Skip to main content Accessibility help

Integration of Motivational Interviewing into Practice in the National Exercise Referral Scheme in Wales: A Mixed Methods Study

  • Graham F. Moore (a1), Laurence Moore (a1) and Simon Murphy (a1)


Background: Though motivational interviewing (MI) has demonstrated efficacy in a range of behaviour change settings, effectiveness will require successful integration into everyday practice. This study examines implementers’ views on delivering MI within an exercise referral scheme and consistency of consultations with MI before and after a 2-day workshop. Method: Semi-structured interviews were conducted with 27 exercise professionals and 10 area coordinators delivering the Welsh National Exercise Referral Scheme (NERS), and the MI trainer. Eleven professionals provided consultation recordings before and 6-months after training, coded for fidelity using the Behaviour Change Counselling Index. Results: The workshop was well received by most, triggering increased recognition of potential motivational roles of consultations. However, some cited difficulties combining MI with structured data gathering activities, whilst a minority rejected MI, seeing current practice as effective, or MI as unnecessary because patients were ready to change. Although limited aggregate improvement in practice was observed, substantial improvements were observed in some individuals. Comments on the need for further practice or training were widespread. Conclusions: Efforts to implement MI should ensure that training and structures to provide monitoring and feedback are in place and that activities incorporated within consultations are compatible with MI delivery.


Corresponding author

Reprint requests to Graham Moore, Cardiff Institute of Society and Health, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, Wales. E-mail:


Hide All
Baldwin, T. and Ford, J. (1988). Transfer of training: a review and directions for research. Personnel Psychology, 41, 63104.
Befort, C. A., Nollen, N., Ellerbeck, E. F., Sullivan, D. K., Thomas, J. L. and Ahluwalia, J. S. (2008). Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial. Journal of Behavioral Medicine, 31, 367377.
Bennett, G. A., Moore, J., Vaughan, T., Rouse, L., Gibbins, J. A., Thomas, P., et al. (2007). Strengthening Motivational Interviewing skills following initial training: a randomised trial of workplace-based reflective practice. Addictive Behaviors, 32, 29632975.
Bennett, J. A., Lyons, K. S., Winters-Stone, K., Nail, L. M., and Scherer, J. (2007). Motivational interviewing to increase physical activity in long-term cancer survivors: a randomized controlled trial. Nursing Research, 56, 1827.
Bennett, J. A., Young, H. M., Nail, L. M., Winters-Stone, K. and Hanson, G. (2008). A telephone-only motivational intervention to increase physical activity in rural adults: a randomized controlled trial. Nursing Research, 57, 2432.
Braun, V. and Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77101.
Brehm, J. W. (1966). A Theory of Psychological Reactance. New York: Academic Press.
Brodie, D. A. and Inoue, A. (2005). Motivational interviewing to promote physical activity for people with chronic heart failure. Journal of Advanced Nursing, 50, 518527.
Broers, S., Smets, E., Bindels, P., Evertsz, F. B., Calff, M. and de Haes, H. (2005). Training general practitioners in behavior change counseling to improve asthma medication adherence. Patient Education and Counseling, 58, 279287.
Brug, J., Spikmans, F., Aartsen, C., Breedveld, B., Bes, R. and Fereira, I. (2007). Training dieticians in basic motivational interviewing skills results in changes in their counseling style and in lower saturated fat intakes in their patients. Journal of Nutrition Education and Behavior, 39, 812.
Campbell, J. P., Maxey, V. A. and Watson, W. A. (1995). Hawthorne effect: implications for prehospital research. Annals of Emergency Medicine, 26, 590594.
Carels, R. A., Darby, L., Cacciapaglia, H. M., Konrad, K., Coit, C., Harper, J., et al. (2007). Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach. Health Psychology, 26, 369374.
Forsberg, L., Forsberg, L., Lindqvist, H. and Helgason, A. (2010). Clinician acquisition and retention of Motivational Interviewing skills: a two-and-a-half-year exploratory study. Substance Abuse Treatment, Prevention, and Policy, 5, 8.
Greaves, C. J., Middlebrooke, A., O'Loughlin, L., Holland, S., Piper, J., Steele, A., et al. (2008). Motivational interviewing for modifying diabetes risk: a randomised controlled trial. British Journal of General Practice, 58, 535540.
Hardcastle, S., Taylor, A., Bailey, M. and Castle, R. (2008). A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Education and Counseling, 70, 3139.
Harland, J., White, M., Drinkwater, C., Chinn, D., Farr, L. and Howel, D. (1999). The Newcastle exercise project: a randomised controlled trial of methods, to promote physical activity in primary care. British Medical Journal, 319, 828832B.
Hecht, J., Borrelli, B., Breger, R. K. R., DeFrancesco, C., Ernst, D. and Resnicow, K. (2005). Motivational interviewing in community-based research: experiences from the field. Annals of Behavioral Medicine, 29, 2934.
Hillsdon, M., Thorogood, M., White, I. and Foster, C. (2002). Advising people to take more exercise is ineffective: a randomized controlled trial of physical activity promotion in primary care. International Journal of Epidemiology, 31, 808815.
Kazi, M. (2003). Realist Evaluation for Practice. British Journal of Social Work, 33, 803818.
Lane, C. (2005). The Behaviour Change Counselling Index (BECCI): manual for coding behaviour change counselling. From
Lane, C., Huws-Thomas, M., Hood, K., Rollnick, S., Edwards, K. and Robling, M. (2005). Measuring adaptations of motivational interviewing: the development and validation of the behavior change counseling index (BECCI). Patient Education and Counseling, 56, 166173.
Lane, C., Johnson, S., Rollnick, S., Edwards, K. and Lyons, M. (2003). Consulting about lifestyle change: evaluation of a training course for specialist diabetes nurses. Practical Diabetes International, 20, 204208.
Madson, M. B., Loignon, A. C. and Lane, C. (2009). Training in motivational interviewing: a systematic review. Journal of Substance Abuse Treatment, 36, 101109.
Martins, R. K. and McNeil, D. W. (2009). Review of Motivational Interviewing in promoting health behaviors. Clinical Psychology Review, 29, 283293.
Miller, S. T. and Beech, B. M. (2009). Rural healthcare providers question the practicality of motivational interviewing and report varied physical activity counseling experience. Patient Education and Counseling, 76, 279282.
Miller, W. R. (1983). Motivational Interviewing with problem drinkers. Behavioural Psychotherapy, 11, 147172.
Miller, W. R. and Mount, K. A. (2001). A small study of training in motivational interviewing: does one workshop change clinician and client behavior? Behavioural and Cognitive Psychotherapy, 29, 457471.
Miller, W. R. and Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37, 129140.
Miller, W. R. and Rose, G. R. (2009). Toward a theory of motivational interviewing. American Psychologist, 64, 527537.
Miller, W. R., Yahne, C. E, Moyers, T. B., Martinez, J. and Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 10521062.
Mitcheson, L., Bhavsar, K. and McCambridge, J. (2009). Randomized trial of training and supervision in motivational interviewing with adolescent drug treatment practitioners. Journal of Substance Abuse Treatment, 37, 7378.
Moran, J., Bekker, H. and Latchford, G. (2008). Everyday use of patient-centred, motivational techniques in routine consultations between doctors and patients with diabetes. Patient Education and Counseling, 73, 224231.
Moyers, T. B., Martin, T., Manuel, J. K., Hendrickson, S. M. L. and Miller, W. R. (2005). Assessing competence in the use of motivational interviewing. Journal of Substance Abuse Treatment, 28, 1926.
Murphy, S., Raisanen, L., Moore, G., Edwards, R., Linck, P., Williams, N., et al. (2010). A pragmatic randomised controlled trial of the Welsh National Exercise Referral Scheme: protocol for trial and integrated economic and process evaluation. BMC Public Health, 10, 352.
Pierson, H. M., Hayes, S. C., Gifford, E. V., Roget, N., Padilla, M., Bissett, R., et al. (2007). An examination of the Motivational Interviewing Treatment Integrity code. Journal of Substance Abuse Treatment, 32, 1117.
Resnicow, K., Davis, R. and Rollnick, S. (2006). Motivational interviewing for pediatric obesity: conceptual issues and evidence review. Journal of the American Dietetic Association, 106, 20242033.
Rollnick, S. and Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325334.
Rollnick, S., Miller, W. R. and Butler, C. C. (2008). Motivational Interviewing in Health Care. New York: Guilford Press.
Rubak, S., Sandbaek, A., Lauritzen, T., Borch-Johnsen, K., and Christensen, B. (2009). General practitioners trained in motivational interviewing can positively affect the attitude to behaviour change in people with type 2 diabetes. Scandinavian Journal of Primary Health Care, 27, 172179.
Rubak, S., Sandboek, A., Lauritzen, T. and Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. British Journal of General Practice, 55, 305312.
Smith, J. L., Amrhein, A. P., Brooks, A. C., Carpenter, K. M., Levin, D., Schreiber, E. A., et al. (2007). Providing live supervision via teleconferencing improves acquisition of motivational interviewing skills after workshop attendance. The American Journal of Drug and Alcohol Abuse, 33, 163168.
Spillane, J. P., Reiser, B. J. and Reimer, T. (2002). Policy implementation and cognition: reframing and refocusing implementation research. Review of Educational Research, 72, 387431.
Thyrian, J. R., Freyer-Adam, J., Hannover, W., Roske, K., Mentzel, F., et al. (2007) Adherence to the principles of Motivational Interviewing, clients’ characteristics and behavior outcome in a smoking cessation and relapse prevention trial in women postpartum. Addictive Behaviors, 32, 22972303.
Van Dorsten, B. (2007). The use of motivational interviewing in weight loss. Current Diabetes Reports, 7, 386390.
Van Wormer, J. J. and Boucher, J. L. (2004). Motivational Interviewing and diet modification: a review of the evidence. The Diabetes Educator, 30, 404419.
Wahab, S., Menon, U. and Szalacha, L. (2008). Motivational interviewing and colorectal cancer screening: a peek from the inside out. Patient Education and Counseling, 72, 210217.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Integration of Motivational Interviewing into Practice in the National Exercise Referral Scheme in Wales: A Mixed Methods Study

  • Graham F. Moore (a1), Laurence Moore (a1) and Simon Murphy (a1)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *