Study of Changes in Nurses’ Leadership Behavior Following an Intervention Based on the Transtheoretical Model and the Principles of Motivational Interviewing: An Empirical Research Study

Abstract

Introduction: Leadership is one of the most extensively studied yet complex areas of management science. It serves as a link between organizational vision and outcomes, supporting organizational adaptability and sustainability through decision-making, rational resource management, and the development of a culture of safety and quality. Numerous studies have demonstrated a strong association between leadership behavior and the quality of healthcare services, including reductions in mortality rates and healthcare-associated infections, fewer medical errors, improved patient satisfaction, more effective allocation and utilization of resources, and increased employee job satisfaction and organizational commitment. Nurses’ leadership behavior is particularly relevant to healthcare quality and patient safety and may be developed through targeted interventions. Leadership behavior can be modified and improved through reflection and the implementation of appropriate methods and interventions. Improving leadership behavior is not a static process but rather an ongoing process of learning, development, and adaptation. Among behavioral approaches to behavior modification, the Transtheoretical Model (TTM), supported by the principles of Motivational Interviewing (MI), was selected to investigate changes in nurses’ leadership behavior. By examining self-reported leadership outcomes and participants’ progression through the stages of change, this study sought to contribute to the understanding of leadership behavior change and inform the development of evidence-based leadership development strategies in nursing. Aim: The aim of this study was to determine whether nurses’ leadership behavior could be improved through the application of the TTM and MI, assessing not only self-efficacy and perceived importance of change but also participants’ progression through the stages of change described by the TTM. More specifically, the study aimed to examine whether an individualized intervention based on the TTM and the principles of MI was associated with short-term changes in nurses’ self-reported leadership styles and outcomes, including transformational and transactional leadership, perceived leadership effectiveness, extra effort, and satisfaction with leadership. The intervention was based on self-administered questionnaires and semi-structured interviews. Materials and Methods: A quasi-experimental, nonrandomized, two-group longitudinal intervention design was used to examine changes in self-reported leadership outcomes following an individualized intervention based on the TTM and the principles of MI. The study was conducted among nurses employed in a tertiary hospital in the Attica region of Greece. A convenience sample of 100 participants was recruited from the researcher’s professional setting and allocated to two groups by alternating assignment, without random allocation. A total of 50 participants were assigned to the Intervention Group, and 50 were assigned to the Control Group. The Intervention Group received a two-month individualized intervention involving follow-up meetings, telephone contacts, and a change diary, whereas the Control Group received a single educational session. Leadership styles and outcomes were assessed at baseline and after two months using the self-rating form of the Multifactor Leadership Questionnaire (MLQ-5X). Qualitative information was also collected through semi-structured interviews, observations during the intervention process, and telephone contacts. This information was used primarily to individualize, implement, and monitor the intervention and, where appropriate, was categorized and quantified for descriptive and process-evaluation purposes. It was not subjected to an independent qualitative thematic analysis. Results: The intervention did not result in a complete change in the way nursing staff managed everyday situations or exercised leadership. Compared with the Control Group, the Intervention Group showed a greater increase in self-reported transformational leadership (time × group interaction, p < 0.001; ηp2 = 0.20), perceived leadership effectiveness (p < 0.001; ηp2 = 0.17), extra effort (p < 0.001; ηp2 = 0.11), and satisfaction with leadership (p = 0.005; ηp2 = 0.08). After adjustment for baseline differences, the time × group interaction for transactional leadership was not statistically significant (p = 0.095). No changes were observed in passive/avoidant leadership. Overall, the findings suggest that the intervention was associated with short-term improvements in selected self-reported leadership outcomes. However, the nonrandomized design, unequal contact time between groups, and reliance on self-reported measures limit the conclusions that can be drawn. Randomized studies with attention-matched comparison groups, longer follow-up, and multi-source assessment are needed.

The authors' abstract, as published at the source. International Journal of Environmental Research and Public Health, 2026 · DOI ↗