Randomized Trial of Teaching Brief Motivational Interviewing to Pediatric Trainees to Promote Healthy Behaviors in Families

Lozano, Paula; McPhillips, Heather; Hartzler, Bryan; Robertson, Andrea; Runkle, Cecilia; Scholz, Kelley; Stout, James; Kieckhefer, Gail M.

doi:10.1001/archpediatrics.2010.86

Cited by 39 publications

(33 citation statements)

References 45 publications

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“…[16][17][18][19][20][21][22][23][24] T A B L E 1 displays details extracted from the studies, and T A B L E 2 includes strengths and limitations of the studies. Five studies were preintervention and postintervention studies, 3 were postintervention studies, and 1 study was a randomized controlled trial.…”

Section: Resultsmentioning

confidence: 99%

Motivational Interviewing Interventions in Graduate Medical Education: A Systematic Review of the Evidence

Dunhill¹,

Schmidt²,

Klein³

2014

Journal of Graduate Medical Education

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Background Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial. Objective To review the current evidence regarding the impact of MI education in graduate medical education. Results Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures. Conclusions Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Motivational Interviewing Interventions in Graduate Medical Education: A Systematic Review of the Evidence

Dunhill¹,

Schmidt²,

Klein³

2014

Journal of Graduate Medical Education

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“…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. 16 Although there is currently no standardized curriculum for teaching MI, various approaches have been described [16][17][18][19] ; yet, few studies have examined MI training for specialists.…”

Section: Introductionmentioning

confidence: 99%

“…16 Although there is currently no standardized curriculum for teaching MI, various approaches have been described [16][17][18][19] ; yet, few studies have examined MI training for specialists. 13 We developed and piloted the feasibility,…”

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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“…Surface, or cognitive, empathy may be improved by learning to vocalize more reflective statements, 35 whereas global assessment of emotional or deep empathy may be more challenging to improve. 36 Limitations of our study include a small sample size (n ϭ 63); however, the sample size was sufficient to confirm our primary hypothesis. The sample may not be representative of all patients with a new diagnosis of major depression and starting antidepressant medication, yet the RCT's systematic screening and recruitment process strengthens external validity.…”

Section: Multivariate Model Of Pdcmentioning

confidence: 77%

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

Kaplan

Keeley²,

Engel³

et al. 2013

The Journal of the American Board of Family Medicine

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Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.Methods: We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.Results: Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: r s >0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: r s >0.25; P < .05). In an adjusted analysis, empathy (t ‫؍‬ 2.3; P ‫؍‬ .027) and >2 CT statements (t ‫؍‬ 2.3; P ‫؍‬ .024) were associated with higher PDC. Nonadherence to antidepressant medication is one of a few potentially modifiable predictors of a poor clinical outcome for people with depression, 1-3 and up to 50% of adults treated for depression in primary care experience clinically significant nonadherence due to side effects, delay in symptom relief, perceived harm of antidepressant medications, and other factors. 4,5 Up to 10% experience primary nonadherence due to not picking up the initial prescription. 6,7 Despite decades of research, there is currently a lack of knowledge about simple, effective interventions to improve medication adherence, and a Cochrane review concluded that most adherence interventions failed to achieve enduring medication adherence or improve patient outcomes.8 Meta-analytical evidence identifies the patient-clinician communication process as a critical and modifiable determinant of subsequent antidepressant adherence, and novel interventions targeting aspects of communication hold promise for positive effects. 9 -11 Yet which aspects of the clinician's or patient's communication are specifically associated with better or worse adherence are unclear.Researchers in the field of motivational interviewing (MI), a patient-centered style of communication intended to help patients resolve ambivalence and work toward improving a targeted maladaptive behavior, 12 have developed instru-

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Randomized Trial of Teaching Brief Motivational Interviewing to Pediatric Trainees to Promote Healthy Behaviors in Families

Cited by 39 publications

References 45 publications

Motivational Interviewing Interventions in Graduate Medical Education: A Systematic Review of the Evidence

Motivational Interviewing Interventions in Graduate Medical Education: A Systematic Review of the Evidence

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

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

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