Motivational interviewing for policymakers

One of the advantages of doing advocacy work in partnership is that different individuals and groups are perceived differently by policymakers. Researchers can be perceived as less threatening than an organized community group or coalition of service providers, particularly when the interaction is framed as research rather than advocacy. There may well be a host of valuable data that can only be gathered from policymakers. In addition to their views of current and proposed policies, policymakers generally have a sophisticated view of the policy environment. They may or may not be aware of various public health issues or community issues.

It is worthwhile for a partnership to think about interviewing policymakers, to collaborate on questions asked, and to consider the value of the research interaction beyond data gathering. This brings me to the construct of motivational interviewing. Designed as a therapeutic and not an investigative technique, its tenets never-the-less hold some value for action researchers. The motivational interviewing goals of establishing rapport, eliciting change talk, and establishing commitment language mirror that of the CBPR policy cycle. Beginning with creating rapport between the policymaker and the research partnership, the researchers have an opportunity to uncover information critical to policy change.

The policymaker will likely fall into one of three general camps
1) understands your issues, and is diametrically opposed
2) doesn't really understand your issue, and is either willing or unwilling to listen
3) supports your issue, but expresses some sense of powerlessness to move it forward

(There is another category of the policymaker who supports your issue and feels empowered to act upon it, but that is rare and unproblematic.)

So the first goal when approaching policymaker interviews is to understand in which camp the policymaker belongs. Then to delve deeper. Why do they disagree? Is it ideological? Practical? The more you understand opposition, the better you will understand your issue. For those who don't understand your issue the research relationship could also be used to educate. In political circles this is sometimes called push polling, where information that the interviewee does not know is built into the question to try to sway their allegiance. In key informant interviews, the approach is to simply provide what data you have already gathered on the issue as a basis for reactions from the policymaker. In the final camp, the researcher needs to explore the barriers that separate the policymaker from effective action. This information can then form the basis of a collaborative effort between the community and the policymaker to raise the level of political will to the point of action.

Throughout the process of a single or multiple interviews, the researcher can establish the reality as seen by the policymaker, and then use questions to elicit the changes in status quo that the policymaker seeks. This information can then be used to target persuasive arguments to this policymaker and others, when the partnership moves to the advocacy phase and begins to seek commitments from policymakers.

Does this feel ethically murky? Sure it does. But the reality is that qualitative research that engages public officials is an area poorly understood by IRBs and others. As this research becomes more common we will no doubt parse out some reasonable ethical guidelines. But to get to that point we have to first give it a try!