Motivational interviewing experiences from a community health worker-led HIV prevention and care intervention in rural Uganda: a qualitative study

ABSTRACT

Motivational Interviewing (MI) and Community Health Workers (CHWs) are increasingly utilized in global settings to improve HIV outcomes, yet research exploring implementation strategies using MI and CHWs is lacking. We examined the experiences of CHWs and their clients in a counseling intervention which used MI-informed counseling to increase engagement in HIV prevention and treatment. This study was nested within the mLAKE cluster-randomized trial in a high HIV prevalence fishing community in rural Rakai District, Uganda. We conducted in-depth interviews with purposively-sampled CHWs (n = 8) and clients (n = 51). Transcripts were analyzed thematically to characterize CHWs’ implementation of the intervention. Main themes identified included use of specific MI strategies (including evocation, guidance towards positive behavior change, active listening, and open-ended questions), and MI spirit (including collaboration, power-sharing, trust, and non-judgmental relationship building). Through these specific MI mechanisms, CHWs supported client behavior change to facilitate engagement with HIV services. This study provides evidence from a low-resource setting that CHWs with no previous experience in MI can successfully implement MI-informed counseling that is well-received by clients. CHW-led MI-informed counseling appears to be a feasible and effective approach to increase uptake of HIV prevention and care services in low-resource, HIV endemic regions.

KEYWORDS:

• HIV
• motivational interviewing
• community health workers
• Uganda

Acknowledgements

We thank all participants and community health workers of the Health Scout intervention for their time and involvement in this study. We thank the RHSP department of Social and Behavioral Sciences leadership team and interviewers: William Ddaaki, Dauda Isabirye, Aminah Nambuusi, Ann Lindah Namuddu and Charles Ssekyewa. Authors’ contributions: All authors contributed to study conception and design. Larry W Chang originated the concept and obtained funding for the parent trial. Rose Pollard Kaptchuk, Ismail Mbabali, K. Rivet Amico, Larry W Chang, Neema Nakyanjo, Aggrey Anok, and Jeremiah Mulamba developed and implemented data collection procedures. Rose Pollard Kaptchuk, Heidi Hutton, and Holly Nishimura developed and contributed to the data analysis plan and analysis. Holly Nishimura wrote the first draft of the paper. All authors contributed important intellectual content to the manuscript and all authors approved the final submission.

Disclosure statement

emocha Mobile Health Inc. is the company that developed and supported the smartphone application used in the Health Scouts intervention. LC is entitled to royalties on certain non-research revenue generated by this company and owns company equity. Specific to this study, LC did not and will not receive royalties or compensation from emocha Mobile Health Inc. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. All other authors have no relevant financial or non-financial interests to disclose.

Additional information

Funding

The parent study was funded by National Institute of Mental Health (PI: LWC, R01MH107275), National Institutes of Health (www.nih.gov), and the Johns Hopkins University Center for AIDS Research (P30AI094189, hopkinscfar.org). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.