Training Primary Care Providers in the Use of Motivational Interviewing for Youth Behavior Change

Abstract

Background and Purpose Adolescent obesity is a global epidemic. Motivational interviewing (MI) is a promising strategy to address adolescent obesity risk behaviors. However, primary care providers (PCPs) tend to express discomfort with learning and adopting MI practices and with addressing patient weight issues. PCP proficiency in using MI to discuss body mass index, health screening results, and nutrition and physical activity behaviors after receiving training and coaching from an MI expert and practicing the technique was evaluated. We hypothesized that comfort with MI would increase consistently over time. Methods Self-assessment surveys in MI proficiency were administered to PCPs after every youth participant MI session. MI comfort as determined by proficiency was categorized into low, medium, and high comfort according to survey Likert scale responses. Data were analyzed using ANOVA and Fisher’s exact tests. Results Two hundred twenty-seven youth were seen for MI-based discussions by four PCPs. Two hundred twenty-six surveys had complete data for analysis. As anticipated, overall PCPs reported significantly more comfort with MI from the first to the final MI session over a two to three month period (p < 0.001). Comfort scores did not increase linearly over time for all PCPs. Despite standard training practices, overall MI proficiency as measured by comfort scores varied by PCP (p <0.01). Implications for Practice This type of MI training program should be considered for clinical nurses and nurse practitioners during their nursing education training to facilitate their ability to consistently and effectively support youth behavior change for conditions like obesity. (ClinicalTrials.gov number: NCT02502383)

Motivational Interviewing to Treat Adolescents With Obesity: A Meta-analysis

“…Concerns regarding MI treatment fidelity are salient, given evidence that training workshops alone do not typically result in enduring changes in practice 57 and that MI skill fluctuates between providers and over time. 21,58 According to an SR by Hall et al, 59 in the absence of supervision and ongoing training after initial training, the majority of clinicians are unlikely to achieve beginning efficiency in MI. Moreover, comfort with MI may not be achieved until at least 3 months, even with ongoing use and coaching, 58 and proficiency and skill may not be achieved until 6 to 12 months.…”

“…21,58 According to an SR by Hall et al, 59 in the absence of supervision and ongoing training after initial training, the majority of clinicians are unlikely to achieve beginning efficiency in MI. Moreover, comfort with MI may not be achieved until at least 3 months, even with ongoing use and coaching, 58 and proficiency and skill may not be achieved until 6 to 12 months. 60,61 Given the relatively short duration of many of the studies in the current SR, it is possible that many of the providers delivering the MI intervention may not have achieved proficiency and skill.…”

Elaboration and refinement of a motivational communication training program for healthcare professionals in pediatric oncology: a feasibility and acceptability study

“…As a point of comparison, we found a randomized trial evaluating the outcome of an MI training for practitioners working in adolescent substance abuse (Mitcheson et al, 2009 ). Other studies have assessed the implementation of MI training programs in nursing students, and the training of healthcare providers and counselors in the use of MI for youth behavior change (Eenshuistra et al, 2020 ; Seigart et al, 2018 ; Vallabhan et al, 2017 ).…”

“…Evaluation studies of these programs systematically support training effects for all MI skills, despite variations in training structure, outcome measures, and the quality of studies (Barwick et al, 2012 ). The research evaluating training programs for professionals applying motivational strategies to pediatric populations have focused on adolescent health, particularly substance abuse (Eenshuistra, Harder, & Knorth, 2020 ; Mitcheson, Bhavsar, & McCambridge, 2009 ; Seigart, Veltman, Willhaus, & Letterle, 2018 ; Vallabhan et al, 2017 ).…”

The impact of motivational therapy in the management of enuretic children

“…[7] Limited evidence shows that a motivational interviewing approach may be an effective behavioral intervention to prevent dental caries in children, [8] to reduce the depression scale scores in adolescents with obesity and overweight, [9] to maintain a good diet among obese patients, and for the correct management of dyslipidemic children. [10] There are also studies describing the potential benefit of only toilet/diet/motivation training in the treatment of functional constipation in children. [11] Nocturnal enuresis (NE) is another condition that may be responsible for behavioral, psychological, and social problems.…”