Implementing Motivational Counseling for Patients with Type 2 Diabetes

描述（由申请人提供）：针对不健康饮食和缺乏身体活动的生活方式干预是预防和管理2型糖尿病的重要组成部分。辅导2型糖尿病患者改变其危险健康行为是初级保健中的一个重要问题。初级保健医生需要有效的行为咨询策略。动机访谈是一种广为接受的循证干预方法，已被用于帮助患者解决身体活动不足、戒烟、不健康饮食和药物依从性等问题。简短的动机访谈是一种形式的动机访谈，解决初级保健的时间限制，并提供所需的咨询技能，帮助医生成为更有效的代理人，改变他们的2型糖尿病患者。然而，初级保健医生对动机咨询技术的应用尚未得到严格的评估。为了测试这种方法在基层医疗环境中是否有效，首先必须确保它可以实施和采用。此应用程序将专门针对实施和采用动机咨询技术在初级保健2型糖尿病患者。具体而言，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于他们的实践。为了更好地理解动机咨询沟通培训的吸引力和障碍，我们将进行一项定性研究，使用焦点小组的初级保健医生。 20名医生将被随机分配到动机咨询培训组或对照组。对于动机咨询培训组，将与10名初级保健医生进行为期12个月的培训计划，以教授动机咨询技术。该计划将从3小时的研讨会开始，随后参与者将定期参加培训课程。在两次会议之间，他们将录音与自己的2型糖尿病患者的两次会面。所有录音带将使用两种标准测量工具进行评级。采用动机咨询技术将衡量自我报告和使用未经通知的标准化病人。对照组和干预组医生将在以下方面进行比较：1）动机咨询技术的表现和2）糖尿病临床和过程结果。我们将进行和分析3个焦点小组，以研究如何激励临床医生激励他们的病人。 公共卫生相关性：2型糖尿病患者的生活方式咨询是初级保健中的一个重要问题。教授初级保健医生行为改变咨询技巧，将提高他们帮助病人改变不健康行为的能力。该提案将专门讨论医生是否可以学习动机咨询技术，并在初级保健环境中对2型糖尿病患者使用这些技能。

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.