Evaluating the Impact of Training in Obesity Prevention Methods on the Counseling, Knowledge, and Skills of WIC Nutritionists in Georgia, 2014-2015

Abstract

Objectives: Motivational interviewing, a client-centered intervention method focused on enhancing intrinsic motivation for behavior change, shows a positive impact on children's weight status (ie, stabilizing or slowing down weight gain as a child grows). We evaluated the impact of a training program on knowledge and adoption of evidence-based obesity prevention counseling strategies among counselors from Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).Methods: Between July 2014 and September 2015, Children's Healthcare of Atlanta's Strong4Life program provided 388 WIC counselors in Georgia with a 2-hour training session on motivational interviewing, patient-centered counseling, and goal setting for obesity prevention. We evaluated the training using (1) self-administered pre-and post-training surveys that assessed knowledge of counseling strategies, (2) post-training observation of counseling interactions, and (3) a review of behavior change goal quality pre-and post-training in a random sample of 200 WIC client charts.Results: In a comparison of pre-training knowledge with immediate post-training knowledge among 388 counselors, 81% vs 91% (P < .001) knew that, to be effective, goals must be important to clients, and 66% vs 94% (P < .001) knew the 5 A's (assess, advise, agree, assist, arrange) of counseling. Knowledge improvements were sustained at 3 months post-training. We observed no improvements in the quality of chart-documented behavior goals.Conclusions: WIC nutrition counselors in Georgia were aware of evidence-based counseling strategies but did not consistently apply them. The training program was helpful, but time and additional support are needed to adopt new practices.

Physical Activity Counseling and Documentation by Pediatric Residents in Primary Care: Before and After Introduction of the FITT Principle

“…A study involving nutritionists who received training on motivational interviewing, counseling, and goal-setting, did not find increased goal-setting on chart review despite improvement of knowledge-based outcomes. 17 Lifestyle counseling training among pediatric physicians in another study resulted in increased goal documentation from 3.9% of charts reviewed at baseline, to 16.4% at 6 months, to 57.9% at 12 months. 18 Therefore, progress in implementation may occur gradually over time.…”