No reductions and some improvements in South African lay HIV/AIDS counsellors' motivational interviewing competence one year after brief training

Abstract

In South Africa, lay HIV/AIDS counsellors are trained in both client-centred and more directive, health-advising techniques. Both approaches are limited in facilitating health behaviour when clients are ambivalent. Motivational interviewing (MI) is a counselling approach that develops the client's intrinsic motivation to change. Evangeli et al. evaluated a 12-hour course of MI delivered to 17 lay HIV/AIDS counsellors in Western Cape Province, South Africa. There was a marked change from MI non-adherent practice to more MI adherent practice at the end of the training. Few counsellors, however, reached the level of beginning proficiency in MI. The current study was a one-year follow-up of MI competence in the same cohort of lay HIV counsellors. Ten counsellors participated.

Results confirmed that changes in lay HIV counsellors' level of MI competence as a result of a brief MI course were maintained over a one-year period and in some cases were enhanced. MI competence was independent of self-report and demographic factors. As in Evangeli et al., the majority of counsellors did not attain beginning proficiency level. Reasons for the findings are explored, including consideration of baseline level of counselling, characteristics of the training and individual motivation. Ideas for future research are outlined.

Keywords:

• HIV
• motivational interviewing
• lay counsellors
• training
• evaluation

Acknowledgements

The considerable assistance of Melanie Basson, Nolundi Ndudane and Elsie Smith is gratefully acknowledged. This work was funded by a British Academy Small Grant.