The Impact of Motivational Interviewing on Personal Health Decisions

For Jabari Douglas, the pandemic hit home just days after the declaration of the public health emergency in March 2020. While Douglas was in graduate school at Howard University in Washington, D.C., his father died of COVID-19 in a hospital in New York City. Douglas said his goodbyes over Facetime.

Douglas knew he had to do what he could to prevent others from losing loved ones or dying themselves. As executive director of a substance use disorder treatment program in Southeast D.C., a pastor of a church, and a member of the District of Columbia’s Ward 8 Health Council, Douglas was in a unique position to get accurate information about the virus to his community. “I had to get the word out,” he said.

So he quickly said “yes” in 2021 when he learned about an opportunity on the DC, Maryland, and Virginia (DMV) CEAL research team based at Howard University. The goal of the project was to understand and effectively respond to beliefs that underlie vaccine hesitancy.

The DMV CEAL research team is a cooperative effort among five universities serving two states and the District of Columbia: Johns Hopkins University, Morgan State University, and University of Maryland Baltimore in Baltimore, Maryland; The George Washington University and Howard University in Washington, D.C. At each university, a principal investigator leads a unique research project aimed at addressing misinformation and mistrust in local communities by developing effective partnerships and providing accurate information about COVID-19 and participation in clinical trials. The Howard University project, conceived by principal investigator Thomas Mellman, M.D., Denise Scott, Ph.D., and Gloria Cain, L.M.S.W., Ph.D., focused on using a technique called motivational interviewing (MI) to address vaccine hesitancy.

MI was originally developed as an approach for improving communication and motivating health behavior changes in people who have substance use disorders. More recently, health professionals have used the technique to encourage other behavior change. The Howard University researchers wanted to see if the technique could be adapted and used by community members to engage and influence peers who express hesitancy about vaccination against COVID-19.

Attempts to convince people to get vaccinated can get confrontational and end up just entrenching people in their positions — which is more likely to end in a screaming match than vaccination. MI takes a more conversational approach, Douglas explained, focusing on “building rapport with the individual, letting them know who you are, asking them about their thoughts about COVID-19 and the vaccine, and talking that through with them.” MI can keep the conversation going and open doors that would otherwise stay shut, he says. The goal is to get the person to possibly change their mind — or at least think differently or do more research with credible sources.

The researchers recruited people from the community who then received MI training to become facilitators. The trained facilitators learned that MI is a potentially effective way of speaking to an underserved population who has some hesitancy around health care and medical professionals. A survey of facilitators found that some had used the technique for conversations with vaccine-hesitant friends and family members. “Some said the people they had spoken to had gotten vaccinated after the conversation,” Douglas says.

In addition to training 21 facilitators in the District of Columbia, the Howard project has trained employees for the Baltimore County Health Department — adding up to more than 100 people trained on this promising technique.

As Douglas has seen in his work with people with substance use disorder, MI, rather than offering a quick fix, takes the long view. “It’s more like planting a seed. You don’t necessarily know when it will grow or who’s going to water it. Years later, someone will tell you that something you said made them pause and think differently and it helped save their life.”