MOTIVATIONAL INTERVIEWING (MI) FOR USE IN HIV/AIDS PREVENTION PROGRAMS IN DEVELOPING COUNTRIES
Training Participant’s Guide (Condensed) July 2006
Trish Long, MPH & Tom Davis, MPH
1 Motivational Interviewing Training – Welcome!
How to Use This Guide
Welcome to the MI Training! This guide is meant to help you by providing a handy copy of the training objectives, directions for each task, and additional materials that will be useful to you during the training (such as scripts for role-plays). We encourage you to write notes on the pages, and fill in the charts where appropriate to help you remember different steps in the MI process. References for materials used in the training and materials that may be helpful as you continue learning about MI can also be found at the end.
About Motivational Interviewing
Motivational Interviewing (MI) is one of the more successful counseling methods that aims to help people change their behaviors for better health. It is the work of Dr. William Miller of the University of New Mexico and Dr. Stephen Rollnick of the University of Wales, College of Medicine. These two men have extensive experience counseling people in the United States and Europe in changing addictive behaviors such as alcohol or substance abuse. Building on the work of many colleagues in areas such as people- centered counseling, they developed and tested a theory of how and why people change particularly difficult behaviors, and how counseling styles can help or hinder them. Out of these experiences grew the practices of motivational interviewing, a “way of being with people” which can help them to change.1
MI is a form of counseling that helps people to make decisions. It has the goal of behavior change – usually in a particular direction (e.g., promoting HIV prevention, smoking cessation, water purification), but not necessarily through a single means. There are other forms of counseling that can be used when emotional consolation (during grieving) or other another purpose (e.g., achieving peace of mind concerning a situation that cannot be changed, like paralysis) is the goal of the counseling. For these goals, another form of counseling would be more appropriate.
For More Information
For more information on Motivational Interviewing, see the References section at the back of this manual. Several published works are available, and websites where additional motivational interviewing training and materials may be obtained are given. You may also wish to contact Food for the Hungry at [email protected].
1 Miller, W. R. and Rollnick, S. Motivational Interviewing: Preparing People for Change. 2nd Ed. 2002. Guilford Press: New York.
2 Motivational Interviewing Training – Welcome!
ACHIEVEMENT-BASED OBJECTIVES: MOTIVATIONAL INTERVIEWING HIV/AIDS PREVENTION IN DEVELOPING COUNTRIES
Part A: What is Motivational Interviewing (MI)? After completing Part A, you will have:
Categorized people in various stages of change in Prochaska’s Stages of Change Model and related their situations to key determinants described in Barrier Analysis Compared an example of MI to an example of traditional health promotion; Reviewed evidence of MI’s effectiveness Reflected on the key principles of MI and their relationship to development work, African culture, and Christian teaching
Part B. Basic MI Skills After completing Part B, you will have:
Examined an outline of the practice of Motivational Interviewing Distinguished between open and closed questions Assessed how reflective listening skills can help develop discrepancy between current behavior and personal values Experienced, Heard, and Practiced reflective listening Compared resistance and change talk as indicators of how the counseling conversation is progressing towards the goal of behavior change; Practiced using motivational interviewing skills in role-playing situations
Part C. MI in the Context of a Christian AIDS Prevention Program: Change, Special Cases, and Problems After completing Part C, you will have:
Ordered the steps in creating a plan for change Listed and examined special groups with whom your learners are likely to work Heard the specific ways in which MI can be adapted to work with special groups Reviewed common problems in using MI and identified how to avoid them using MI skills.
3 Motivational Interviewing Training – Task #3 Script
Task #3 Script: Afiya and Imani Talk about HIV Prevention
[Part I: Health Promotion]
[Afiya is a Health Promoter and Imani is a young married woman. Afiya has arrived for a visit at Imani’s home.]
Afiya: Hi, Imani. How are you doing today?
Imani: I am doing well, but I think I will get sick soon. I have been caring for my husband, and he has been ill. I will probably catch whatever he has.
Afiya: Oh, I’m sorry to hear that – being sick is nothing to look forward to. What does he have?
Imani: I’m not sure. It came on slowly, but it has lingered. He has very bad diarrhea on and off, an itchy rash, and a fever.
Afiya: I am sure you have been taking good care of him – you were always very receptive to our talks about health and hygiene. Do you have any questions about it that I can answer?
Imani: Well, I just want to know if it could be something more serious than just a flu. He’s had it for a few weeks, and it doesn’t seem to be getting any better.
Afiya: It might be a stomach flu. You should take him to the clinic: they can help you to figure out what it is and tell you how best to treat him. The symptoms you describe are symptoms of many illnesses, including HIV. That is what I am here to talk about today.
Imani: [worried] I know what HIV is, we’ve talked about it before. That can’t have anything to do with my husband?
Afiya: Just to be clear, I am not telling you that he has HIV. The only way a person can know if he or she has HIV is to be tested for it, like we discussed in our last talk. He may very well have a stomach flu. I wonder, have you both been tested for HIV?
Imani: I know I never have. I have never asked him if he has or not. And anyway, we are married. We have nothing to worry about with HIV.
Afiya: You should go to the clinic to get tested. It would be a good idea to do this so you will know your HIV status. Maybe you could do that when you take him there for treatment for this illness that he has. In addition, I can tell you some ways to prevent HIV. You can get HIV even if you are married, you know.
4 Motivational Interviewing Training – Task #3 Script
Imani: How is that possible?
Afiya: Even if you are married, if one spouse had it before the marriage, it can be passed to the other spouse. In addition if either of you has slept with someone else after being married, this also puts you at risk for getting HIV.
Imani: [defensive] I would never be unfaithful to my husband! I am a good wife! What a man does is his own business. I could never ask him if he has ever been unfaithful to me!
Afiya: [patiently] I think you may have misunderstood me: I am not saying that you have ever been unfaithful, nor am I saying that your husband was unfaithful to you. It is very important, however, for you both to talk with each other about these sorts of things, and to be tested for HIV, so that you can be sure you prevent yourselves from getting it. As a first step, how about going together to be tested for HIV?
Imani: How would I even bring up such a subject? He will think I am implying something, and I do not need to upset him even further while he is ill!
Afiya: Perhaps it will have to wait until he is feeling better. I can help you with some strategies to start this conversation, so that it will be easier for you.
[Part II: Using Motivational Interviewing] [Same day and place, but Afiya approaches it differently.]
Afiya: Hi, Imani. How are you doing today?
Imani: I am doing well, but I think I will get sick soon. I have been caring for my husband, and he has been ill. I will probably catch whatever he has.
Afiya: Oh, I’m sorry to hear that – being sick is nothing to look forward to. What does he have?
Imani: I’m not sure. It came on slowly, but it has lingered. He has very bad diarrhea on and off, an itchy rash, and a fever.
Afiya: I am sure you have been taking good care of him – you were always very receptive to our talks about health and hygiene. You know, I am supposed to talk with you about preventing HIV today. Is that what you would like to talk about, or is there something more important to you that we should discuss?
Imani: Well, I just want to know if his illness could be something more serious than just a flu. He’s had it for a few weeks, and it doesn’t seem to be getting any better.
5 Motivational Interviewing Training – Task #3 Script
Afiya: The symptoms you describe could be many different illnesses, most of which are not serious. If you take him to the clinic, they can help you figure out what it is and how best to treat him. It is probably just a stomach flu, but I can understand why you are concerned. What else do you think it could be?
Imani: I don’t know. I thought it was probably a stomach flu, too. It couldn’t be HIV, could it? I thought that you could only get HIV through sex with an infected person, or through infected blood, like something on a used needle.
Afiya: You’re correct that the only way a person can get HIV is through sex with an infected person or through infected blood. The only way you can know if he has HIV is to go and have him tested for it at the clinic, like we discussed before. Although the symptoms you describe are also symptoms of HIV, it does not mean that he has HIV.
Imani: We are both generally healthy people. I don’t know if we really need to be tested for HIV.
Afiya: How do you feel about being tested for HIV?
Imani: [hesitant] I guess it would be nice to know for sure that we didn’t have it. I can’t imagine that either of us could have it, though. After all, we are married.
Afiya: So you think you might want to get tested for HIV, just for peace of mind. But you are pretty sure that neither one of you has HIV, since both of you have been faithful in your marriage.
Imani: Well…I know that I have been faithful, but what a man does is a man’s business. I do not know if my husband has been with other women since our marriage. If he has been unfaithful, is he at risk for HIV, though?
Afiya: Yes, and so is anyone else that he has slept with. How important is it to you to talk with him about being tested for HIV? Would you say it is very important, somewhat important, a little important, or not at all important?
Imani: [nervously] Given what you have just told me, it is quite important.
Afiya: Why is it quite important, more than just a little?
Imani: I don’t want to be at risk. We will have a family soon, I feel sure, and I know that HIV can be passed from mother to child. And what would I do if my husband died of HIV? It would be awful, knowing that I could lose him, and that I and my children could have it too! I do not want that for my family.
Afiya: So you feel it’s quite important to talk with him about this issue of being tested for HIV. It’s important for you, your husband, and your future children. How
6 Motivational Interviewing Training – Task #3 Script
confident are you that you could talk to him about it? Let’s use the same scale, from very confident to not at all confident
Imani: [sadly] Ah, I do not know how I could even bring it up with him. I not very confident I could do it. What would he think of me, if I said such things? I am afraid of what he would say if I even brought up the issue of testing. [alarmed] Maybe he would even think that I have been unfaithful!
Afiya: So you are worried that he might feel think you have been unfaithful, if you brought up being tested for HIV.
Imani: Yes, I think he would. I am sure he would wonder where I got such ideas.
Afiya: What would need to happen for you to become more confident that you could talk with him about it?
7 Motivational Interviewing Training – Task 5
Task #5: Principles of MI
5a. Read the following definition of Motivational Interviewing. Underline what strikes you in this definition. What do you have questions about?
Time: 15 minutes
Motivational Interviewing is a people-centered, directive method for increasing a person’s inner motivation to change by exploring and helping them to resolve their mixed feelings about a new behavior.
5b. Listen to the following guiding values and principles of Motivational Interviewing.
Time: 15 minutes
5c. Divide into three groups and reflect on the relationships between these values/principles and:
Group 1: Community development work Group 2: African culture Group 3: Christian teaching
What examples of other development interventions, cultural beliefs or proverbs, and religious beliefs and passages from religious texts are supportive of the guiding values and principles of motivational interviewing?
Time: 20 minutes 5d. We will hear all responses.
Time: 10 minutes MI’s Guiding Values • Collaborating Together • Bringing Forth Strength for Change (“Evocation”2 in Miller & Rollnick) • Free Choice (“Autonomy” in Miller & Rollnick)
MI’s Four Principles 1. Express Understanding (Express Empathy in Miller & Rollnick) 2. Develop Difference (“Develop Discrepancy” in Miller & Rollnick) 3. Roll with Resistance 4. Support Self-Efficacy
2 The terms “Evocation,” “Autonomy,” “Express Empathy,” etc. have been changed to make them more easily understandable to non-English speaking trainees.
8 Motivational Interviewing Training – Task # 8 Script
Homework for Part B
Think of two stories from your life where you were conflicted (ambivalent) about something.
The story you choose to present should meet the following criteria: You were trying to change your own behavior (e.g., a habit you wanted to get rid of, change, or adopt). There were good reasons to change, but also good reasons not to change. It is okay if you did not resolve the situation. The story can be from any point in your life. (It does not be to recent.) The story should not be so personal that you would be unwilling to share it with the other participants. You should be able to finish telling the story in five minutes or less.
We will tell each other our stories for an exercise in Part B of this training.
Time: 10 minutes Task #7 - Is this an open or closed question? • Have you ever been tested for HIV? • How would being abstinent before marriage be good for you? • What are your views on faithfulness in marriage? • Do you want to stay in this relationship? • What consequences of HIV concern you most? • What would make it easier for you to be faithful? • Who decides whether or not you will use a condom, you or your partner? • Have you ever thought about being abstinent? • What do you like about being abstinent? • Don’t you think you should get tested for HIV? • Do you believe you can get HIV, even if you are married? • What are the reasons that you would want to continue having sex with your boyfriend? • Does your girlfriend ever ask you if you have other partners? • Is this an open or a closed question?
9 Motivational Interviewing Training – Task # 8 Script
Interview with James3, a married truck driver
Afiya: [calmly] Let me make sure I understood what you meant, James. You told me that you feel that not having sex with other women when you are on the road is different from not drinking beer or stopping other behaviors which you know could harm you.
James: That’s right. I am a man, and men must have sex. It is like breathing – one can not go without it for very long. [chuckles] Now I suppose you are going to tell me I have to stop? But I tell you, we will all die someday, whether it’s from AIDS or something else. Why shouldn’t I enjoy myself while I am alive?
Afiya: [still calmly] So even if you got AIDS, it wouldn’t matter. You will die someday anyway and you want to enjoy your life to the fullest.
James: Well, it’s not that it wouldn’t matter if I had AIDS. I suppose we would have to keep it quiet. I would not want my family to suffer, and if people here thought I had AIDS, they would shun them.
Afiya: So your family’s reputation is important to you. You wouldn’t want them to be shunned by the community if you got AIDS and became ill. You obviously have their best interests at heart.
James: Yes, and that happened to our neighbor, too – he was an old truck driver too, and his wife always had a wandering eye when he was away. But when his wife came down so ill, everyone whispered that it was AIDS. No one would help him care for her, not even his children, and then he got sick.
Afiya: So on the one hand, you want to have sex while you’re out on the road – you want to enjoy yourself when you’re away from your wife, and on the other hand, if you got AIDS, your family would have to hide your illness somehow to make sure they are still welcome in the community. If they could not hide your illness, there would be terrible consequences: the community would shun them.
James: Yes, I guess so.
Afiya: So where does all of this leave you?
3 The character of James is based on Louis Chikoka, a Botswanan truck driver interviewed by Johanna McGeary for Time Magazine’s feature report “Death Stalks a Continent.” Feb. 12, 2001.
10 Quality Checklist for Motivational Interviewing Training Task # 9 – Using the OARS Name of Interviewer:______Evaluator:______
YES NO Opening Methods
1. Did the Interviewer ask open-ended questions? ...... q q
2. Did the Interviewer encourage the interviewee to talk by nodding, smiling, or other actions that show that s/he was listening? ......
3. Did the Interviewer use affirmations? ...... q q
4. Did the Interviewer listen reflectively? ...... q q
5. If yes, what types of reflective listening were used? (Check all that apply.)
q Simple reflection q Double-sided reflection q Amplified reflection
6. Did the Interviewer make summary statements?...... q q
7. Was the Interviewer directive in their reflective listening? ...... q q
Final Observations
8. Did the person (interviewee) talk more than the Interviewer?...... q q
9. Overall assessment of the Interviewer’s performance:
1 2 3 4 5 6 7 8 9 10 Poor Excellent
Comments: ______
11 Quality Checklist for Motivational Interviewing Training Task # 9 – Using the OARS Name of Interviewer:______Evaluator:______
YES NO Opening Methods
1. Did the Interviewer ask open-ended questions? ...... q q
2. Did the Interviewer encourage the interviewee to talk by nodding, smiling, or other actions that show that s/he was listening? ......
3. Did the Interviewer use affirmations? ...... q q
4. Did the Interviewer listen reflectively? ...... q q
5. If yes, what types of reflective listening were used? (Check all that apply.)
q Simple reflection q Double-sided reflection q Amplified reflection
6. Did the Interviewer make summary statements?...... q q
7. Was the Interviewer directive in their reflective listening? ...... q q
Final Observations
8. Did the person (interviewee) talk more than the Interviewer?...... q q
9. Overall assessment of the Interviewer’s performance:
1 2 3 4 5 6 7 8 9 10 Poor Excellent
Comments: ______
12 Motivational Interviewing Training – Task # 12
Rolling with Resistance Shifting Focus: if you find a barrier in the road, it may be easier to go around it rather than trying to go over it.
Reframing, you acknowledge the truth in the statement, but interpret the situation differently, in a way that also acknowledges the possibility of change.
Agree with a twist: reflect what’s been said, and then reframe the discussion.
Emphasize personal control. This can be very effective with people who are upset or arguing fiercely.
Coming alongside: you take on the anti-change point of view and may even argue for it.
Four Kinds of Change Talk
Disadvantages of the Behavior “When I am unfaithful, my wife suspects it, becomes angry, and then we argue.”
Advantages of Change “My parents won’t worry about me as much if they know that I have committed to abstinence.”
Optimism about Change “It would be wonderful to be married and know for sure that my wife and I will not have HIV.”
Intention to Change “I think I would like to use a condom in the future, and maybe I can work towards being faithful.”
Encouraging Change Talk
Ask open questions “What worries you about having sex with your girlfriend now?”
Ask for more description of change talk “In what ways do you think your friends would support your decision to be abstinent?”
Ask about extreme situations
13 Motivational Interviewing Training – Task # 12
“If you were complete successful at being abstinent until marriage, what positive things would happen?”
Explore the past and the future “Before you had these worries about HIV, what was your life like?” “If you continue on as you are now, what do you think will happen? Tell me what life will be like for you in ten years.”
Explore goals and values “What do you think people should do about sex before marriage?” “What is God’s will for married couples?”
Use the other OARS Ask open questions about change Affirm change talk Reflect change talk Summarize reasons for change
14 Motivational Interviewing Training – Task # 14
Task #14: Recognizing Readiness for Change
14a. Look at this list of behaviors. Circle those which may be an indication of readiness for change. Time: 5 minutes 14b. We will hear examples of your choices.
14c. Which ones surprise you? Time: 10 minutes
Which Ones Indicate a Person is Ready to Change?
Asking about change
Trying out a change behavior
Arguing against change
Feeling a sense of loss and resignation
Increased talk about the problem
Feeling peaceful and calm
Imagining difficulties if a change were made
Blaming others for the problem
Discussing the advantages of change
Expressing hope for the future
Saying the problem isn’t that bad
15 Motivational Interviewing Training – Task # 15
Motivational Interviewing: Creating a Plan for Change In Practice
The following script is an abbreviated version of creating a change plan, meant to demonstrate how all the steps in Part 2 of Motivational Interviewing might fit together. The length of this conversation is not necessarily realistic, but has been abbreviated for the sake of time.
[This script is a conversation between James, a youth group leader, and Joseph, a member of a youth group. James and Joseph have been meeting individually over a period of several months to discuss a decision to be abstinent before marriage. This conversation begins in the middle of one of their meetings.]
James: Let me just see if I can put everything we’ve talked about so far together. You have been thinking about being abstinent before marriage for a month or so now, ever since your girlfriend, whom you wish to marry, brought it up. She told you how she felt pressured to have sex with you, even if she didn’t want to, and felt that she couldn’t say no to you. She wasn’t angry with you, but it upset you to hear this from her because you certainly never wanted her to feel forced. She wanted you to know that she felt this way, and because you expressed a desire to marry her she felt it was important to tell you before you were married. You love her very much, and are very attracted to her, so it is hard to contemplate being secondarily abstinent, now that you have already started having sex. But you are worried that if you continue to have sex, she will get pregnant and it will rush you into marriage before she can finish school, which you both feel is important. Worse yet, if she becomes pregnant, her parents will not approve of you, which will put you at a disadvantage in proposing marriage. Even though you’re both sleeping only with each other, and you both know that you do not have HIV because you have been tested, you also want to set a good example for your younger siblings by practicing abstinence, to help strengthen their resolve to be abstinent also and protect themselves from HIV. [summarizing, checking for understanding] Did I get all of it?
Joseph: Yeah, I felt terrible – I had no idea she felt that way. [change talk: disadvantage of current situation.]
James: What are you thinking about doing? [asking a key question]
Joseph: I really think we should be abstinent. If I can ask her parents’ permission to marry her in the next month or two, then it will be settled and we won’t have that long to wait anyway. But man, it will feel like forever! And I want to talk to my little brother too: I want him to know what I am doing and why, so that he remains safe.
16 Motivational Interviewing Training – Task # 15
James: You have a lot on your mind: I can see it will not be easy, but you really want to do the right thing by your future wife and by your brother, and that is a sign that you are no longer a boy. You are taking on responsibility like a man. [affirming and adding a personal assessment of the situation] You listed a lot of different things there. Where do you want to begin?
Joseph: I don’t know. I think it might be quite tough, you know? I can’t wait too long to ask her parents, so maybe I should do that first. But then there’s the whole matter of telling others about this decision to be abstinent. I think she would support it, but maybe my friends would think I’m less of a man for giving in to her. [ambivalence returns]
James: You certainly want your future wife’s respect, but your friends’ opinions are also important to you. [simple reflection] Can I suggest something? [asking permission to provide advice]
Joseph: Okay.
James: How about just trying abstinence for a short time? You don’t have to commit to it until marriage today. Try it for a while and see how it feels to you. If you like it, you can stick with it, and if you don’t, you can talk to your girlfriend and reconsider. [providing an option, helping with setting goals]
Joseph: Umm…okay, but what do I tell my friends? [subtle resistance to change]
James: That’s your decision of course. What would happen if you just didn’t say anything?
Joseph: Maybe nothing. It’s not something that we really talk about anymore – it’s old news. But I think I would have to say something eventually. I mean, she’s going to tell her friends if I decide to be abstinent, even for a little while. That will be big news to them. And then it might get around, you know.
James: This is a tough situation for you, and only you know what the right decision will be. [expressing understanding, and emphasizing personal control again] Just imagine for a second, if word did get around to your friends, is there anything positive that could result from that? [eliciting change talk: imagining the future]
Joseph: I think some of them would think less of me, but a few others might reconsider their own situations with their girlfriends. I think I could argue that being abstinent is a good decision though, especially because they are putting themselves at risk for HIV. [change talk: confidence in his ability to convince his friends he’s made a good decision]
17 Motivational Interviewing Training – Task # 15
James: So you think you might have some friends who would support you, or at least might be come around to your way of thinking, if you told them more about it. [simple reflection] Try it out on me. What could you say to them?
Joseph: Maybe I would say something like “If I become abstinent, I know that I will not get HIV, and my wife and children will not get HIV. My family will thrive if I am strong. That alone is worth a little self-denial.” [more change talk]
James: That was convincing to me. What are some other ways to tell them? [developing a menu of options]
Joseph: I could say that “Only a fool treads loudly when his wife is sleeping.” They know I want to marry her. But I think the best argument is talking about HIV. If there’s one thing that stops them talking and makes them listen, it’s the idea of getting HIV.
James: Perhaps you will even help your friends to avoid HIV by talking about it with them. [affirming] You feel like you can do it, and that some will be convinced to reexamine their own situations, even if a few will think you are not manly. [reflecting change talk] Do you want to start by telling your friends, or should another step come first? [back to goal setting]
Joseph: No, first I have to tell my girlfriend. That is the right thing to do. Then, if it comes up, I’ll tell my friends why I made the decision that I did.
James: What comes next?
Joseph: I want to ask her parents’ permission to marry her. I think they want her to marry soon after she finishes school, so I should ask soon, probably by the end of next month. [Sets a goal for himself!]
James: You also said that talking to your little brother about your decision was important to you. What do you want to say to him?
Joseph: Well, I don’t want to go talking to him about abstinence if I can’t do it myself, you know? That will probably make him less likely to do it, if he sees that I can’t.
James: He really looks up to you. [simple reflection]
Joseph: Yeah, he does. Maybe I should just do what you suggested and try out abstinence for a month. We can see how it goes. Then if I decide to continue, I can tell my little brother all about it.
James: So you’ve decided to be abstinent for a month, just to try it out. You’ll tell your girlfriend first, and you will explain it to your friends if they ask you. By the end
18 Motivational Interviewing Training – Task # 15
of next month, you want to ask your girlfriend’s parents for permission to marry her. By that point, you will have tried abstinence for a month, and you will have considered whether or not you want to continue with it afterward, after talking with your girlfriend about it. If it works for you, you want to tell your little brother about it. [summarizing the plan] [takes a deep breath] Is that what you want to do? [elicits commitment to the plan]
Joseph: Yes, that’s what I want to do.
James: [concealing a big sigh of relief] Great! I think you have a lot of personal qualities that will make you successful at secondary abstinence. Tell me how it’s going the next time we meet.
19 References
Carey, M. and Lewis, B. “Motivational Strategies Can Enhance HIV Risk Reduction Programs.” AIDS and Behavior. 1999; 3(4): 269 – 276.
Davis, T. Barrier Analysis Facilitator’s Guide: A Tool for Improving Behavior Change Communication in Child Survival and Community Development Programs. 2004. Food for the Hungry.
McGeary, J. “Death Stalks a Continent.” Time. 12 Feb, 2001. 157(6).
Miller, W. and Rollnick, S. Motivational Interviewing: Preparing People for Change. 2002. 2nd Ed. The Guilford Press: New York.
Miller, W. and Rollnick, S., and Moyers, T. Motivational Interviewing Professional Training DVD. 1998. The University of New Mexico: Albuquerque.
Patterson, T. L., Semple, S. J., Fraga, M., Bucardo, J., Davila-Fraga, W., & Strathdee, S. A. “An HIV Prevention-Intervention for Sex Workers in Tijuana, Mexico: A Pilot Study.” Hispanic Journal of Behavioral Science. 2005; 27(1): 82-100.
Rollnick, S., Mason, P., and Butler, C. Health Behavior Change: A Guide for Practitioners. 1999. Churchill Livingstone: Edinburgh.
Thevos, A.K., Kaona, F. A. D., Siajunza, M.T., & Quick, R.E. “Adoption of safe water behaviors in Zambia: Comparing educational and motivational approaches.” Education for Health. (2000); 13(3): 366 - 376.
Thevos A, Quick R, and Yanduli V. “Motivational Interviewing enhances the adoption of water disinfection practices in Zambia.” Health Promotion International. 2000; 15(3): 207-214.
Online Motivational Interviewing Resources http://www.motivationalinterview.org http://www.e-help.com/motivational_interviewing.htm
MINT (Motivational Interviewing Network of Trainers) Bulletin, May 2005 – Adobe pdf http://motivationalinterview.org/mint/MINT12.1.full.pdf Character Sheet: Blank You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Worksheet for Motivational Interview Roleplay Characters
If you have decided to make up your own character for the roleplay exercise (Task #13), use this sheet to develop your character. Take a few moments to fill in answers to the questions below to help you respond to your partner during the role play.
Name of character: Age: Gender: Married or single?
What is this person’s background (where they are from, family, education, etc.)?
What does this person know about HIV?
What is this person ambivalent about? [We suggest that the ambivalence center around abstinence before marriage, faithfulness in marriage, or another HIV-related behavior.]
What are the person’s arguments against change?
What are the person’s arguments for change?
Rate this person on a scale of 1 to 10 in confidence and importance. Importance of change:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Confidence in ability to change:
1 2 3 4 5 6 7 8 9 10 Not important Very important
21 Character Sheet: Benito You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Name of character: Benito Age: 17 Gender: male Married or single? single
What is this person’s background (where they are from, family, education, etc.)? Benito is from Maputo, Mozambique, where he grew up. He’s a ‘city kid’ and considers himself very worldly. Benito is a laborer, and has a job at a flour mill near the port of Maputo.
What is this person ambivalent about? Benito is ambivalent about abstinence from sexual activity marriage. He has been having sex for three years.
What does this person know about HIV? Benito has heard many factually correct messages about HIV prevention, including abstinence and condom use, but he doesn’t want to use condoms because he thinks they are not ‘manly’. Benito has never been tested for HIV because he is afraid of finding out that he has HIV.
What are the person’s arguments against change? Benito figures that since he is already having sex, and has not been using condoms regularly, it is already too late for him to begin to worry about HIV now. Benito and some of his friends go out to clubs to meet women often, and he enjoys meeting different girls and having sex with them – it makes him feel attractive and powerful. He is also worried about what his friends will think of him if he no longer goes out to clubs with them.
What are the person’s arguments for change? Benito’s mother recently introduced him to a girl who is a prospective bride. His mother is pushing him to get married. Benito likes the girl and thinks he might want to marry her, but he is afraid that if he has HIV, he will give it to her if they marry. An older man who Benito works with at the mill told Benito that he has HIV. He has been encouraging Benito to make better choices than he made so that he will not get HIV, such as protecting himself and staying away from prostitutes. Benito likes the man, and helps to care for him when he is ill. Benito recently started going to a church with one of his friends, who has decided to abstain from sex before marriage. This friend has been encouraging Benito to do the same thing.
Importance of changing to be abstinent to Benito:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Benito’s confidence in his ability to change and be abstinent:
1 2 3 4 5 6 7 8 9 10 Not confident Very confident
22 Character Sheet: Jamila You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Name of character: Jamila Age: 19 Gender: female Married or single? Single
What is this person’s background (where they are from, family, education, etc.)? Jamila is from a small village north of Dar es Salaam. She was orphaned at 15, and supports her three younger siblings by having sex for money. She did not complete secondary school, dropping out after her parents died.
What is this person ambivalent about? Jamila is ambivalent about condom use. As she feels a responsibility to support her younger brothers and sisters, she does not feel that she can become abstinent because she does not see another way to support herself and them.
What does this person know about HIV? She has heard much about HIV prevention, including condoms, various folk remedies, and abstinence. She understands that she is at risk for HIV. She was tested six months ago and tested negative.
What are the person’s arguments against change? Jamila fears that her customers will take their business elsewhere if she insists on condom use, and she will not have enough money for food. Jamila is afraid of that her customers might hurt her if she asks them to use condoms.
What are the person’s arguments for change? Jamila worries about how her younger brothers and sisters would manage if she were to get HIV. Jamila herself would like to complete her schooling, leave prostitution, and get a job. If she becomes ill with HIV, she believes these dreams will not be attainable. Many of Jamila’s friends who also work as prostitutes have become ill, she thinks with HIV. She does not want to follow in their footsteps.
Importance of using condoms to Jamila:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Jamila’s confidence in her ability to ask customers to use condoms:
1 2 3 4 5 6 7 8 9 10 Not confident Very confident
23 Character Sheet: Safiya You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Name of character: Safiya Age: 14 Gender: female Married or single? single
What is this person’s background (where they are from, family, education, etc.)? Safiya is from a relatively prosperous family in her village in Uganda. She expects to finish secondary school and then get married and start her family.
What is this person ambivalent about? Safiya is somewhat ambivalent about being abstinent before marriage, although she is leaning toward abstinence.
What does this person know about HIV? Safiya understands how people get HIV, and she knows that it is undesirable to have it. She knows that being abstinent until marriage will prevent HIV. She does not know much about the consequences of the disease, what it feels like, etc. She only knows that people with HIV who can not afford the drugs do not live long.
What are the person’s arguments against change? Safiya doesn’t really think that HIV would affect her if she got it – her family is wealthy and one of the few in the area who could afford anti-retroviral medicines. Sex seems to be a kind of glamorous and grown-up thing to do.
What are the person’s arguments for change? Safiya’s family and her religion approve of abstinence before marriage. She would not have to worry about getting any other kinds of sexually- transmitted infections in addition to HIV. Safiya thinks her future husband would like her to be a virgin.
Importance of being abstinent to Safiya:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Safiya’s confidence in her ability to be abstinent:
1 2 3 4 5 6 7 8 9 10 Not confident Very confident
24 Character Sheet: Philip You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Name of character: Philip Age: 28 Gender: Male Married or single? Married
What is this person’s background (where they are from, family, education, etc.)? Philip is a farmer from Kenya. He and his wife, Fatima, have been married for eight years and have four children, ranging in age from two to seven years old.
What is this person ambivalent about? Philip is ambivalent about participating in a ritual sexual cleansing. His older brother is extremely ill, and the family expects his death soon. Anticipating the brother’s death, Philip has been asked to ‘cleanse’ his brother’s wife by sleeping with her.
What does this person know about HIV? Philip knows that his brother probably has HIV, although he has not been tested. Philip understands how HIV is transmitted, and that he might get HIV from sleeping with his brother’s wife after his brother’s death, although at this point, it is not clear whether or not she also has the disease. Philip does not know his own HIV status.
What are the person’s arguments against change? Philip fears the curse that is said to impact the clan of a woman who is not ‘cleansed’ after the death of her husband. He fears that if he does not participate and the clan is cursed, it will be his fault. Philip is also receiving a lot of pressure from people in his village to participate in the ritual.
What are the person’s arguments for change? The headman in Philip’s village says it is Philip’s choice to participate in the ritual or not – he will not force Philip to participate. Philip’s wife is very much against the cleansing, as is Philip’s sister-in-law – both cite the possibility that AIDS will spread if the ritual is not stopped. This is a source of argument between Philip and Fatima, as some people in the village have accused Fatima of wishing to curse the clan because of her outspoken opposition to the ritual.
Importance of not participating in the ritual to Philip:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Philip’s confidence in his ability to refuse to participate in the ritual:
1 2 3 4 5 6 7 8 9 10
25 Character Sheet: Philip You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Not confident Very confident
26 Character Sheet: ?? You are not limited to this information, and may also make up information on the spot as you respond to your interviewer.
Name of character: Charity Age: 36 Gender: Female Married or single? Married
What is this person’s background (where they are from, family, education, etc.)? Charity has been married for 15 years to her husband, Sam. Sam is a trader who travels frequently, while Charity stays at home with their six children, who are between the ages of eight and thirteen.
What is this person ambivalent about? Charity is ambivalent about talking to her husband about faithfulness in marriage. She suspects that he is unfaithful to her when he is away on business because a friend’s husband saw him with another woman while he was traveling. She has been unfaithful to him once, as well, but broke it off because she felt guilty. She is worried that she and her husband are both at risk for HIV because they have slept with others.
What does this person know about HIV? The man that Charity slept with has fallen ill with HIV-like symptoms. Charity knows that because she slept with him, she is at risk for HIV. She also knows that if her husband has been unfaithful, they both are at additional risk. She knows that there is a test for HIV, but she does not know where to get such a test, or if she could afford it.
What are the person’s arguments against change? Charity is afraid of bringing this subject up with her husband for fear that: o He will suspect she has been unfaithful o He will be offended that she suspects he is unfaithful
What are the person’s arguments for change? Charity is worried that if they do not already have AIDS, they will have it if they are not faithful to each other. Charity is strongly afraid of what would happen to her children if she and her husband died.
Importance of talking with her husband about faithfulness to Charity:
1 2 3 4 5 6 7 8 9 10 Not important Very important
Charity’s confidence in her ability to talk with her husband about faithfulness:
1 2 3 4 5 6 7 8 9 10 Not confident Very confident
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