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Vallis M, Shepherd T. Awareness is not enough: Developing competencies in behaviour change counselling for obesity management. OBESITY PILLARS 2024; 11:100124. [PMID: 39252794 PMCID: PMC11382007 DOI: 10.1016/j.obpill.2024.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/11/2024]
Abstract
Background This study describes the development and evaluation of a competency based training program in behaviour change counselling for obesity management. This was a real world study attempting to obtain evidence on the learning experience; specifically, achievement of level of competency as well as personal experiences of the integration of skills learned into practice. Methods This was a training effectiveness study involving a total of 28 evaluable licenced healthcare providers providing obesity care services. The design for this study is pre-experimental; specifically a one-group post-test only quasi-experimental design.Based on previous work developing a competency-based model of behaviour change counselling (developing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification when ready, and addressing psychosocial determinants of behaviour) we report on training outcomes; specifically, the level of competency achieved in the various skill components of the intervention model. The model of training was based on corrective feedback, the development of peer-based learning and the creation of a mindmap to guide adaptation of interventions to the unique characteristics of individuals with obesity. Quantitative data on competency of components skills and qualitative information on the experience of training were used to evaluate the program. Results Objective assessment of skill competency post training demonstrated moderate to high skill in all aspects of behaviour change counselling. Learners reported frequent use of skills in clinical practice, particularly change-based relationships and readiness assessment/intervention. Qualitative interviews confirmed the value to learners in creating a safe place for corrective feedback, the development of the mindmap concept and the opportunity to teach back learned skills to peers. Conclusion Provision of competency-based behaviour change counselling in obesity management is critical to support the reformulation of obesity as a chronic disease and to be an important adjunct to medical/surgical interventions. In this paper, we have demonstrated the value of an intensive training program for obesity providers.
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Affiliation(s)
- Michael Vallis
- Family Medicine, Dalhousie University, 2137 Purcells Cove Rd, Halifax, B3P 1C5, Canada
| | - Tiffany Shepherd
- Nova Scotia Health Primay Care, 6960 Mumford Rd, Halifax, B3L 4P1, Canada
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Forsetlund L, O'Brien MA, Forsén L, Reinar LM, Okwen MP, Horsley T, Rose CJ. Continuing education meetings and workshops: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2021; 9:CD003030. [PMID: 34523128 PMCID: PMC8441047 DOI: 10.1002/14651858.cd003030.pub3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Educational meetings are used widely by health personnel to provide continuing medical education and to promote implementation of innovations or translate new knowledge to change practice within healthcare systems. Previous reviews have concluded that educational meetings can result in small changes in behaviour, but that effects vary considerably. Investigations into which characteristics of educational meetings might lead to greater impact have yielded varying results, and factors that might explain heterogeneity in effects remain unclear. This is the second update of this Cochrane Review. OBJECTIVES • To assess the effects of educational meetings on professional practice and healthcare outcomes • To investigate factors that might explain the heterogeneity of these effects SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC, Science Citation Index Expanded (ISI Web of Knowledge), and Social Sciences Citation Index (last search in November 2016). SELECTION CRITERIA We sought randomised trials examining the effects of educational meetings on professional practice and patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. One review author assessed the certainty of evidence (GRADE) and discussed with a second review author. We included studies in the primary analysis that reported baseline data and that we judged to be at low or unclear risk of bias. For each comparison of dichotomous outcomes, we measured treatment effect as risk difference adjusted for baseline compliance. We expressed adjusted risk difference values as percentages, and we noted that values greater than zero favour educational meetings. For continuous outcomes, we measured treatment effect as per cent change relative to the control group mean post test, adjusted for baseline performance; we expressed values as percentages and noted that values greater than zero favour educational meetings. We report means and 95% confidence intervals (CIs) and, when appropriate, medians and interquartile ranges to facilitate comparisons to previous versions of this review. We analysed professional and patient outcomes separately and analysed 22 variables that were hypothesised a priori to explain heterogeneity. We explored heterogeneity by using univariate meta-regression and by inspecting violin plots. MAIN RESULTS We included 215 studies involving more than 28,167 health professionals, including 142 new studies for this update. Educational meetings as the single intervention or the main component of a multi-faceted intervention compared with no intervention • Probably slightly improve compliance with desired practice when compared with no intervention (65 comparisons, 7868 health professionals for dichotomous outcomes (adjusted risk difference 6.79%, 95% CI 6.62% to 6.97%; median 4.00%; interquartile range 0.29% to 13.00%); 28 comparisons, 2577 health professionals for continuous outcomes (adjusted relative percentage change 44.36%, 95% CI 41.98% to 46.75%; median 20.00%; interquartile range 6.00% to 65.00%)) • Probably slightly improve patient outcomes compared with no intervention (15 comparisons, 2530 health professionals for dichotomous outcomes (adjusted risk difference 3.30%, 95% CI 3.10% to 3.51%; median 0.10%; interquartile range 0.00% to 4.00%); 28 comparisons, 2294 health professionals for continuous outcomes (adjusted relative percentage change 8.35%, 95% CI 7.46% to 9.24%; median 2.00%; interquartile range -1.00% to 21.00%)) The certainty of evidence for this comparison is moderate. Educational meetings alone compared with other interventions • May improve compliance with desired practice when compared with other interventions (6 studies, 1402 health professionals for dichotomous outcomes (adjusted risk difference 9.99%, 95% CI 9.47% to 10.52%; median 16.5%; interquartile range 0.80% to 16.50%); 2 studies, 72 health professionals for continuous outcomes (adjusted relative percentage change 12.00%, 95% CI 9.16% to 14.84%; median 12.00%; interquartile range 0.00% to 24.00%)) No studies met the inclusion criteria for patient outcome measurements. The certainty of evidence for this comparison is low. Interactive educational meetings compared with didactic (lecture-based) educational meetings • We are uncertain of effects on compliance with desired practice (3 studies, 370 health professionals for dichotomous outcomes; 1 study, 192 health professionals for continuous outcomes) or on patient outcomes (1 study, 54 health professionals for continuous outcomes), as the certainty of evidence is very low Any other comparison of different formats and durations of educational meetings • We are uncertain of effects on compliance with desired practice (1 study, 19 health professionals for dichotomous outcomes; 1 study, 20 health professionals for continuous outcomes) or on patient outcomes (1 study, 113 health professionals for continuous outcomes), as the certainty of evidence is very low. Factors that might explain heterogeneity of effects Meta-regression suggests that larger estimates of effect are associated with studies judged to be at high risk of bias, with studies that had unit of analysis errors, and with studies in which the unit of analysis was the provider rather than the patient. Improved compliance with desired practice may be associated with: shorter meetings; poor baseline compliance; better attendance; shorter follow-up; professionals provided with additional take-home material; explicit building of educational meetings on theory; targeting of low- versus high-complexity behaviours; targeting of outcomes with high versus low importance; goal of increasing rather than decreasing behaviour; teaching by opinion leaders; and use of didactic versus interactive teaching methods. Pre-specified exploratory analyses of behaviour change techniques suggest that improved compliance with desired practice may be associated with use of a greater number of behaviour change techniques; goal-setting; provision of feedback; provision for social comparison; and provision for social support. Compliance may be decreased by the use of follow-up prompts, skills training, and barrier identification techniques. AUTHORS' CONCLUSIONS Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Our findings suggest that multi-strategy approaches might positively influence the effects of educational meetings. Additional trials of educational meetings compared with no intervention are unlikely to change the review findings; therefore we will not further update this review comparison in the future. However, we note that randomised trials comparing different types of education are needed.
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Affiliation(s)
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Lisa Forsén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mbah P Okwen
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
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Kaczmarek T, Kavanagh DJ, Lazzarini PA, Warnock J, Van Netten JJ. Training diabetes healthcare practitioners in motivational interviewing: a systematic review. Health Psychol Rev 2021; 16:430-449. [PMID: 33970799 DOI: 10.1080/17437199.2021.1926308] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diabetes presents significant self-care challenges that require sustained motivation. Motivational Interviewing (MI) has substantial support in enhancing motivation for behavioural change, but its effective application in routine healthcare requires practitioners to acquire and use related skills. The aim of this systematic review was to investigate the impact of MI training on MI-related skills of practitioners who provide diabetes healthcare. PubMed, EMBASE and PsycINFO were searched using the terms motivational interviewing, motivation enhancement, and diabetes. Two assessors independently screened titles, abstracts and full texts for papers reporting the impact of MI training on diabetes healthcare practitioners' outcomes. Of 625 abstracts screened, 22 papers from 17 unique studies were included. All 17 studies reported some improvement in MI skills, with 14 finding improvements in more than 50% and three less than 35%. However, the risk of bias and outcome measures varied widely between studies. All studies showed diabetes healthcare practitioners acquired and applied MI skills post-training, to varying levels. Findings suggest training should include education, role play, and ongoing supervision to maintain skills.
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Affiliation(s)
- Tracey Kaczmarek
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - David J Kavanagh
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Jason Warnock
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, Australia
| | - Jaap J Van Netten
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.,Department of Rehabilitation, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Kaczmarek T, Van Netten JJ, Lazzarini PA, Kavanagh D. Effects of training podiatrists to use imagery-based motivational interviewing when treating people with diabetes-related foot disease: a mixed-methods pilot study. J Foot Ankle Res 2021; 14:12. [PMID: 33568218 PMCID: PMC7877056 DOI: 10.1186/s13047-021-00451-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/26/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. Motivational Interviewing (MI) can engage people in self-care and modifying it by 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 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 years, 9 female and 2 male) received two 4-h training sessions, and three received subsequent 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 (η2 = .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, η2 = .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.
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Affiliation(s)
- Tracey Kaczmarek
- School of Clinical Sciences, Queensland University of Technology, The Prince Charles Hospital Rhode Road, Brisbane, Queensland, 4032, Australia.
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, QLD, Australia.
| | - Jaap J Van Netten
- School of Clinical Sciences, Queensland University of Technology, The Prince Charles Hospital Rhode Road, Brisbane, Queensland, 4032, Australia
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Peter A Lazzarini
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Podiatry, Metro North Hospital & Health Service, Queensland Health, Brisbane, QLD, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - David Kavanagh
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Child Health Research and School of Psychology & Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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Beck AK, Baker AL, Carter G, Wratten C, Bauer J, Wolfenden L, McCarter K, Britton B. Assessing Adherence, Competence and Differentiation in a Stepped-Wedge Randomised Clinical Trial of a Complex Behaviour Change Intervention. Nutrients 2020; 12:E2332. [PMID: 32759848 PMCID: PMC7469004 DOI: 10.3390/nu12082332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A key challenge in behavioural medicine is developing interventions that can be delivered adequately (i.e., with fidelity) within real-world consultations. Accordingly, clinical trials should (but tend not to) report what is actually delivered (adherence), how well (competence) and the distinction between intervention and comparator conditions (differentiation). PURPOSE To address this important clinical and research priority, we apply best practice guidelines to evaluate fidelity within a real-world, stepped-wedge evaluation of "EAT: Eating As Treatment", a new dietitian delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. METHODS Dietitians (n = 18) from five Australian hospitals delivered a period of routine care and following a randomly determined order each site received training and began delivering the EAT Intervention. A 20% random stratified sample of audio-recorded consultations (control n = 196; intervention n = 194) was coded by trained, independent, raters using a study specific checklist and the Behaviour Change Counselling Inventory. Intervention adherence and competence were examined relative to apriori benchmarks. Differentiation was examined by comparing control and intervention sessions (adherence, competence, non-specific factors, and dose), via multiple linear regression, logistic regression, or mixed-models. RESULTS Achievement of adherence benchmarks varied. The majority of sessions attained competence. Post-training consultations were clearly distinct from routine care regarding motivational and behavioural, but not generic, skills. CONCLUSIONS Although what level of fidelity is "good enough" remains an important research question, findings support the real-world feasibility of integrating EAT into dietetic consultations with HNC patients and provide a foundation for interpreting treatment effects.
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Affiliation(s)
- Alison Kate Beck
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Gregory Carter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Chris Wratten
- Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Waratah, NSW 2298, Australia
| | - Judith Bauer
- Centre for Dietetics Research, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kristen McCarter
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ben Britton
- Hunter New England Health, New Lambton 2305, Australia
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Kelly PJ, Baker AL, Fagan NL, Turner A, Deane F, McKetin R, Callister R, Collins C, Ingram I, Wolstencroft K, Townsend C, Osborne BA, Zimmermann A. Better Health Choices: Feasability and preliminary effectiveness of a peer delivered healthy lifestyle intervention in a community mental health setting. Addict Behav 2020; 103:106249. [PMID: 31881407 DOI: 10.1016/j.addbeh.2019.106249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/29/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. METHODS The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. RESULTS Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. CONCLUSIONS Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550).
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Gill I, Oster C, Lawn S. Assessing competence in health professionals' use of motivational interviewing: A systematic review of training and supervision tools. PATIENT EDUCATION AND COUNSELING 2020; 103:473-483. [PMID: 31585819 DOI: 10.1016/j.pec.2019.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To conduct a systematic review of instruments for assessing the competency of therapists in motivational interviewing (MI) for training purposes. METHODS A search of Medline, Emcare, CINAHL, Scopus, Proquest, and Web of Science databases yielded 20,313 articles, of which 105 were included in the review. Data were summarised in terms of the instruments' development, adherence to MI principles, administration characteristics, psychometric properties, advantages, and disadvantages. RESULTS Twelve instruments were identified. Tools tended to be better at covering simpler MI techniques. Differences in administration burden allow users to choose between briefer but cheaper and more detailed yet costly tools. Psychometric testing was often limited, and even if more extensive, the quality was often inconsistent. Although each tool tended to have relatively unique advantages (e.g. use of client ratings), they shared common disadvantages (e.g. lack of psychometric testing). CONCLUSION A number of tools can be used to assess MI competency, each with their own strengths but notable weaknesses that should be considered by potential users. PRACTICE IMPLICATIONS There is a need to further test existing tools before creating new ones, due to the repetition of the same limitations. Standardised guidelines should also be created to ensure each tool meets the same quality standards.
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Affiliation(s)
- Isabelle Gill
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, South Australia, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, South Australia, Australia.
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Engelen MM, van Dulmen S, Nijhuis-van der Sanden MWG, Adriaansen MJM, Vermeulen H, Bredie SJH, van Gaal BGI. Self-management support in cardiovascular consultations by advanced practice nurses trained in motivational interviewing: An observational study. PATIENT EDUCATION AND COUNSELING 2020; 103:159-164. [PMID: 31362901 DOI: 10.1016/j.pec.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/14/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This observational study explores advanced practice nurses' (APN) performance in secondary prevention and self-management support in patients with cardiovascular disease. METHODS Real-life consultations in three outpatient clinics were recorded on audio and analysed. First, discussed (sub)categories were determined using five categories of self-management: symptom management, treatment, biomedical cardiovascular risk factors, psychosocial consequences, and lifestyle changes. Second, the extent in which motivational interviewing aspects were applied was determined using the Behaviour Change Counselling Index (BECCI). RESULTS In total, 49 consultations performed by five female APNs were analysed. Physical topics were discussed in 98% and psychological subthemes in 41% of the consultations. Although not all components of motivational interviewing were applied, talking about current behaviour and behaviours that should change were discussed, and information was provided. Especially setting targets and exchanging ideas on how to reach behavioural goals were applied to a small extent. CONCLUSION Well-trained APNs in the current study do not carry out motivational interviewing in a structural and complete manner according to BECCI and do not discuss all self-management categories. PRACTICE IMPLICATIONS Psychological topics should be more integrated in providing self-management support by APNs and the application of motivational interviewing should be enhanced by regularly and repeated training.
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Affiliation(s)
- Marscha M Engelen
- Radboud university medical center, Radboud Institute for Health Science, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Science, Faculty of Health and Social Studies, Institute of Nursing, Nijmegen, The Netherlands.
| | - Sandra van Dulmen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, The Netherlands; Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | | | - Marian J M Adriaansen
- HAN University of Applied Science, Faculty of Health and Social Studies, Institute of Nursing, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud university medical center, Radboud Institute for Health Science, IQ healthcare, Nijmegen, The Netherlands
| | - Sebastian J H Bredie
- Radboud university medical center, Department of Internal Medicine, Nijmegen, The Netherlands
| | - Betsie G I van Gaal
- Radboud university medical center, Radboud Institute for Health Science, IQ healthcare, Nijmegen, The Netherlands; HAN University of Applied Science, Faculty of Health and Social Studies, Institute of Nursing, Nijmegen, The Netherlands
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Zhou W, Huang J, Yang L, Qiu T, Zhang Y, Liu F, Zhou Z. Long-term training in diabetes-related knowledge, attitudes, and self-reported practice among diabetes liaison nurses. J Int Med Res 2019; 48:300060519882838. [PMID: 31662018 PMCID: PMC7873921 DOI: 10.1177/0300060519882838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective We aimed to investigate whether long-term regular training of diabetes
liaison nurses (DLNs) could improve their diabetes-related knowledge,
attitudes, and self-reported practice. Methods We enrolled 45 diabetes liaison nurses (DLNs) and 45 non-specialist nurses
(controls). DLNs received 11 days of qualifying training, followed by
regular theory classes and practice sessions for 4 years. All nurses were
administered a questionnaire assessing demographic characteristics,
knowledge about diabetes mellitus (DM), attitudes toward DM, and DM
management practices, before and after the 4-year DLN training period. Results At baseline, there were no significant differences between the DLN and
control groups for sex, age, educational level, nurse title/grade, work
experience, hospital department, or questionnaire scores. At 4 years, the
DLN group had a higher overall questionnaire score and higher scores for
knowledge about DM, attitudes toward DM, and DM management practices, as
compared with baseline scores. Conclusion Long-term regular training provided by a multidisciplinary diabetes care team
can improve the knowledge, attitudes, and self-reported practice levels of
DLNs.
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Affiliation(s)
- Wen Zhou
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jin Huang
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,Diabetes Center, Department of Endocrinology, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
| | - Lingfeng Yang
- Diabetes Center, Department of Endocrinology, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
| | - Tieying Qiu
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Zhang
- Diabetes Center, Department of Endocrinology, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
| | - Fang Liu
- Diabetes Center, Department of Endocrinology, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
| | - Zhiguang Zhou
- Diabetes Center, Department of Endocrinology, Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, Hunan, China
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The Effect of Diabetes-Specific Enteral Nutrition Formula on Cardiometabolic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Nutrients 2019; 11:nu11081905. [PMID: 31443185 PMCID: PMC6722646 DOI: 10.3390/nu11081905] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The prevalence of diabetes is on the increase in the UK and worldwide, partly due to unhealthy lifestyles, including poor dietary regimes. Patients with diabetes and other co-morbidities such as stroke, which may affect swallowing ability and lead to malnutrition, could benefit from enteral nutrition, including the standard formula (SF) and diabetes-specific formulas (DSF). However, enteral nutrition presents its challenges due to its effect on glycaemic control and lipid profile. AIM The aim of this review was to evaluate the effectiveness of diabetes-specific enteral nutrition formula versus SF in managing cardiometabolic parameters in patients with type 2 diabetes. METHOD This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses. Three databases (Pubmed, EMBASE, PSYCInfo) and Google scholar were searched for relevant articles from inception to 2 January 2019 based on Population, Intervention, Comparator, Outcomes and Study designs (PICOS) framework. Key words, Medical Subject Heading (MeSH) terms, and Boolean operators (AND/OR) formed part of the search strategy. Articles were evaluated for quality and risks of bias. RESULTS Fourteen articles were included in the systematic review and five articles were selected for the meta-analysis. Based on the findings of the review and meta-analysis, two distinct areas were evident: the effect of DSF on blood glucose parameters and the effect of DSF on lipid profile. All fourteen studies included in the systematic review showed that DSF was effective in lowering blood glucose parameters in patients with type 2 diabetes compared with SF. The results of the meta-analysis confirmed the findings of the systematic review with respect to the fasting blood glucose, which was significantly lower (p = 0.01) in the DSF group compared to SF, with a mean difference of -1.15 (95% CI -2.07, -0.23) and glycated haemoglobin, which was significantly lower (p = 0.005) in the DSF group compared to the SF group following meta-analysis and sensitivity analysis. However, in relation to the sensitivity analysis for the fasting blood glucose, differences were not significant between the two groups when some of the studies were removed. Based on the systematic review, the outcomes of the studies selected to evaluate the effect of DSF on lipid profile were variable. Following the meta-analysis, no significant differences (p > 0.05) were found between the DSF and SF groups with respect to total cholesterol, LDL cholesterol and triglyceride. The level of the HDL cholesterol was significantly higher (p = 0.04) in the DSF group compared to the SF group after the intervention, with a mean difference of 0.09 (95% CI, 0.00, 0.18), although this was not consistent based on the sensitivity analysis. The presence of low glycaemic index (GI) carbohydrate, the lower amount of carbohydrate and the higher protein, the presence of mono-unsaturated fatty acids and the different amounts and types of fibre in the DSF compared with SF may be responsible for the observed differences in cardiometabolic parameters in both groups. CONCLUSION The results provide evidence to suggest that DSF is effective in controlling fasting blood glucose and glycated haemoglobin and in increasing HDL cholesterol, but has no significant effect on other lipid parameters. However, our confidence in these findings would be increased by additional data from further studies.
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Abstract
PURPOSE OF REVIEW Implementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care. RECENT FINDINGS Two trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs' MI-related language and patients' arguments for positive behavior changes, "change talk," appeared to explain the positive effects of MI training on depression outcome. MI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting "change talk" from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.
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Magill N, Graves H, de Zoysa N, Winkley K, Amiel S, Shuttlewood E, Landau S, Ismail K. Assessing treatment fidelity and contamination in a cluster randomised controlled trial of motivational interviewing and cognitive behavioural therapy skills in type 2 diabetes. BMC FAMILY PRACTICE 2018; 19:60. [PMID: 29747575 PMCID: PMC5946533 DOI: 10.1186/s12875-018-0742-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/23/2018] [Indexed: 12/05/2022]
Abstract
Background Competencies in psychological techniques delivered by primary care nurses to support diabetes self-management were compared between the intervention and control arms of a cluster randomised controlled trial as part of a process evaluation. The trial was pragmatic and designed to assess effectiveness. This article addresses the question of whether the care that was delivered in the intervention and control trial arms represented high fidelity treatment and attention control, respectively. Methods Twenty-three primary care nurses were either trained in motivational interviewing (MI) and cognitive behavioural therapy (CBT) skills or delivered attention control. Nurses’ skills in these treatments were evaluated soon after training (treatment arm) and treatment fidelity was assessed after treatment delivery for sessions midway through regimen (both arms) using the Motivational Interviewing Treatment Integrity (MITI) domains and Behaviour Change Counselling Index (BECCI) based on consultations with 151 participants (45% of those who entered the study). The MITI Global Spirit subscale measured demonstration of MI principles: evocation, collaboration, autonomy/support. Results After training, median MITI MI-Adherence was 86.2% (IQR 76.9–100%) and mean MITI Empathy was 4.09 (SD 1.04). During delivery of treatment, in the intervention arm mean MITI Spirit was 4.03 (SD 1.05), mean Empathy was 4.23 (SD 0.89), and median Percentage Complex Reflections was 53.8% (IQR 40.0–71.4%). In the attention control arm mean Empathy was 3.40 (SD 0.98) and median Percentage Complex Reflections was 55.6% (IQR 41.9–71.4%). Conclusions After MI and CBT skills training, detailed assessment showed that nurses had basic competencies in some psychological techniques. There appeared to be some delivery of elements of psychological treatment by nurses in the control arm. This model of training and delivery of MI and CBT skills integrated into routine nursing care to support diabetes self-management in primary care was not associated with high competency levels in all skills. Trial registration ISRCTN75776892; date registered: 19/05/2010.
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Affiliation(s)
- Nicholas Magill
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Helen Graves
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicole de Zoysa
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kirsty Winkley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Amiel
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
| | - Emma Shuttlewood
- Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, London, UK
| | - Sabine Landau
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK
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Oberink R, Boom SM, van Dijk N, Visser MRM. Assessment of motivational interviewing: a qualitative study of response process validity, content validity and feasibility of the motivational interviewing target scheme (MITS) in general practice. BMC MEDICAL EDUCATION 2017; 17:224. [PMID: 29162090 PMCID: PMC5698949 DOI: 10.1186/s12909-017-1052-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Motivational Interviewing target Scheme (MITS) is an instrument to assess competency in Motivational Interviewing (MI) and can be used to assess MI in long and brief consultations. In this qualitative study we examined two sources of the Unified Model of Validity, the current standard of assessment validation, in the context of General Practice. We collected evidence concerning response process validity and content validity of the MITS in general practice. Furthermore, we investigated its feasibility. METHODS Assessing consultations of General Practitioners and GP-trainees (GPs), the assessors systematically noted down their considerations concerning the scoring process and the content of the MITS in a semi-structured questionnaire. Sampling of the GPs was based on maximum variation and data saturation was used as a stopping criterion. An inductive approach was used to analyse the data. In response to scoring problems the score options were adjusted and all consultations were assessed using the original and the adjusted score options. RESULTS Twenty seven assessments were needed to reach data saturation. In most consultations, the health behaviour was not the reason for encounter but was discussed on top of discussing physical problems. The topic that was most discussed in the consultations was smoking cigarettes. The adjusted score options increased the response process validity; they were more in agreement with theoretical constructs and the observed quality of MI in the consultations. Concerning content validity, we found that the MITS represents the broad spectrum and the current understanding of MI. Furthermore, the MITS proved to be feasible to assess MI in brief consultations in general practice. CONCLUSIONS Based on the collected evidence the MITS seems a promising instrument to measure MI interviewing in brief consultations. The evidence gathered in this study lays the foundation for research into other aspects of validation.
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Affiliation(s)
- Riëtta Oberink
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Saskia M. Boom
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
| | - Mechteld R. M. Visser
- Department of General Practice/Family Medicine, Academic Medical Centre–University of Amsterdam, meibergdreef 15, 1105 Amsterdam, The Netherlands
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Westland H, Schröder CD, de Wit J, Frings J, Trappenburg JCA, Schuurmans MJ. Self-management support in routine primary care by nurses. Br J Health Psychol 2017; 23:88-107. [DOI: 10.1111/bjhp.12276] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/31/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Carin D. Schröder
- Center of Excellence in Rehabilitation Medicine; Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
- De Hoogstraat Rehabilitation; Utrecht The Netherlands
| | - Jessica de Wit
- Center of Excellence in Rehabilitation Medicine; Brain Center Rudolf Magnus; University Medical Center Utrecht; The Netherlands
- De Hoogstraat Rehabilitation; Utrecht The Netherlands
| | - Judith Frings
- Faculty of Health; University of Applied Sciences Utrecht; The Netherlands
| | - Jaap C. A. Trappenburg
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
| | - Marieke J. Schuurmans
- Julius Center for Health Sciences and Primary Care; University Medical Center Utrecht; The Netherlands
- Faculty of Health; University of Applied Sciences Utrecht; The Netherlands
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Abstract
This article describes a pilot study that involves nurses learning motivational interviewing techniques as a way to enhance confidence in educating patients about diabetes. The pilot study took place in the medical telemetry unit of a large teaching hospital in southwest United States. The intervention included a 2-hour session that involved didactic and role-playing components. Presurvey and postsurvey results indicated that the intervention significantly improved nurses' confidence in teaching patients (t = -7.474, p = .0001).
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Oftedal B, Kolltveit BCH, Zoffmann V, Hörnsten Å, Graue M. Learning to practise the Guided Self-Determination approach in type 2 diabetes in primary care: A qualitative pilot study. Nurs Open 2017; 4:134-142. [PMID: 28694977 PMCID: PMC5500461 DOI: 10.1002/nop2.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/14/2016] [Indexed: 11/12/2022] Open
Abstract
Aim To describe how diabetes nurses in primary care experience the process of learning to practise the person‐centred counselling approach Guided Self‐Determination among adults with type 2 diabetes. Design A descriptive qualitative design. Method Data were collected in 2014–2015 by means of individual interviews with four diabetes nurses at two points in time. The data were analysed using qualitative content analysis. Results Three themes that reflect nurses’ processes in learning to use the Guided Self‐Determination approach were identified: (1) from an unfamiliar interaction to “cracking the code”; (2) from an unspecific approach to a structured, reflective, but demanding approach; and (3) from a nurse‐centred to a patient‐centred approach. The overall findings indicate that the process of learning to practise Guided Self‐Determination increased the nurses’ counselling competence. Moreover, the nurses perceived the approach to be generally helpful, as it stimulated reflections about diabetes management and about their own counselling practices.
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Affiliation(s)
- Bjørg Oftedal
- Department of Health Studies University of Stavanger Stavanger Norway
| | | | - Vibeke Zoffmann
- The Research Unit Women's and Children's Health The Juliane Marie Centre Copenhagen University Hospital Copenhagen Denmark
| | - Åsa Hörnsten
- Department of Nursing Umeå University Umeå Sweden
| | - Marit Graue
- Centre for Evidence-Based Practice Bergen University College Bergen Norway
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Duprez V, Vandecasteele T, Verhaeghe S, Beeckman D, Van Hecke A. The effectiveness of interventions to enhance self-management support competencies in the nursing profession: a systematic review. J Adv Nurs 2017; 73:1807-1824. [DOI: 10.1111/jan.13249] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Veerle Duprez
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
| | - Tina Vandecasteele
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Department Health Care; VIVES University College; Roeselare Belgium
| | - Sofie Verhaeghe
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Department Health Care; VIVES University College; Roeselare Belgium
| | - Dimitri Beeckman
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- School of Health Sciences; Nursing and Midwifery; University of Surrey; United Kingdom
| | - Ann Van Hecke
- Department of Public Health; University Centre for Nursing and Midwifery; Ghent University; Belgium
- Ghent; University Hospital; Belgium
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18
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Process evaluation of a tailored intervention programme of cardiovascular risk management in general practices. Implement Sci 2016; 11:164. [PMID: 27978857 PMCID: PMC5159979 DOI: 10.1186/s13012-016-0526-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background A tailored implementation programme to improve cardiovascular risk management (CVRM) in general practice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on counselling skills and CVRM knowledge of practice nurses, (2) their use of the various components of the intervention programme and adoption of recommended practices and (3) patients’ perceptions of counselling for CVRM. Methods A mixed-methods process evaluation was conducted. We assessed practice nurses’ motivational interviewing skills on audio-taped consultations using Motivational Interviewing Treatment Integrity (MITI). They also completed a clinical knowledge test. Both practice nurses and patients reported on their experiences in a written questionnaire and interviews. A multilevel regression analysis and an independent sample t test were used to examine motivational interviewing skills and CVRM knowledge. Framework analysis was applied to analyse qualitative data. Results Data from 34 general practices were available, 19 intervention practices and 14 control practices. No improvements were measured on motivational interviewing skills in both groups. There appeared to be better knowledge of CVRM in the control group. On average half of the practice nurses indicated that they adopted the recommended interventions, but stated that they did not necessarily record this in patients’ medical files. The tailored programme was perceived as too large. Time, follow-up support and reminders were felt to be lacking. About 20% of patients in the intervention group visited the general practice during the intervention period, yet only a small number of these patients were referred to recommended options. Conclusions The tailored programme was only partly used by practice nurses and had little impact on either their clinical knowledge and communication skills or on patient reported healthcare. If the assumed logical model of change is valid, a more intensive programme is needed to have an impact on CVRM in general practice at all.
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19
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Channon S, Bekkers MJ, Sanders J, Cannings-John R, Robertson L, Bennert K, Butler C, Hood K, Robling M. Motivational interviewing competencies among UK family nurse partnership nurses: a process evaluation component of the building blocks trial. BMC Nurs 2016; 15:55. [PMID: 27660554 PMCID: PMC5029038 DOI: 10.1186/s12912-016-0176-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/13/2016] [Indexed: 11/10/2022] Open
Abstract
Background Motivational Interviewing (MI) is a person-centred counselling approach to behaviour change which is increasingly being used in public health settings, either as a stand-alone approach or in combination with other structured programmes of health promotion. One example of this is the Family Nurse Partnership (FNP) a licensed, preventative programme for first time mothers under the age of 20, delivered by specialist family nurses who are additionally trained in MI. The Building Blocks trial was an individually randomised controlled trial comparing effectiveness of Family Nurse Partnership when added to usual care compared to usual care alone within 18 sites in England. The aim of this process evaluation component of the trial is to determine the extent to which Motivational Interviewing skills taught to Family Nurse Partnership nurses were used in their home visits with clients. Methods Between July 2010 and November 2011, 92 audio-recordings of nurse-client consultations were collected during the ‘pregnancy’ and ‘infancy’ phases of the FNP programme. They were analysed using The Motivational Interviewing Treatment Integrity (MITI) coding system. Results A competent level of overall MI adherent practice according to the MITI criteria for ‘global clinician ratings’ was apparent in over 70 % of the consultations. However, on specific behaviours and the MITI-derived practitioner competency variables, there was a large variation in the percentage of recordings in which “beginner proficiency” levels in MI (as defined by the MITI criteria) was achieved, ranging from 73.9 % for the ‘MI adherent behaviour’ variable in the pregnancy phase to 6.7 % for ‘percentage of questions coded as open’ in the infancy phase. Conclusions The results suggest that it is possible to deliver a structured programme in an MI-consistent way. However, some of the behaviours regarded as key to MI practice such as the percentage of questions coded as open can be more difficult to achieve in such a context. This is an important consideration for those involved in designing effective structured interventions with an MI-informed approach and wanting to maintain fidelity to both MI and the structured programme. Trial registration Current Controlled Trials ISRCTN23019866 Registered 20/4/2009.
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Affiliation(s)
- Sue Channon
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Marie-Jet Bekkers
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Laura Robertson
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | | | | | - Kerenza Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
| | - Michael Robling
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neauadd Meirionnydd, Heath Park, Cardiff, CF14 4YS UK
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Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system. BMC FAMILY PRACTICE 2015; 16:179. [PMID: 26666285 PMCID: PMC4678460 DOI: 10.1186/s12875-015-0390-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022]
Abstract
Background Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. Methods We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Results Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients’ lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals’ and patients’ views on patient’s knowledge and self-management. Conclusions Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients’ knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.
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Garzonis K, Mann E, Wyrzykowska A, Kanellakis P. Improving Patient Outcomes: Effectively Training Healthcare Staff in Psychological Practice Skills: A Mixed Systematic Literature Review. EUROPES JOURNAL OF PSYCHOLOGY 2015; 11:535-56. [PMID: 27247676 PMCID: PMC4873062 DOI: 10.5964/ejop.v11i3.923] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/09/2015] [Indexed: 11/24/2022]
Abstract
Training is an important part of modern European healthcare services and is often cited as a way to improve care quality. To date, various training methods have been used to impart skills relevant to psychological practice in a variety of mental health professionals. However, patient outcomes are rarely used in evaluating the effectiveness of the different training methods used, making it difficult to assess true utility. In the present review, we consider methods of training that can effectively impact trainee and patient outcomes. To do so, PubMed, PsycNET, Scopus, CENTRAL and ERIC were searched for studies on training of healthcare staff in psychological practice approaches. In total, 24 studies were identified (16 quantitative and 8 qualitative). For the most part, group, individual, and web-based training was used. A variety of health professionals were trained in skills including ‘communication’, ‘diagnosis’, and ‘referral’ to name but a few. In the majority of studies staff skill level improved. These findings hold implications for the design, implementation, and evaluation of training for mental healthcare staff.
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Affiliation(s)
- Katherine Garzonis
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Eryn Mann
- Saint Andrew's Healthcare, Northampton, United Kingdom
| | - Aleksandra Wyrzykowska
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, United Kingdom
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Campbell TS, Bacon SL, Corace K, Lavoie KL, Rash JA, Vallis M. Comment on Pladevall et al, "A Randomized Controlled Trial to Provide Adherence Information and Motivational Interviewing to Improve Diabetes and Lipid Control". DIABETES EDUCATOR 2015; 41:625-6. [PMID: 26246594 DOI: 10.1177/0145721715597479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB Canada (Dr Campbell, Mr Rash)
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Research Centre, Hôpital du Sacré-Cœur de Montréal-a University of Montreal affiliated hospital, Québec, Canada (Dr Bacon, Dr Lavoie),Department of Exercise Science, Concordia University, Montréal, QC, Canada (Dr Bacon)
| | - Kim Corace
- The Royal Ottawa Mental Health CentreUniversity of OttawaInstitute of Mental Health Research, Ottawa, ON, Canada (Dr Corace)
| | - Kim L Lavoie
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada (Dr Lavoie),Montreal Behavioural Medicine Centre, Research Centre, Hôpital du Sacré-Cœur de Montréal-a University of Montreal affiliated hospital, Québec, Canada (Dr Bacon, Dr Lavoie)
| | - Joshua A Rash
- Department of Psychology, University of Calgary, Calgary, AB Canada (Dr Campbell, Mr Rash)
| | - Michael Vallis
- Behaviour Change Institute, Capital Health and Dalhousie University, Halifax, NS, Canada (Dr Vallis)
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van de Glind I, Heinen M, Geense W, Mesters I, Wensing M, van Achterberg T. Making the connection-factors influencing implementation of evidence supported and non-evaluated lifestyle interventions in healthcare: a multiple case study. HEALTH EDUCATION RESEARCH 2015; 30:521-541. [PMID: 26025211 DOI: 10.1093/her/cyv020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
Many implementation barriers relate to lifestyle interventions (LIs) being developed by scientists. Exploring whether implementation of non-evaluated LIs is less complicated, might offer insight how to improve the use of effective interventions. This study aimed to identify influencing factors for implementation and compare factors between evidence supported and non-evaluated LIs. Evidence-supported (n = 7) and non-evaluated LIs (n = 7) in hospitals, general practices and community care organizations were included as cases. Semi-structured interviews (n = 46) were conducted. Additionally, documents (n = 207) were collected describing intervention, implementation process, and policy. We used a stepwise approach to inductively identify factors, organize them by diffusion phase, and an existing framework. A total of 37 factors were identified. 'Dissemination' factors were mainly observed in evidence-supported LIs. 'Compatibility to existing structures' ('adoption'), 'funding' and 'connection to existing care processes' ('implementation') was factors identified in all cases. 'Quality control' and 'ongoing innovation' ('maintenance') were reported in evidence-supported interventions. In all domains of the framework factors were observed. Factors identified in this study are in line with the literature. The findings do not support the assumption that implementation of non-evaluated LIs is perceived as less complex.
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Affiliation(s)
- Irene van de Glind
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse Mesters
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo van Achterberg
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
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Curry-Chiu ME, Catley D, Voelker MA, Bray KK. Dental Hygienists’ Experiences with Motivational Interviewing: A Qualitative Study. J Dent Educ 2015. [DOI: 10.1002/j.0022-0337.2015.79.8.tb05979.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Delwyn Catley
- Departments of Psychology and Dentistry; University of Missouri-Kansas City
| | - Marsha A. Voelker
- Division of Dental Hygiene; University of Missouri-Kansas City School of Dentistry
| | - Kimberly Krust Bray
- Division of Dental Hygiene; University of Missouri-Kansas City School of Dentistry
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Giudice EL, Lewin LO, Welsh C, Crouch TB, Wright KS, Delahanty J, DiClemente CC. Online Versus In-Person Screening, Brief Intervention, and Referral to Treatment Training in Pediatrics Residents. J Grad Med Educ 2015. [PMID: 26217423 PMCID: PMC4507928 DOI: 10.4300/jgme-d-14-00367.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Pediatricians underestimate the prevalence of substance misuse among children and adolescents and often fail to screen for and intervene in practice. The American Academy of Pediatrics recommends training in Screening, Brief Intervention, and Referral to Treatment (SBIRT), but training outcomes and skill acquisition are rarely assessed. OBJECTIVE We compared the effects of online versus in-person SBIRT training on pediatrics residents' knowledge, attitudes, behaviors, and skills. METHODS Forty pediatrics residents were randomized to receive either online or in-person training. Skills were assessed by pre- and posttraining standardized patient interviews that were coded for SBIRT-adherent and -nonadherent behaviors and global skills by 2 trained coders. Thirty-two residents also completed pre- and postsurveys of their substance use knowledge, attitudes, and behaviors (KABs). Two-way repeated measures multivariate analyses of variance (MANOVAs) and analyses of variance (ANOVAs) estimates were used to assess group differences in skill acquisition and KABs. RESULTS Findings indicated that both groups demonstrated skill improvement from pre- to postassessment. Results indicated that both groups increased their knowledge, self-reported behaviors, confidence, and readiness with no significant between-group differences. Follow-up univariate analyses indicated that, while both groups increased their SBIRT-adherent skills, the online training group displayed more "undesirable" behaviors posttraining. CONCLUSIONS The current study indicates that brief training, online or in-person, can increase pediatrics residents' SBIRT skills, knowledge, self-reported behaviors, confidence, and readiness. The findings further indicate that in-person training may have incremental benefit in teaching residents what not to do.
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Wang D, Li XY, Zhang LN, Zhou L, Zhang KJ. WITHDRAWN: Effects of motivational interviewing on lifestyle modification and diabetes prevention in adults with pre-diabetes. Diabetes Res Clin Pract 2015:S0168-8227(15)00082-0. [PMID: 25748829 DOI: 10.1016/j.diabres.2015.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 01/29/2015] [Indexed: 11/25/2022]
Abstract
This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Dan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiu-Yun Li
- West Mofan Road Community Health Service Center, Nanjing, China
| | - Li-Na Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ling Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Kai-Jin Zhang
- School of Public Health, Southeast University, Nanjing, China.
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27
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Mulder BC, Lokhorst AM, Rutten GEHM, van Woerkum CMJ. Effective Nurse Communication With Type 2 Diabetes Patients. West J Nurs Res 2014; 37:1100-31. [DOI: 10.1177/0193945914531077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many type 2 diabetes mellitus patients have difficulties reaching optimal blood glucose control. With patients treated in primary care by nurses, nurse communication plays a pivotal role in supporting patient health. The twofold aim of the present review is to categorize common barriers to nurse–patient communication and to review potentially effective communication methods. Important communication barriers are lack of skills and self-efficacy, possibly because nurses work in a context where they have to perform biomedical examinations and then perform patient-centered counseling from a biopsychosocial approach. Training in patient-centered counseling does not seem helpful in overcoming this paradox. Rather, patient-centeredness should be regarded as a basic condition for counseling, whereby nurses and patients seek to cooperate and share responsibility based on trust. Nurses may be more successful when incorporating behavior change counseling based on psychological principles of self-regulation, for example, goal setting, incremental performance accomplishments, and action planning.
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28
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Martin L, Leveritt MD, Desbrow B, Ball LE. The self-perceived knowledge, skills and attitudes of Australian practice nurses in providing nutrition care to patients with chronic disease. Fam Pract 2014; 31:201-8. [PMID: 24243871 DOI: 10.1093/fampra/cmt070] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Nutrition is important for the management of chronic diseases. While practice nurses have numerous roles in primary care, the expectations on practice nurses to provide nutrition care for chronic disease management are increasing. The self-perceived knowledge, skills and attitudes of practice nurses in providing nutrition care has not been widely investigated. OBJECTIVES The aim of the present study was to investigate the perceptions of Australian practice nurses on the provision of nutrition care for chronic disease management, including specific nutrition-related activities. METHODS A cross-sectional online survey was completed by 181 Australian practice nurses in 2013. Descriptive analyses were conducted on each survey item. The survey sample was tested for representation of the Australian practice nurse workforce, and associations between respondents' demographic characteristics and responses to survey items were explored. RESULTS Almost all practice nurses (89%) felt it was important to address diet whenever they cared for a patient. Over half of practice nurses (61%) were unsure if their practices were effective in increasing patients' compliance with nutritional recommendations. Nearly all practice nurses (98%) perceived further education on nutrition would assist them in their role. CONCLUSION Practice nurses perceive they have an important role and favourable attitudes towards providing nutrition care; however, further training and education to enhance their self-perceived effectiveness is warranted. Future research should clarify whether an increase in nutrition-focused training results in improved effectiveness of nutrition care provided by practice nurses in terms of patient health outcomes.
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Affiliation(s)
- Louise Martin
- School of Public Health, Griffith University, Gold Coast
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29
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Braspenning J, Jansink R. Response to the letter to the editor. Scand J Prim Health Care 2013; 31:256. [PMID: 24164406 PMCID: PMC3860304 DOI: 10.3109/02813432.2013.846999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jozé Braspenning
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
| | - Renate Jansink
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, 6500 HB, The Netherlands.
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30
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Adams C, Cohen D, Schreiber J, Valpey R, Benoit K, Puyana S, Zhang X, Douaihy A. The authors' conclusion that their study brings into question "the impact of motivational interviewing in terms of its ability to improve routine diabetes care in practice" is deserving of significant inquiry. Scand J Prim Health Care 2013; 31:255. [PMID: 24164391 PMCID: PMC3860303 DOI: 10.3109/02813432.2013.846579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carson Adams
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Daniel Cohen
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Justin Schreiber
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Robin Valpey
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Kristy Benoit
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Salomon Puyana
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Xiaoran Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
| | - Antoine Douaihy
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States. E-mail:
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