A Multicenter Randomized Controlled Trial of Motivational Interviewing in Teenagers With Diabetes

Channon, Susan Jane; Huws‐Thomas, Michelle; Rollnick, Stephen; Hood, Kerenza; Cannings‐John, Rebecca; Rogers, Carol; Gregory, John Welbourn

doi:10.2337/dc06-2260

Cited by 291 publications

(283 citation statements)

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“…diet and exercise) in patients with diabetes [13]. Research has not yet been able to establish full consensus on the effect of MI on clinical [14][15][16][17][18][19] and psychosocial aspects [15,18,[20][21][22] in diabetes. Previous reviews emphasise the need for studies of high methodological quality and adequate power to explore the effect of MI on glycaemic control and wellbeing in patients with diabetes [11,13,23].…”

Section: Introductionmentioning

confidence: 99%

The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial

et al. 2011

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Aims/hypothesis The aim of this study was to measure the efficacy of motivational interviewing (MI) compared with usual care on changes in glycaemic control and competence of diabetes self-management in patients with diabetes mellitus.Methods Patients were eligible if they had type 1 or 2 diabetes mellitus, were over 18 years of age and had participated in a 4 day group education programme offered at a diabetes clinic at a university hospital in Denmark. Exclusion criteria included pregnancy, severe debilitating disease and cognitive deficit. Out of 469 patients who attended the group education programme, 349 patients were randomised to either a usual care control group or an intervention group, which received up to five individual counselling sessions in 1 year based on MI, in addition to usual care. A randomised parallel design was used and openlabel allocation was done by random permuted blocks, with allocation concealment by sequentially numbered, sealed, opaque envelopes. The primary outcome was glycated haemoglobin (HbA 1c ). Analysis regarding measurements of glycated haemoglobin (HbA 1c ) and competence of selfmanagement (using the Problem Areas in Diabetes Scale [PAID] and Perceived Competence for Diabetes Scale [PCDS]) was based on 298 participants followed for a 24 month period. Data were collected at the Department of Endocrinology at Odense University Hospital. Our hypotheses were that MI could: (1) reduce HbA 1c levels; (2) increase self-efficacy; and (3) increase diabetes self-care, compared with usual care. Results Out of the 176 included in the control group and 173 in the intervention group, 153 and 145 were analysed in the groups, respectively. When using the baseline value as covariate there were no significant differences in change score between the two study groups with regard to mean level of HbA 1c (0.131, p=0.221), PAID scores (−1.793, p=0.191) or PCDS scores (0.017, p=0.903) at the 24 month follow-up, using a mixed effects regression model. TheElectronic supplementary material The online version of this article

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Section: Introductionmentioning

confidence: 99%

The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial

et al. 2011

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“…1 Main components include health professionals exhibiting empathy and eliciting the patient's own reasons for wanting to change in a collaborative, nonjudgmental manner. 1 General practitioners [2][3][4] and specialists 5 are increasingly using this technique, and its efficacy has been demonstrated across multiple behavioral domains, 6,7 including diet, 8 medication adherence, 9 diabetes care, 10,11 and substance abuse. 6 Within endocrinology, the role of behavior modification is a critical part of helping patients manage their diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…In a randomized controlled trial of MI among patients with type 1 diabetes, hemoglobin A1c values were lower in the MI group than the control group, suggesting the efficacy of this approach in improving meaningful health outcomes. 10 Because of the growing use and support of MI, there is an increased need to examine effective training methods for health professionals. [12][13][14] However, providers and trainees have a limited amount of time available to learn a new clinical style, 15 and multiday training workshops may not be feasible.…”

Section: Introductionmentioning

confidence: 99%

Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology

Bean¹,

Biskobing²,

Francis³

et al. 2012

Journal of Graduate Medical Education

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Background Despite the importance of lifestyle change in disease management and the growing evidence supporting motivational interviewing (MI) as an effective counseling method to promote behavioral change, to date there are few published reports about MI training in graduate medical education. Objective The study aimed to pilot the feasibility and effectiveness of a brief MI training intervention for endocrinology fellows and other providers. Methods We used a pretest/posttest design to evaluate a brief MI training for 5 endocrinology fellows and 9 other providers. All participants completed subjective assessments of perceived confidence and beliefs about behavioral counseling at pretest and posttest. Objective assessment of MI was conducted using fellows' audiotaped patient encounters, which were coded using a validated tool for adherence to MI before and after the training. Paired t tests examined changes in objective and subjective assessments. Results The training intervention was well received and feasible in the endocrinology setting. At posttest, participants reported increased endorsement of the MI spirit and improved confidence in MI skills. Objective assessment revealed relative improvements in MI skills across several domains. However, most domains, as assessed by a validated tool, did not reach competency level after the training intervention. Conclusions Although more intensive training may be needed to develop MI competence, the results of our pilot study suggest that brief, targeted MI training has short-term efficacy and is well received by endocrinology fellows and other providers.

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“…52 This has been trialled with promising results in a study in young people with diabetes in Wales. 53 Counselling happened outside the clinic setting and did not specifically focus on diabetes targets, but recipients benefited, with improved HbA1c and improved quality of life. It appears likely that incorporating this style of interviewing into the diabetes consultation will have a beneficial effect on the quality of care and may be more likely to lead to behaviour change.…”

Section: Collaborative Management In Chronic Illnessmentioning

confidence: 99%

The best model of care for children and young people with diabetes

Williamson¹

2010

JRCPE

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introDUCtionThe incidence of diabetes in childhood has been rising by 3.9% each year in Europe in recent years.1 This has been higher in the pre-school age group, where the incidence is predicted to double by 2020 from its 2005 figure.1 Young people (defined as individuals between the ages of 11 and 18 years 2 ) with diabetes struggle to attain the standards for glycaemic control set for them.3,4 They have a high mortality, 5 develop long-term complications at a relatively early age 6 and have high rates of mental health problems. 7 These factors challenge health services to find the best way of caring for increasing numbers of children and young people with diabetes, so the best model of care needs to be clearly defined. This paper summarises the available evidence and expert opinion on the factors that may contribute to the best model of care for children and young people with diabetes. What is a 'model of care'?A clear definition of 'model of care' is hard to find in the medical literature. Examples include: 'an overarching design for the provision of a particular type of health care service that is shaped by a theoretical basis, evidence based practice and defined standards' 8 and 'a multifaceted concept, which broadly defines the way health services are delivered'. 9 The main theme of these definitions is the provision, or delivery, of healthcare. Delivery of healthcare has three components: structure, process and outcome. 10 Structural data are characteristics of personnel and hospitals or clinics. With these a framework is created from which to deliver the process. Process data are the components of the encounter between a doctor or another healthcare professional and a patient (e.g. teaching carbohydrate counting or using a particular insulin regime). The process is intended to create a beneficial effect on outcomes. Outcome data refer to the patient's subsequent health status (e.g. glycosylated haemoglobin, HbA1c, or frequency of hypoglycaemia).A simple definition of the term 'model of care' would therefore be: 'The structures of healthcare and the processes they deliver.' What models of care are used for childhood diabetes?In the UK, children with diabetes in the most part have their care delivered by specific professionals based within secondary care.11 This has been directed by consensus agreements such as the St Vincent declaration and the recommendations of the British Paediatric Association in 1990, 12,13 but it relies on the structures underpinning the secondary healthcare services, which are not specifically designed for chronic care so may have a number of shortcomings. Models of care for childhood diabetes have evolved slowly from this by adopting novel 'processes' into slowly adapting structures (e.g. implementing intensive insulin therapy, then slowly increasing the numbers of nursing staff available to deliver it), rather than making radical changes to structures to enable the most efficient delivery of the process. We therefore do not find radically different models of care for childhood d...

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A Multicenter Randomized Controlled Trial of Motivational Interviewing in Teenagers With Diabetes

Cited by 291 publications

References 20 publications

The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial

The effect of motivational interviewing on glycaemic control and perceived competence of diabetes self-management in patients with type 1 and type 2 diabetes mellitus after attending a group education programme: a randomised controlled trial

Motivational Interviewing in Health Care: Results of a Brief Training in Endocrinology

The best model of care for children and young people with diabetes

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