Minimal improvement of nurses’ motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial

BMC Family Practice

Research Article

Trudy van der Weijden¹  Glyn Elwyn²  Richard Grol³  Renate Jansink³  Jozé Braspenning³  Ellen Keizer³  Miranda Laurant³ 

[1] Department of General Practice, Caphri School for Primary Care and Public Health, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands;Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park, CF14 4XN, Wales, UK;Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands;

关键词: Type 2 diabetes;    Primary care nurses;    Motivational interviewing;    Lifestyle;    General practice;   

DOI  :  10.1186/1471-2296-14-44

 received in 2012-10-11, accepted in 2013-03-21,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients’ readiness to change lifestyle, and quality of life.MethodsFifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients’ readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses.ResultsAt one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, “inviting the patient to talk about behaviour change” (mean difference=0.39, p=0.009), and “assessing patient’s confidence in changing their lifestyle” (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients’ readiness to change health behaviour was associated positively with applying MI skills.ConclusionsThe maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change.Trial registrationCurrent Controlled Trials ISRCTN68707773

【 授权许可】

CC BY   
© Jansink et al.; licensee BioMed Central Ltd. 2013