Measuring Difficult Conversations Between Practitioners and Parents about Babies' Exposure to Environmental Tobacco Smoke

Background and Purpose:  Environmental tobacco smoke (ETS) is a byproduct from smoking tobacco. ETS disperses in the air (secondhand smoke) and as tobacco smoke residue on surfaces/materials (TSR). Harmful effects of ETS and TSR exposure on children’s physical and behavioral health are well documented. Working with parents toward reducing or eliminating their children’s exposure to ETS and TSR is an important goal for health care providers and social workers. The spirit of motivational interviewing (MI) offers professionals a collaborative communication style for engaging in difficult conversations about ETS/TSR exposure. The present study tests a modified version of the Motivational Interviewing Measure of Staff Interaction (MIMSI; Hohman & Matulich, 2010) for evaluating interactions between parents and health care providers about efforts to reduce ETS and TSR exposure.

Methods: Study participants were 90 parents of babies receiving inpatient or outpatient care for bronchopulmonary dysplasia (BPD), a chronic pediatric lung condition. Participants were recruited through an inpatient neonatal intensive care unit and two BPD outpatient clinics. The original MIMSI is a 10-item instrument measuring staff members’ use of the spirit of motivational interviewing in interactions with adult residential treatment clients (Hohman & Matulich, 2010). The present study modifications made each item specific to ETS/TSR exposure conversations. Parents completed the instrument along with an ETS/TSR exposure questionnaire at one infant health visit or during NICU discharge planning. Respondents rated each item using a five-option scale (never, rarely, sometimes, often and always) reflecting their perceptions of staff efforts in utilizing spirit of MI elements in their ETS/TSR exposure conversations.

Results: The first question addressed was whether a single cumulative MIMSI score is appropriate. This was addressed through principal components analysis, and it was determined that more than one scale is represented in the data (Chronbach’s alpha=.463; 34.28% of variance was explained). In our data, the Kaiser-Meyer-Olkin measure of sampling adequacy (.746) and Barlett’s Test of Sphericity (χ² with 45 df=1568, p<.001) indicate that exploratory factor analysis (EFA) is a reasonable strategy. The original MIMSI was analyzed to reflect three scales (collaboration, autonomy, evocation), however in our data a 3-factor exploratory analysis failed using oblique rotation and principal axis factoring (variable communality problem, eigen value < 1.0). Based on the original scree plot, a 2-factor solution was analyzed (resulting eigen >1.0). Based on factor loadings (.401 to .784), Factor 1 included five items (ICC=.756) and Factor 2 included four (.716); one item loaded poorly on both factors. Chronbach’s alpha (after reverse coding negatively worded items) did not improve appreciably with any items deleted from either factor. Qualitative review of the co-loading items suggests that Factor 1 might be labelled “Reflects the Spirit of MI” and Factor 2 might be “Contrary to the Spirit of MI.”

Conclusions and Implications: This brief instrument holds promise as a practical tool for evaluating practitioners’ use of the spirit of MI in ETS/TSR exposure conversations with parents. These findings provide initial support for this measurement approach in evaluating practice, extend generalizable knowledge about the MIMSI, and indicate opportunities for future research.