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Ineke Buskens: Infant feeding research project - phase 2

Brief motivational interviewing as the basis for a new infant feeding counselling format
The counselling format will acknowledge the two worlds and the opposing agendas of nurses and mothers described in phase 1 of the research, and is informed by the awareness of female intra-gender dynamics. It will be based on the attitude and the skills which form the foundation of brief motivational interviewing (BMI). BMI is described as "a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence" (Rollnick & Miller, 1995). Compared with non-directive counselling it is found to be more focused and goal-oriented. It also seems to be successful among patients who do not seek help, which fits the prevention of mother to child HIV transmission (PMTCT) situation well: PMTCT clients do not enter the counselling relationship while having identified a particular behaviour that they want to change. Furthermore, most women who have been identified as HIV-positive have strong ambivalent feelings about the changes in feeding behaviour they have to consider. BMI also places the responsibility for change explicitly on the clients' shoulders. Many of the factors which women have to take into consideration when deciding whether to go for PMTCT participation or not are beyond the health workers' control. Adopting the BMI attitude would prevent health workers from taking responsibility where they cannot and would thus ease their burden. Furthermore, BMI gives the counsellor the opportunity to recognise the fact that there are different agendas at play in the encounter, and to invite the patients' participation through joint "agenda setting" (Mash, 2003; Mash & Levitt, 2003). It appears that BMI, which probably entails as much of a paradigm shift for health workers trained in task orientation as the Rogerian model, none the less gives health workers more control over the situation and would thus not contribute to their anxieties in the same way that Rogerian counselling does.

John Martin: South Africa HIV/AIDS Counseling Training Project
The proposed research activities as part of a USA Fulbright Scholarship will revolve around the goal of developing materials and training and evaluation methods for teaching South African professional workers and lay volunteers state-of-the-science motivational counseling and interviewing for use in HIV prevention and management, and ARV treatment adherence clinics and programs.

The objectives of the project include the following:

1. Develop and test the effectiveness of training materials for teaching motivational counseling to enhance or ensure HIV prevention and ARV treatment adherence with South African medical professionals (physicians, nurses, nurse sisters);
2. Adapt and test developed training materials to lay HIV counselors;
3. write formal training manuals and develop suitable local resource materials such as video for (a) and (b) based on validated materials and methods of training;
4. Begin initial steps toward converting/adapting these successfully developed and implemented training materials and methods to an Internet-based training course that may be employed for subsequent distance learning. It should be noted that at present Internet-based training is not really a viable option for nurses and lay counselors due to lack of access to IT and also a lack of capacity to use IT. At first, these materials can be developed and made available on-line to GPs, but as we are planning to adapt them specifically for use by nurses and lay counselors this will not be immediately relevant for this purpose. An on-line post-graduate course in effective, motivational HIV counseling may be most relevant as part of my South African colleague's (Prof. Bob Mash, University of Stellenbosch Department of Family Medicine and Primary Care) Masters in Family Medicine (MfamMed) programme which is web-based. This would fit in well with Prof. Mash's planned South African Website for Motivational Interviewing, in conjunction with Dr. Stephen Rollnick, one of the original developers of the approach. This would be a separate task, and not a part of either (a) or (b).
5. Design, write and submit for funding a formal study based on the training model and implementation findings, and application/adaptation evaluation data. One critically important study which may be included in future grant funding proposals would be to test whether motivational HIV counseling training might be effectively conducted in groups as well as individually and, further, whether actual motivational counseling might be successfully practiced using group counseling sessions. Given the relative scarcity of medical and trained HIV/AIDS treatment and counseling personnel in the country, group training and counseling may be an essential step, and one in need of initial empirical validation.