Training Primary Care Providers in the Use of Motivational Interviewing for Youth Behavior Change

Abstract

Background and purpose: Adolescent obesity is a global epidemic. Motivational interviewing (MI) is a promising strategy to address adolescent obesity risk behaviors. However, primary care providers (PCPs) tend to express discomfort with learning and adopting MI practices and with addressing patient weight issues. PCP proficiency in using MI to discuss body mass index, health screening results, and nutrition and physical activity behaviors after receiving training and coaching from an MI expert and practicing the technique was evaluated. We hypothesized that comfort with MI would increase consistently over time.

Methods: Self-assessment surveys in MI proficiency were administered to PCPs after every youth participant MI session. MI comfort as determined by proficiency was categorized into low, medium, and high comfort according to survey Likert scale responses. Data were analyzed using analysis of variance (ANOVA) and Fisher's exact tests.

Results: Two hundred twenty-seven youth were seen for MI-based discussions by 4 PCPs. Two hundred twenty-six surveys had complete data for analysis. As anticipated, overall PCPs reported significantly more comfort with MI from the first to the final MI session over a 2- to 3-month period (p< .001). Comfort scores did not increase linearly over time for all PCPs. Despite standard training practices, overall MI proficiency as measured by comfort scores varied by PCP (p< .01).

Implications for practice: This type of MI training program should be considered for clinical nurses and nurse practitioners during their nursing education training to facilitate their ability to consistently and effectively support youth behavior change for conditions such as obesity (ClinicalTrials.gov Number NCT02502383).

Figure 1

Results of Analysis of Variance. Provider comfort with MI over time by provider based on 1–5 point Likert scale survey responses. Patients were divided into quartiles per provider by time from the first day to the last day when patients were seen. Note: PCP = primary care provider

Figure 2

Results of Fisher’s Exact Test. Provider comfort with MI over time by the number of surveys based on 1–5 point Likert scale survey responses. Patients were divided into quartiles per provider by time from the first day to the last day when patients were seen.