Understanding communication on mastitis management: could Motivational Interviewing aid in the uptake of advice?

Objectives:
Mastitis is one of the most significant causes of morbidity and mortality of the adult dairy cow (Ruegg 2011). Compliance with veterinary recommendations is critical to tackle incidence rates on farm (Green et al. 2007), yet improving uptake of advice in daily practice is a challenge (Jansen et al. 2010). Similar challenges are faced by the medical profession, who are increasingly employing an evidence-based communication methodology called Motivational Interviewing (MI) to improve public health. This research examines vet-farmer communication on disease, with the objective of establishing whether MI communication skills are currently in use.

Materials and Methods:
Role play sessions reflecting consultations on lameness and mastitis were recorded between cattle veterinarians (n=15) recruited from two UK practices located in South West England and an actress experienced in role play in medical and veterinary education. The actress was provided with a character and farm profile reflecting a ‘typical’ UK situation, and veterinarians were provided with a short excerpt on the disease issue/risk factors on the farm and evidence to encourage them to broach a broad topic area of change with the farmer. Consultations lasted an average of 11.2 minutes (range 7.7 to 14.9).
Consultations were analysed using the MITI 4.2.1, a treatment integrity measure for clinical trials of MI. In this system, verbal interactions are firstly coded for frequencies of verbal behaviours: Giving Information, Persuading, Persuading with Permission, Questions, Reflections (simple/complex), Affirmations, Seeking Collaboration, Emphasising Autonomy and Confronting. Secondly, global scores are assigned on a five point Likert scale (from 1: low proficiency to 5: high proficiency) to characterise the entire consultation in relation to MI foci: Cultivating Change Talk, Softening Sustain Talk, Partnership and Empathy. To meet the level of ‘basic competency’ in MI, veterinarians required a mean score of 3.5 in Relational globals (Partnership, Empathy) and 3 in Technical globals (Cultivating Change Talk, Softening Sustain Talk), a Reflection to Question ratio of 1:1 and a 40% Complex Reflection percentage (of total Reflections). Coding was performed directly from audiotapes.

Results:
MI communication skills were recorded within these veterinary consultations, yet no veterinarian was classified at a level of overall ‘basic competency’.

Verbal behaviours:
Veterinarians predominantly relied on Persuasion, Questions and Giving Information in their consultation approaches. Communication behaviours inadherent with MI (Persuasion and Confrontation, n=126) far exceed total MI adherent behaviours (Affirmations, Seeking Collaboration and Emphasising Autonomy, n=15), whilst no veterinarian achieved ‘basic competency’ with regards to Question: Reflection ratio (goal: 1:2). However, Reflections were found in nine of the fifteen veterinarian-farmer interactions.

Consultations approach: global scores:
One veterinarian of the fifteen met the criteria for basic competence in MI with a mean score of 3.5 in Relational globals (Partnership, Empathy) and a mean score of 3 in Technical globals (Cultivating Change Talk, Softening Sustain Talk). However, mean global scores overall were low - Relational score = 1.6 (range 1-3.5) and Technical score = 1.7 (range 1- 3).

Conclusions:
These data suggest that current veterinary communication practices do not employ MI methods overall. However, some MI skill naturally occurs in practicing cattle veterinarians, indicating the feasibility of this methodology’s utilisation within this context. Further training in this methodology could enhance the advisory process for both veterinarians and farmers, thereby improving the uptake of advice and reducing the incidence of mastitis rates, amongst other management challenges, on UK dairy farms.