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Randomized Controlled Trial
. 2019 Mar;20(2):217-225.
doi: 10.1111/pedi.12810. Epub 2019 Jan 8.

Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes

Laura J Caccavale  1 , Rosalie Corona  2 , Jessica G LaRose  3 , Suzanne E Mazzeo  2 , Alexandra R Sova  3 , Melanie K Bean  1
Affiliations
Randomized Controlled Trial

Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes

Laura J Caccavale et al. Pediatr Diabetes. 2019 Mar.

Abstract

Objective: Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]).

Methods: Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month.

Results: Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020).

Conclusion: Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.

Keywords: adolescents; communication; motivational interviewing; type 1 diabetes.

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Figures

FIGURE 1
FIGURE 1
Consolidated standards of reporting trials diagram with participant flow through recruitment and study
FIGURE 2
FIGURE 2
Mediation model with self-efficacy for diabetes self-management. Values in parentheses represent the standardized relation between motivational interviewing (MI) non-adherent behaviors and adherence after controlling for diabetes self-efficacy, adolescent age and race/ethnicity, and provider MI training. Note: this model did not control for baseline adherence
See this image and copyright information in PMC

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