Effects of training podiatrists to use imagery-based motivational interviewing to improve self-care for people with diabetes-related foot disease: A mixed-methods pilot study

Abstract

Background Self-care in diabetic foot disease (DFD) is challenging and can contribute to poor outcomes. Motivational Interviewing (MI) engages people in self-care and integrating imagery may further improve its outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care. This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with diabetes-related foot disease (DFD), and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study. Methods Eleven recruited podiatrists (Median age 35, 9 female) received two 4-hour training sessions and three received later mentoring. MI and imagery skills were rated using validated tools during two clinical sessions per participant at baseline, and 2- and 12-weeks post-training. Job satisfaction was assessed at baseline and 12 weeks. Semi-structured interviews at 12 weeks were analysed using the framework approach. Results Significant improvements over time ( p =.006-.044) with substantial effect sizes (η 2 =.50-.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction was high at baseline and unchanged at follow-up ( p =0.34, η 2 =.100). In qualitative interviews, MI training and skills were valued, but significant challenges in using MI when treating people with DFD were reported. Conclusion Training podiatrists in MI may have potential but more training, observation and mentoring appear needed to obtain sustained communication changes in practice.

Effects of training podiatrists to use imagery‐based motivational interviewing when treating people with diabetes‐related foot disease: a mixed‐methods pilot study

“…The qualitative responses suggested this would be highly valued. With 8 h of training provided in the current study, half of the median 16 h found in a systematic review [ 34 ], more training may indeed be needed for lasting positive effects on practice. In particular, further group discussion of difficulties experienced in applying MI is recommended.…”

“…Effective application of imagery-based MI requires that practitioners are sufficiently trained to apply it routinely with high fidelity in their work [ 19 ]. MI skills can be acquired by nurses or general practitioners who care for people with diabetes, albeit to varying success [ 22 , 29 – 33 ], depending in part on the length of MI training and availability of supervision [ 34 ]. However, training podiatrists in using MI to address DFD self-care has not been investigated yet.…”