Implementing Motivational Counseling for Patients with Type 2 Diabetes

描述（由申请人提供）：生活方式干预，以解决不健康的饮食和缺乏运动是预防和管理2型糖尿病的重要组成部分。指导2型糖尿病患者改变其不良健康行为是初级保健的一个重要问题。初级保健医生需要有效的行为咨询策略。动机性访谈是一种广为接受的、基于证据的干预方法，已被用于帮助患者解决缺乏运动、戒烟、不健康饮食和药物依从性等问题。简短动机访谈是动机访谈的一种形式，它解决了初级保健的时间限制，并提供了帮助医生更有效地改变2型糖尿病患者所需的咨询技巧。然而，初级保健医生对动机咨询技术的应用还没有经过严格的评估。为了测试这种方法在初级保健环境中是否有效，必须首先确保它可以实施和采用。本应用程序将专门讨论在2型糖尿病患者的初级保健中实施和采用动机咨询技术。具体来说，本申请的目的是评估动机咨询培训计划，以确定医生是否精通这些技能的使用，并将动机咨询技术应用到他们的实践中。为了更好地了解动机咨询沟通培训翻译的吸引因素和障碍，我们将使用初级保健医生的焦点小组进行定性研究。

DESCRIPTION (provided by applicant): Lifestyle interventions to address unhealthy diet and physical inactivity are an essential part of the prevention and management of type 2 diabetes mellitus. Counseling patients with type 2 diabetes mellitus to change their risky health behaviors is an important issue in primary care. Effective behavioral counseling strategies are needed for primary care physicians. Motivational interviewing is a well-accepted, evidence- based intervention that has been used to help patients address physical inactivity, smoking cessation, unhealthy diet, and medication adherence. Brief motivational interviewing is a form of motivational interviewing that addresses the time constraints of primary care and provides the counseling skills needed to help physicians become more effective agents for change in their patients with type 2 diabetes mellitus. However, the application of motivational counseling techniques by primary care physicians has not been rigorously assessed. In order to test whether this approach is efficacious in the primary care setting, one must first ensure that it can be implemented and adopted. This application will specifically address implementation and adoption of motivational counseling techniques in primary care for patients with type 2 diabetes mellitus. Specifically, the object of this application is to evaluate a motivational counseling training program to determine if physicians become proficient in the use of these skills and will adopt motivational counseling techniques into their practices. To better understand the attractors and barriers to the translation of motivational counseling communication training we will conduct a qualitative study using focus groups of primary care physicians. Twenty physicians will be randomized to either a motivational counseling training group or control group. For the motivational counseling training group, a twelve-month training program to teach motivational counseling techniques will be conducted with ten primary care physicians. The program will start with a 3 hour workshop and subsequently participants will meet on a regular basis for training sessions. In between sessions, they will audiotape two encounters with their own patients with type 2 diabetes mellitus. All audiotapes will be rated using two standard measurement tools. Adoption of motivational counseling techniques will be measured by self-report and the use of unannounced standardized patients. Control and intervention physicians will be compared with respect to: 1) performance of motivational counseling techniques and 2) diabetes clinical and process outcomes. We will conduct and analyze 3 focus groups to examine what it will take to motivate clinicians to motivate their patients. PUBLIC HEALTH RELEVANCE: Lifestyle counseling for patients with type 2 diabetes mellitus is an important issue in primary care. Teaching behavior change counseling skills to primary care physicians would enhance their ability to assist their patients in making needed changes in unhealthy behaviors. This proposal will specifically address whether physicians can learn motivational counseling techniques and adopt the use of these skills with patients with type 2 diabetes mellitus in the primary care setting.