Patient-provider concordance with behavioral change goals drives measures of motivational interviewing consistency

•We coded behavioral counseling in routine outpatient HIV care.•Patient discordance with behavioral goals is associated with physician directiveness.•Patient discordance is associated with Motivational Interviewing (MI) inconsistency.•Counseling episodes are typically brief; evolution of patient talk toward change is not observed.•Association of MI consistency with patient change talk should be interpreted cautiously.

ObjectiveMotivational Interviewing (MI) consistent talk by a counselor is thought to produce “change talk” in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior.MethodsWe applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit (“episodes”), assesses patient concordance with the behavioral goal, and labels providers' counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system.ResultsPatient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second.ConclusionObservations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency.Practice implicationsCounseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients.