Email updates

Keep up to date with the latest news and content from BMC Family Practice and BioMed Central.

Open Access Highly Accessed Research article

Minimal improvement of nurses’ motivational interviewing skills in routine diabetes care one year after training: a cluster randomized trial

Renate Jansink1*, Jozé Braspenning1, Miranda Laurant1, Ellen Keizer1, Glyn Elwyn2, Trudy van der Weijden3 and Richard Grol1

Author Affiliations

1 Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands

2 Department of Primary Care and Public Health, School of Medicine, Cardiff University, Heath Park CF14 4XN, Wales, UK

3 Department of General Practice, Caphri School for Primary Care and Public Health, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands

For all author emails, please log on.

BMC Family Practice 2013, 14:44  doi:10.1186/1471-2296-14-44

Published: 28 March 2013

Abstract

Background

The effectiveness of nurse-led motivational interviewing (MI) in routine diabetes care in general practice is inconclusive. Knowledge about the extent to which nurses apply MI skills and the factors that affect the usage can help to understand the black box of this intervention. The current study compared MI skills of trained versus non-trained general practice nurses in diabetes consultations. The nurses participated in a cluster randomized trial in which a comprehensive program (including MI training) was tested on improving clinical parameters, lifestyle, patients’ readiness to change lifestyle, and quality of life.

Methods

Fifty-eight general practices were randomly assigned to usual care (35 nurses) or the intervention (30 nurses). The ratings of applying 24 MI skills (primary outcome) were based on five consultation recordings per nurse at baseline and 14 months later. Two judges evaluated independently the MI skills and the consultation characteristics time, amount of nurse communication, amount of lifestyle discussion and patients’ readiness to change. The effect of the training on the MI skills was analysed with a multilevel linear regression by comparing baseline and the one-year follow-up between the interventions with usual care group. The overall effect of the consultation characteristics on the MI skills was studied in a multilevel regression analyses.

Results

At one year follow up, it was demonstrated that the nurses improved on 2 of the 24 MI skills, namely, “inviting the patient to talk about behaviour change” (mean difference=0.39, p=0.009), and “assessing patient’s confidence in changing their lifestyle” (mean difference=0.28, p=0.037). Consultation time and the amount of lifestyle discussion as well as the patients’ readiness to change health behaviour was associated positively with applying MI skills.

Conclusions

The maintenance of the MI skills one year after the training program was minimal. The question is whether the success of MI to change unhealthy behaviour must be doubted, whether the technique is less suitable for patients with a complex chronic disease, such as diabetes mellitus, or that nurses have problems with the acquisition and maintenance of MI skills in daily practice. Overall, performing MI skills during consultation increases, if there is more time, more lifestyle discussion, and the patients show more readiness to change.

Trial registration

Current Controlled Trials ISRCTN68707773

Keywords:
Type 2 diabetes; Primary care nurses; Motivational interviewing; Lifestyle; General practice