Implementing Motivational Counseling for Patients with Type 2 Diabetes

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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.