Evaluating the Impact of Training in Obesity Prevention Methods on the Counseling, Knowledge, and Skills of WIC Nutritionists in Georgia, 2014-2015

Abstract

Objectives: Motivational interviewing, a client-centered intervention method focused on enhancing intrinsic motivation for behavior change, shows a positive impact on children's weight status (ie, stabilizing or slowing down weight gain as a child grows). We evaluated the impact of a training program on knowledge and adoption of evidence-based obesity prevention counseling strategies among counselors from Georgia's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Methods: Between July 2014 and September 2015, Children's Healthcare of Atlanta's Strong4Life program provided 388 WIC counselors in Georgia with a 2-hour training session on motivational interviewing, patient-centered counseling, and goal setting for obesity prevention. We evaluated the training using (1) self-administered pre- and post-training surveys that assessed knowledge of counseling strategies, (2) post-training observation of counseling interactions, and (3) a review of behavior change goal quality pre- and post-training in a random sample of 200 WIC client charts.

Results: In a comparison of pre-training knowledge with immediate post-training knowledge among 388 counselors, 81% vs 91% ( P < .001) knew that, to be effective, goals must be important to clients, and 66% vs 94% ( P < .001) knew the 5 A's (assess, advise, agree, assist, arrange) of counseling. Knowledge improvements were sustained at 3 months post-training. We observed no improvements in the quality of chart-documented behavior goals.

Conclusions: WIC nutrition counselors in Georgia were aware of evidence-based counseling strategies but did not consistently apply them. The training program was helpful, but time and additional support are needed to adopt new practices.

Keywords: WIC; goal setting; motivational interviewing; nutrition; patient-centered counseling.

Figure

Results from observations by champions (ie, highly skilled WIC nutrition counselors) assessing the use of motivational interviewing by WIC nutrition counselors during counseling sessions with clients and their parents in the 9-month period (January to September) after counselor participation in the Strong4Life WIC Training Program, Georgia, 2014-2015. Cochran-Armitage trend tests for categorical data (P values) are shown in graph legend, with P < .05 considered significant. The Strong4Life WIC Training Program consisted of 2-hour training sessions on motivational interviewing, patient-centered counseling, and goal setting for obesity prevention. Motivational interviewing is a patient-centered method for behavior change that uses techniques focused on being empathetic, nonjudgmental, and supportive. The Healthy Habits assessment form is a short survey completed by parents identifying their child’s usual eating and activity habits. Motivation to change is measured from the Healthy Habits assessment form via a 4-point Likert scale (1 = not at all to 4 = very) to answer 2 questions: “How important is it to you that your child works on this healthy habit?” and “How confident are you that your child can improve on this healthy habit?” Permission to share concerns is a component of motivational interviewing whereby the counselor asks the patient if the counselor can share concerns about the patient’s goal setting. Abbreviation: WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.