
strategies – and so examine different
papers!
• We need a broader look at
the evidence to get the full
picture
• Thirty six studies included
(involving 2843 participants)
• Large amount of variation
between studies – different
methods, interventions,
measures etc.
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What evidence is there that treatment interventions increase motivation to change amongst individuals with eating disorders?
Majority of included papers (78%) found improvements in motivation to
change.
A wide range of treatment approaches were used.
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Mixed Do Not Support Support
• Successful interventions also
included digital health approaches
such as web-based delivery as well
as the use of virtual reality.
• Results seem to be largely similar
across eating disorder diagnoses.
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Are motivationally focused interventions more effective than non-motivational treatments at increasing motivation to change?
• Greater impact compared to
low intensity interventions
(self-help or psycho-
education) BUT no significant
benefits over intensive
treatments (inpatient or CBT)
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Do Not Support Support
• Six studies compared a motivational intervention (MI or
MET) to an active control condition.
• The evidence for their ability to improve motivation to
change over non-motivational treatments is mixed.
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Conclusions
Treatment improves motivation to change
amongst eating disorders patients.
The role of motivational interventions
needs careful thought – where and when
should they be used?
Use of online delivery methods present a
new potential treatment option.
More high quality research is needed to
explore motivational interventions, their
use online and differences between
diagnoses.
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Can Digital Technology Help?
NHS Digital First initiative - A key priority is to use digital technology
to improve service attendance
- E.g. using SMS appointment reminders in health services
can halve DNA rates and save the NHS £264 million
Sarah Muir ([email protected])
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How many of us search for health information online?
Online health information seeking is the third most popular online
activity after e-mailing and general searching
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Six reason why the internet can
help
Sarah Muir ([email protected])
1. Web-based interventions are Acceptable
• Popular, used as well as face-to-face, considered
safe first step for those who may not be sure of
commitment to change yet
2. Web-based interventions are Accessible and Timely
• Can be provided when motivation may be highest
and BEFORE contact with services!
3. Web-based interventions offer personalisation and
tailoring
4. Web-based interventions offer autonomy and control
5. Web-based interventions do not impact existing
treatment resources
6. Web-based interventions are effective!
• Can increase stage of change in users (Höetzel et
al., 2013; Leung et al., 2012)
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Positive perceptions of MotivATE
“I think the content is really
good and probably what you
want to know before you went
into a service, answers the
question of ‘what will my first
appointment be like’?” (P3)
“That’s very good too as you
need proof, you desperately
need to see someone or hear of
someone who really has got
better and these are all things
that are building confidence
aren’t they.” (P7)
Sarah Muir ([email protected])
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Considerations
Tailoring to stage of change
Use of language (e.g. “complete
the following exercise”)
Concentration of users
Fears about recovery
“After [I was] diagnosed
and before [I was]
assessed not sure I would
have felt any of these
things…. But as I was
through my recovery then
yes I probably said all of
these things… But some
of the statements, are
actually contrary to my
beliefs at the time… “(P1)
“I freaked a little bit then. Thinking
about change in the future. I’m going
to move onto something else (chooses
quiz to distract from message on page)
because that’s what I would do” (P4)
Sarah Muir ([email protected])
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Potential benefits of MotivATE
Earlier intervention (reduced chronicity)
Higher motivation before treatment may mean
More engagement
Reduced symptoms
Less motivational intervention needed with clinician
Empowering for those with a long wait for assessment (but
must not be seen as a panacea)
Reduced cost associated with DNAs (e.g. costs of wasted
appointments, GP re-referral, and increased inpatient costs
from increased severity of symptoms)
Generalizable to other groups…?
Sarah Muir ([email protected])
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Acknowledgements
The MotivATE team
Ciarán Newell
Jess Griffiths
Katherine Appleton
Sarah Thomas
Jon Arcelus
Peter Thomas
All of the people who provided stories, videos and
feedback on earlier versions of MotivATE
Any questions – [email protected]
