Implementing Motivational Counseling for Patients with Type 2 Diabetes

描述(申请人提供)：针对不健康饮食和缺乏运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。建议2型糖尿病患者改变其危险的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。激励性访谈是一种被广泛接受的循证干预措施，已被用于帮助患者解决身体不活动、戒烟、不健康饮食和服药依从性问题。简短的激励性访谈是一种激励性访谈形式，它解决了初级保健的时间限制，并提供了必要的咨询技能，以帮助医生成为更有效地推动2型糖尿病患者改变的因素。然而，初级保健医生对激励咨询技术的应用还没有得到严格的评估。为了测试这种方法在初级保健环境中是否有效，必须首先确保它能够得到实施和采用。本应用程序将具体说明在2型糖尿病患者的初级保健中实施和采用激励性咨询技术。具体地说，本申请的目的是评估激励咨询培训计划，以确定医生是否精通这些技能的使用，并将激励咨询技术应用到他们的实践中。为了更好地了解激励咨询沟通培训翻译的吸引力和障碍，我们将使用初级保健医生的焦点小组进行定性研究。 20名医生将被随机分为激励性咨询训练组或对照组。对于动机咨询训练组，将与10名初级保健医生一起进行为期12个月的培训计划，教授动机咨询技巧。该计划将从3小时的研讨会开始，随后参与者将定期会面进行培训。在治疗间隙，他们将录制两次与自己的2型糖尿病患者的接触。所有录音带将使用两种标准测量工具进行评级。采用激励咨询技术将通过自我报告和使用未经宣布的标准化患者来衡量。对照医生和干预医生将在以下方面进行比较：1)激励性咨询技术的表现；2)糖尿病的临床和过程结果。我们将引导和分析3个焦点小组，以检查需要采取什么措施来激励临床医生激励他们的患者。 公共卫生相关性：对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。向初级保健医生传授行为改变咨询技能将增强他们帮助患者改变不健康行为的能力。这项提案将具体讨论医生是否可以学习激励咨询技术，并在初级保健环境中对2型糖尿病患者采用这些技能。

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.