Implementation of Motivational Interviewing as a Personalised Behavior Change Counselling Approach for Disease Control in South African Primary Health Care: A Systematic Scoping Review

Background: Addressing the pervasive issue of low medication adherence is a critical step in reducing South Africa's disease burden. While counselling is mandated in key disease initiatives, primary health care services often employ directive, information-based methods that do not sufficiently encourage lasting behavior change. Motivational Interviewing is a person-centered, evidence-based approach that enhances motivation, fosters adherence, and supports active engagement in care. However, the extent of its application in South African PHC remains unexplored. Objectives: This review synthesizes current evidence on MI's usage in South African primary health care, emphasizing its effectiveness, identifying implementation gaps, and its potential to enhance person-centered disease management. Methods: This scoping review followed the Arksey and O'Malley framework and PRISMA-ScR guidelines. The research question was formulated with an expansive scope to comprehensively map MI's application, ensuring alignment with policy-oriented aims to integrate MI systematically into PHC. Electronic databases and grey literature were searched for studies published from 2000 to 2025 on MI or similar counselling in South African PHC and community public sector settings. Data were collected and summarized against established objectives to generate critical insights to inform policy and practice improvements. Results: Of the 38 identified records, 21 studies met the inclusion criteria. Among these, 81% used MI as brief, MI-informed counselling in routine PHC services rather than full-protocol MI. Seventy-six percent focused on HIV adherence, while 62% ad-dressed non-communicable diseases, with emerging evidence in tuberculosis care. Reported benefits included improved medication adherence, increased engagement and retention in care, and stronger patient-provider relationships. Challenges included limited staff training, inadequate supervision or monitoring, and reliance on project-based delivery. Conclusion: Motivational Interviewing is practical and can be scaled up to support behavior change in South African PHCs, particularly to improve adherence and long-term care engagement. However, its effectiveness is constrained by uneven implementation and insufficient system support. Integrating MI into national policies, PHC routines, and workforce training could strengthen person-centered care and improve disease control.