Assessing motivational interviewing integrity in the Toddler Oral Health Intervention study

Objectives: The Toddler Oral Health Intervention (TOHI) was launched in 2017 to promote oral health prevention at well-baby clinics, with a focus on parents with children aged 6–48 months. This study aims to evaluate the integrity of motivational interviewing (MI) as one of the core intervention pillars in the TOHI study. Methods: The TOHI study was conducted at nine well-baby clinics in the central and southern regions of the Netherlands, with 11 trained oral health coaches (OHCs) delivering a tailored individual counselling programme. Audio recordings of counselling sessions were uploaded by the OHCs into an online portal for feedback and integrity evaluation purposes. A trained independent assessor evaluated MI integrity using the MITI 4.2.1 coding scale. IBM SPSS Statistics was used to analyse the data, with ratings on technical and relational components and behavior counts computed by adding up the scores and categorizing them into six key MI skills. Descriptive statistics, including frequencies, percentages and median scores with interquartile ranges, were calculated. Results: The median ratings on the technical and relational components were 2.5 (IQR 2.0–3.5) and 3.5 (IQR 3.0–4.0) out of a maximum of 5, with 45% and 58% of recordings showing fair or good MI integrity, respectively. A median of 38% (IQR 25–55%) of complex reflections and a reflection-to-question ratio of 0.7 (IQR 0.4–1.0), with 47% and 24% of recordings showing fair or good MI integrity, respectively. Median counts of MI-adherent and non-adherent statements were 3.0 (IQR 2.0–5.0) and 0.0 (IQR 0.0–1.0), respectively. The duration of recordings and MI integrity varied among oral health coaches. Conclusion: Overall, this study revealed that, while intensive training was provided, not all OHCs in the TOHI study met fair thresholds for MI integrity. These findings emphasize the necessity of ongoing training, reflection and support to achieve and maintain a fair or good level of MI integrity in clinical practice.