Motivational interviewing in health settings: a review

Building skills, knowledge and confidence in eating and exercise behavior change: brief motivational interviewing training for healthcare providers

OBJECTIVE

Obesity related health problems affect individuals, families, communities and the broader health care system, however few healthcare providers (e.g., doctors, nurses, social workers, psychologists, counselors) receive formal training in obesity prevention interventions. We examined the effectiveness of training healthcare providers in brief motivational interviewing (brief MI) targeting eating and exercise behavior change.

METHODS

163 healthcare providers participated. 128 participants completed a one-day experiential brief MI training workshop followed by electronic peer-support and a further 35 matched controls did not receive the training.

RESULTS

Participant's knowledge of brief MI and confidence in their ability to counsel patients using brief MI significantly improved following training (p<0.05) and remained at 3 and 6-month follow-up (p<0.05). Brief MI skills assessed during the simulated patient interactions indicated a significant improvement across two practical training blocks (p<0.05).

CONCLUSION

Healthcare providers can learn brief MI skills and knowledge quickly and confidence in their counseling abilities improves and is sustained.

PRACTICE IMPLICATIONS

Healthcare providers may consider brief MI as an obesity prevention intervention.

Integration of Technology-based Behavioral Health Interventions in Substance Abuse and Addiction Services

The past decade has witnessed revolutionary changes to the delivery of health services, ushered in to a great extent by the introduction of electronic health record systems. More recently, a new class of technological advancements-technology-based behavioral health interventions, which involve the delivery of evidence-informed practices via computers, web-based applications, mobile phones, wearable sensors, or other technological platforms-has emerged and is primed to once again radically shift current models for behavioral healthcare. Despite the promise and potential of these new therapeutic approaches, a greater understanding of the impact of technology-based interventions on cornerstone issues of mental health and addiction services-namely access, quality, and cost-is needed. The current review highlights 1) relevant conceptual frameworks that guide this area of research, 2) key studies that inform the relevance of technology-based interventions for behavioral healthcare access, quality, and cost, 3) pressing methodological issues that require attention, 4) unresolved questions that warrant further investigation, and 5) practical implications that underscore important new directions for this emerging area of research.

Cardiac rehabilitation and risk reduction: time to "rebrand and reinvigorate"

Atherosclerotic cardiovascular disease (ASCVD) continues to increase annually in the United States along with its associated enormous costs. A multidisciplinary cardiac rehabilitation (CR) and risk reduction program is an essential component of ASCVD prevention and management. Despite the strong evidence for CR in the secondary prevention of ASCVD, it remains vastly underutilized due to significant barriers. The current model of CR delivery is unsustainable and needs significant improvement to provide cost-effective, patient-centered, comprehensive secondary ASCVD prevention.

Mechanisms of change within motivational interviewing in relation to health behaviors outcomes: a systematic review

OBJECTIVE

Motivational interviewing (MI) has been identified as an effective treatment for health behaviors. Understanding the mechanisms of MI could have practical implications for MI delivery. This review is the first to examine mechanisms within MI that affect health behavior outcomes and summarizes and evaluates the evidence.

METHODS

A systematic literature search was conducted in PSYCHINFO, MEDLINE and EMBASE to identify studies that delivered individual MI in the context of health behaviors, excluding addictions, and investigated mechanisms of MI. Effect sizes were calculated.

RESULTS

291 studies were identified and 37 met the inclusion criteria. Few of the 37 studies included, conducted mediation analyses. MI spirit and motivation were the most promising mechanisms of MI. Although self-efficacy was the most researched, it was not identified as a mechanism of MI. Study quality was generally poor.

CONCLUSION

Although this review has indicated possible mechanisms by which MI could influence health behavior outcomes, it also highlights that more high quality research is needed, looking at other possible mechanisms or causal pathways within health behavior outcomes.

PRACTICE IMPLICATIONS

MI spirit possibly plays an important role within MI and may potentially be used to evoke change talk which links to outcomes.

Improving cardiovascular health of underserved populations in the community with Life's Simple 7

PURPOSE

The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools.

DATA SOURCES

Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program.

CONCLUSIONS

Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors.

IMPLICATIONS FOR PRACTICE

NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success.

Assessment of hypertensive patients' self-care agency after counseling training of nurses

PURPOSE

The aim of the study was to assess hypertensive patients' self-care agency and any correlation with the patient's lifestyle changes and the nurse's degree of patient centeredness after counseling training.

DATA SOURCES

Nurses in the intervention group (IG; n = 19) working at nurse-led clinics at health centers were trained in patient centeredness (motivational interviewing) and the stages of change model and included 137 patients. Nurses in the control group (CG; n = 14) included 51 patients. The Exercise of Self-Care Agency (ESCA) instrument was used. There was a significant difference from baseline to the 2-year follow-up in the ESCA score (IG, p = .0001). An increase in ESCA score was correlated with an increased level of physical activity after 2 years (IG, p = .0001; CG, p = .040).

CONCLUSIONS

The counseling training gave an increase in the patients' self-care agency scores, which was significantly correlated with increased physical activity.

IMPLICATIONS FOR PRACTICE

In clinical practice it is important for nurses to be patient centered in their counseling to affect patients' self-care agency in a positive direction.

Motivational interviewing for smoking cessation

BACKGROUND

Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to quit smoking.

OBJECTIVES

To determine whether or not motivational interviewing (MI) promotes smoking cessation.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. Date of the most recent search: August 2014.

SELECTION CRITERIA

Randomized controlled trials in which motivational interviewing or its variants were offered to tobacco users to assist cessation.

DATA COLLECTION AND ANALYSIS

We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. We counted participants lost to follow-up as continuing smoking or relapsed. We performed meta-analysis using a fixed-effect Mantel-Haenszel model.

MAIN RESULTS

We identified 28 studies published between 1997 and 2014, involving over 16,000 participants. MI was conducted in one to six sessions, with the duration of each session ranging from 10 to 60 minutes. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (risk ratio (RR) 1.26; 95% confidence interval (CI) 1.16 to 1.36; 28 studies; N = 16,803). Subgroup analyses found that MI delivered by primary care physicians resulted in an RR of 3.49 (95% CI 1.53 to 7.94; 2 trials; N = 736). When delivered by counsellors the RR was smaller (1.25; 95% CI 1.15 to 1.63; 22 trials; N = 13,593) but MI still resulted in higher quit rates than brief advice or usual care. When we compared MI interventions conducted through shorter sessions (less than 20 minutes per session) to controls, this resulted in an RR of 1.69 (95% CI 1.34 to 2.12; 9 trials; N = 3651). Single-session treatments might increase the likelihood of quitting over multiple sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing. Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports.  

AUTHORS' CONCLUSIONS

Motivational interviewing may assist people to quit smoking. However, the results should be interpreted with caution, due to variations in study quality, treatment fidelity, between-study heterogeneity and the possibility of publication or selective reporting bias.

WITHDRAWN: Effects of motivational interviewing on lifestyle modification and diabetes prevention in adults with pre-diabetes

This article has been withdrawn at the request of the editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Long-term effect of motivational interviewing on dietary intake and weight loss in Iranian obese/overweight women

BACKGROUND

This study aimed to determine whether motivational interviewing (MI) could change dietary habit and body mass index (BMI) in obese/overweight women.

METHODS

A cluster-randomized controlled study was performed in four health centers in Qazvin, central Iran. In total, 327 obese/overweight women were selected by a multi-stage sampling method and randomly assigned into control and experimental groups. Food frequency (using questionnaire; FFQ), BMI, and metabolic markers including blood pressure, total serum cholesterol and fasting blood glucose levels were measured in all participants. Data were collected twice (before and one year after the MI interventions). Data were analyzed using student t-test, and Stepwise Linear Regression.

RESULTS

There was a significant increase in daily consumption of dietary fiber, whole grain products, fruits and vegetables in the MI group (P<0.05). The consumption of meat product, total fat, saturated fat, carbohydrate and total energy intake were also significantly reduced after MI intervention (P<0.05). As a result, body weight and BMI were significantly reduced in the intervention group compared to the control group (P<0.05).

CONCLUSION

MI is suggested to be an effective strategy to change life style and reduce BMI in overweight/obese women in the long term. This effect needs to be further investigated in different gender and age populations.

Proactive tobacco cessation outreach to smokers of low socioeconomic status: a randomized clinical trial

IMPORTANCE

Widening socioeconomic disparities in mortality in the United States are largely explained by slower declines in tobacco use among smokers of low socioeconomic status (SES) than among those of higher SES, which points to the need for targeted tobacco cessation interventions. Documentation of smoking status in electronic health records (EHRs) provides the tools for health systems to proactively offer tobacco treatment to socioeconomically disadvantaged smokers.

OBJECTIVE

To evaluate a proactive tobacco cessation strategy that addresses sociocontextual mediators of tobacco use for low-SES smokers.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, randomized clinical trial included low-SES adult smokers who described their race and/or ethnicity as black, Hispanic, or white and received primary care at 1 of 13 practices in the greater Boston area (intervention group, n = 399; control group, n = 308).

INTERVENTIONS

We analyzed EHRs to identify potentially eligible participants and then used interactive voice response (IVR) techniques to reach out to them. Consenting patients were randomized to either receive usual care from their own health care team or enter an intervention program that included (1) telephone-based motivational counseling, (2) free nicotine replacement therapy (NRT) for 6 weeks, (3) access to community-based referrals to address sociocontextual mediators of tobacco use, and (4) integration of all these components into their normal health care through the EHR system.

MAIN OUTCOMES AND MEASURES

Self-reported past-7-day tobacco abstinence 9 months after randomization ("quitting"), assessed by automated caller or blinded study staff.

RESULTS

The intervention group had a higher quit rate than the usual care group (17.8% vs 8.1%; odds ratio, 2.5; 95% CI, 1.5-4.0; number needed to treat, 10). We examined whether use of intervention components was associated with quitting among individuals in the intervention group: individuals who participated in the telephone counseling were more likely to quit than those who did not (21.2% vs 10.4%; P < .001). There was no difference in quitting by use of NRT. Quitting did not differ by a request for a community referral, but individuals who used their referral were more likely to quit than those who did not (43.6% vs 15.3%; P < .001).

CONCLUSIONS AND RELEVANCE

Proactive, IVR-facilitated outreach enables engagement with low-SES smokers. Providing counseling, NRT, and access to community-based resources to address sociocontextual mediators among smokers reached in this setting is effective.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01156610.

Telephone-based motivational interviewing for medication adherence: a systematic review

Adherence to prescribed medications continues to be a problem in the treatment of chronic disease. Motivational interviewing (MI) has been shown to be successful for eliciting patients' motivations to change their medication-taking behaviors. Due to the constraints of the US healthcare system, patients do not always have in-person access to providers. Because of this, there is increasing use of non-traditional healthcare delivery methods such as telephonic counseling. A systematic review was conducted among published studies of telephone-based MI interventions aimed at improving the health behavior change target of medication adherence. The goals of this review were to (1) examine and describe evidence and gaps in the literature for telephonically delivered MI interventions for medication adherence and (2) discuss the implications of the findings for research and practice. The MEDLINE, CINAHL, psycINFO, psycARTICLES, Academic Search Premier, Alt HealthWatch, Health Source: Consumer Edition, and Health Source: Nursing/Academic Edition databases were searched for peer-reviewed research publications between 1991 and October 2012. A total of nine articles were retained for review. The quality of the studies and the interventions varied significantly, which precluded making definitive conclusions but findings among a majority of retained studies suggest that telephone-based MI may help improve medication adherence. The included studies provided promising results and justification for continued exploration in the provision of MI via telephone encounters. Future research is needed to address gaps in the current literature but the results suggest that MI may be an efficient option for healthcare professionals seeking an evidence-based method to reach remote or inaccessible patients to help them improve their medication adherence.

Improving the counselling skills of lay counsellors in antiretroviral adherence settings: a cluster randomised controlled trial in the Western Cape, South Africa

Little research has investigated interventions to improve the delivery of counselling in health care settings. We determined the impact of training and supervision delivered as part of the Options: Western Cape project on lay antiretroviral adherence counsellors' practice. Four NGOs employing 39 adherence counsellors in the Western Cape were randomly allocated to receive 53 h of training and supervision in Options for Health, an intervention based on the approach of Motivational Interviewing. Five NGOs employing 52 adherence counsellors were randomly allocated to the standard care control condition. Counselling observations were analysed for 23 intervention and 32 control counsellors. Intervention counsellors' practice was more consistent with a client-centred approach than control counsellors', and significantly more intervention counsellors engaged in problem-solving barriers to adherence (91 vs. 41 %). The Options: Western Cape training and supervision package enabled lay counsellors to deliver counselling for behaviour change in a manner consistent with evidence-based approaches.

Development and validation of the Hypertension Self-care Profile: a practical tool to measure hypertension self-care

BACKGROUND

Adequate self-care is crucial for blood pressure control. A number of hypertension (HBP) self-care instruments are available, but existing tools do not capture all the critical domains of HBP self-care and have limited evidence of reliability and validity.

OBJECTIVE

The purpose of this study was to develop and validate a new tool--the HBP Self-Care Profile (HBP SCP)--in a sample of inner-city residents.

METHODS

The HBP SCP encompasses comprehensive domains of HBP self-care behaviors. Guided by 2 validated theoretical approaches--Orem's self-care model and Motivational Interviewing--the HBP SCP includes 3 scales that can be used together or independently: Behavior, Motivation, and Self-efficacy. The sample included 213 English-speaking inner-city residents with HBP (mean age, 68.6 years; 76.1% women; 81.7% African American).

RESULTS

Item-total correlations ranged from 0.20 to 0.63 for Behavior, 0.46 to 0.70 for Motivation, and 0.40 to 0.74 for Self-efficacy, meeting the cutoff set a priori at 0.15. Internal consistency reliability coefficients ranged from 0.83 to 0.93. Concurrent and construct validities of the HBP SCP were achieved by significant correlations between HBP SCP scales and theoretically selected instruments (P < .05 for all correlation coefficients). The HBP SCP-Behavior scale also successfully discriminated between those with or without blood pressure control (P < .05).

CONCLUSIONS

The reliability and validity of the HBP SCP were supported in this sample of inner-city residents with HBP. The high reliability estimates and strong evidence of validity should allow researchers to use the HBP SCP to assess and identify gaps in HBP self-care behavior, motivation, and self-efficacy. Future research is warranted to evaluate the HBP SCP in diverse ethnic and age samples of hypertensive patient populations.

Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis

Background

Research indicates that one third of smokers have low motivation to stop smoking. The purpose of the study was to use Conversational Analysis to enhance understanding of the process in Motivational Interviewing sessions carried out by primary care doctors and nurses to motivate their patients to quit smoking. The present study is a substudy of the Systematic Intervention on Smoking Habits in Primary Health Care Project (Spanish acronym: ISTAPS).

Methods

Motivational interviewing sessions with a subset of nine participants (two interview sessions were conducted with two of the nine) in the ISTAPS study who were current smokers and scored fewer than 5 points on the Richmond test that measures motivation to quit smoking were videotaped and transcribed. A total of 11 interviews conducted by five primary health care professionals in Barcelona, Spain, were analysed. Qualitative Content Analysis was used to develop an analytical guide for coding transcriptions. Conversation Analysis allowed detailed study of the exchange of words during the interaction.

Results

Motivational Interviewing sessions had three phases: assessment, reflection on readiness to change, and summary. The interaction was constructed during an office visit, where interactional dilemmas arise and can be resolved in various ways. Some actions by professionals (use of reiterations, declarations, open-ended questions) helped to construct a framework of shared relationship; others inhibited this relationship (focusing on risks of smoking, clinging to the protocol, and prematurely emphasizing change). Some professionals tended to resolve interactional dilemmas (e.g., resistance) through a confrontational or directive style. Interactions that did not follow Motivational Interviewing principles predominated in seven of the interviews analysed.

Conclusions

Conversational analysis showed that the complexity of the intervention increases when a health professional encounters individuals with low motivation for change, and interactional dilemmas may occur that make it difficult to follow Motivational Interview principles. Incorporating different forms of expression during the Motivational Interviewing could help to build patient-centred health care relationships and, for patients with low motivation to stop smoking, offer an opportunity to reflect on tobacco use during the office visit. The study findings could be included in professional training to improve the quality of motivational interviewing.

Evaluation of integrated psychological services in a university-based primary care clinic

Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.

Weight's up? Predictors of weight-related communication during primary care visits with overweight adolescents

OBJECTIVE

Physicians' use of Motivational Interviewing (MI) techniques when discussing weight with adolescent patients is unknown.

METHODS

We coded audio-recorded encounters between 49 primary care physicians and 180 overweight adolescent patients. During weight discussions, we used the MITI 3.0 to assess: Empathy, MI Spirit, open-ended questions, reflections, MI consistent behaviors (e.g., praising) and MI inconsistent behaviors (e.g., confronting). We examined associations of patient and physician characteristics with (1) MI techniques, (2) time discussing weight, and (3) encounter time.

RESULTS

Physicians used more MI consistent techniques with female patients (p=0.06) and with heavier patients (p=0.02). Physicians with prior MI training also used more MI consistent techniques (p=0.04) and asked more open-ended questions (p=0.05). Pediatricians had a higher MI Spirit score than family physicians (p=0.03). Older patient age was associated with physicians spending less time discussing weight-related topics (p=0.04) and higher BMI percentile was associated with physicians spending more time discussing weight-related topics (p=0.01). Increased use of MI inconsistent techniques was associated with longer encounters (p=0.02).

CONCLUSION

Physicians' weight discussions vary based on adolescent and physician characteristics. Importantly, not using MI lengthened encounter time.

PRACTICE IMPLICATIONS

Physicians might consider using MI techniques more and attempt to use these equally with all adolescents.

Addressing patients' psychosocial concerns regarding hearing aids within audiology appointments for older adults

PURPOSE

It has long been documented that patients may experience emotional reactions to a diagnosis of hearing impairment and recommendation of hearing aids. Because of this, patients may raise psychosocial concerns regarding their hearing rehabilitation during audiology appointments, particularly in relation to getting hearing aids. However, thus far there has been little systematic research exploring how patients' concerns about hearing aids are addressed by audiologists within appointments.

METHOD

This study used conversation analysis to examine a corpus of 63 video-recorded initial audiology appointments with older adults with hearing impairment.

RESULTS

The findings demonstrated that when patients expressed concerns regarding hearing aids, these concerns were typically psychosocial in nature and expressed in a way that carried a negative emotional stance. These types of turns thus invited an empathic response. However, patients' concerns were not typically addressed by audiologists during the appointment. As a consequence, patients persistently re-raised their concerns in subsequent turns, leading to expanded sequences of interaction during the management phase of the appointment.

CONCLUSIONS

Older adults' psychosocial concerns regarding hearing aids may not always be sufficiently addressed within audiology appointments. A greater emphasis on emotionally focused communication within audiology could result in improved outcomes from hearing health care services.

Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture

BACKGROUND

Our goal is to conduct a multicenter randomized controlled trial (RCT) to investigate whether exercise can reduce incident fractures compared with no intervention among women aged ≥65 years with a vertebral fracture.

OBJECTIVES

This pilot study will determine the feasibility of recruitment, retention, and adherence for the proposed trial.

DESIGN

The proposed RCT will be a pilot feasibility study with 1:1 randomization to exercise or attentional control groups.

SETTING

Five Canadian sites (1 community hospital partnered with an academic center and 4 academic hospitals or centers affiliated with an academic center) and 2 Australian centers (1 academic hospital and 1 center for community primary care, geriatric, and rehabilitation services).

PARTICIPANTS

One hundred sixty women aged ≥65 years with vertebral fracture at 5 Canadian and 2 Australian centers will be recruited.

INTERVENTION

The Build Better Bones With Exercise (B3E) intervention includes exercise and behavioral counseling, delivered by a physical therapist in 6 home visits over 8 months, and monthly calls; participants are to exercise ≥3 times weekly. Controls will receive equal attention.

MEASUREMENTS

Primary outcomes will include recruitment, retention, and adherence. Adherence to exercise will be assessed via calendar diary. Secondary outcomes will include physical function (lower extremity strength, mobility, and balance), posture, and falls. Additional secondary outcomes will include quality of life, pain, fall self-efficacy, behavior change variables, intervention cost, fractures, and adverse events. Analyses of feasibility objectives will be descriptive or based on estimates with 95% confidence intervals, where feasibility will be assessed relative to a priori criteria. Differences in secondary outcomes will be evaluated in intention-to-treat analyses via independent Student t tests, chi-square tests, or logistic regression. The Bonferroni method will be used to adjust the level of significance for secondary outcomes so the overall alpha level is .05.

LIMITATIONS

No assessment of bone mineral density will be conducted. The proposed definitive trial will require a large sample size.

CONCLUSIONS

The viability of a large-scale exercise trial in women with vertebral fractures will be evaluated, as well as the effects of a home exercise program on important secondary outcomes.

Effectiveness of a motivational interviewing intervention on medication compliance

This study investigated the effectiveness of training geriatric home-based primary care (HBPC) nursing staff in motivational interviewing (MI) techniques, with the goal of increasing patient medication adherence. Nursing staff received 4 hours of training in MI techniques from a licensed psychologist. Results indicated that the MI training increased medication adherence in the HBPC veteran sample by a small, but statistically significant, margin both 1 month and 6 months after the intervention. Although the effect size may be considered small, the clinical and cost ramifications of even a small gain in adherence are extremely important for the patient, clinician, and the medical facility. MI techniques may provide a cost-effective and impactful means of enhancing patient adherence to medications.

“The Health Education Juggler”

Purpose

– The purpose of this paper is to explore educator competencies and roles needed to perform participatory patient education, and develop a comprehensive model describing this.

Design/methodology/approach

– Data collection in the qualitative study proceeded through two phases. In the first phase, 28 educators were involved in exploring educator competencies needed to perform participatory, group-based patient education. The paper used qualitative methods: dialogue workshops, interviews and observations. In the second phase, 310 educators were involved in saturating and validating the insights from phase one using workshop techniques such as brainstorming, reflection exercises and the story-dialogue method. A grounded theory approach was used to analyse data.

Findings

– A model called “The Health Education Juggler” was developed comprising four educator roles necessary to perform participatory patient education: the Embracer, the Facilitator, the Translator and the Initiator. The validity of the model was confirmed in phase two by educators and showed fit, grab, relevance, workability and modifiability.

Practical implications

– The model provides a tool that can be used to support the focus on “juggling” skills in educators: the switching between different educator roles when performing participatory, group-based patient education. The model is useful as an analytical tool for reflection and supervision, as well as for observation and evaluation of participatory, group-based patient education.

Originality/value

– The study proposes a comprehensive model consisting of four equally important roles for educators performing participatory, group-based patient education.

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

Background

Women in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject.

Methods

A compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated.

Results

43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice.

Conclusions

This study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended.

Podiatric physicians' perspectives on their role in promoting self-care in high-risk patients with diabetes

BACKGROUND

Foot self-care is key in preventing morbidity in high-risk diabetic patients. Motivational interviewing (MI) is an approach to encourage behavior change by patients that can be used in medical settings. The goal was to explore how podiatric physicians promote self-care in such patients and whether they use MI techniques.

METHODS

We conducted a 19-question online survey of US-based practicing podiatric physicians. Most answers were on a 5-point scale. The MI index was the sum of answers to five relevant questions.

RESULTS

Of 843 podiatric physicians, 86% considered foot self-care to be very important for high-risk diabetic patients, and 90% felt that it was their role to discuss foot self-care with them; 49% felt that they had training and were successful in promoting behavior change, but most were definitely (38%) or possibly (46%) interested in learning more. Only 24% of respondents scored at least 15 of 20 on the MI index. Higher MI scores were associated with more face time and more time discussing foot self-care but were not related to podiatric physicians' age, sex, geographic location, percentage of time in surgery, or years in practice. Reported barriers to counseling were lack of reimbursed time and poor patient engagement.

CONCLUSIONS

Most podiatric physicians view self-care behavior among high-risk diabetic patients and their role in promoting it as very important; most feel already proficient, but only a few demonstrate MI skills; most are willing to learn more. Success in behavioral counseling, such as MI, is likely to require more time and may be encouraged by a move from fee-for-service to outcome-based reimbursement.

Impact of diet and exercise on lipid management in the modern era

Unfortunately, many patients as well as the medical community, continue to rely on coronary revascularization procedures and cardioprotective medications as a first-line strategy to stabilize or favorably modify established risk factors and the course of coronary artery disease. However, these therapies do not address the root of the problem, that is, the most proximal risk factors for heart disease, including unhealthy dietary practices, physical inactivity, and cigarette smoking. We argue that more emphasis must be placed on novel approaches to embrace current primary and secondary prevention guidelines, which requires attacking conventional risk factors and their underlying environmental causes. The impact of lifestyle on the risk of cardiovascular disease has been well established in clinical trials, but these results are often overlooked and underemphasized. Considerable data also strongly support the role of lifestyle intervention to improve glucose and insulin homeostasis, as well as physical inactivity and/or low aerobic fitness. Accordingly, intensive diet and exercise interventions can be highly effective in facilitating coronary risk reduction, complementing and enhancing medications, and in some instances, even outperforming drug therapy.

A mixed methods exploration of family members'/friends' roles in a self-care intervention for depressive symptoms

OBJECTIVES

The aims of this exploratory study were to examine the: (1) family and friend (F/F) support patients reported receiving and F/F reported providing to patients while participating in a self-care intervention (SCI) for depressive symptoms and (2) associations between different types of F/F support and patients' use of the self-care tools in the SCI.

METHODS

Fifty-seven patients aged 40 + participating in an uncontrolled feasibility study of an SCI, completed structured telephone interviews about the support they received from F/F while participating in the SCI. Eighteen F/F completed questionnaires on the support they provided to patients during the SCI. Seven F/F participated in a post-study qualitative interview on their involvement in the SCI.

RESULTS

About 35% of patients reported receiving F/F support with the SCI. Patients' use of the behavioral tools was positively associated with patients' report of F/F support, and with F/F's report of instrumental support provided. F/F reported uncertainty about the type of support they should offer to patients in the SCI.

DISCUSSION

F/F involvement in SCIs for depressive symptoms may be helpful to patients and may foster adherence to these interventions. More research is warranted on the nature of such involvement from the perspective of patients and F/F.

Evaluation of a structured goal planning and tailored follow-up programme in rehabilitation for patients with rheumatic diseases: protocol for a pragmatic, stepped-wedge cluster randomized trial

Background

Comprehensive rehabilitation, involving health professionals from various disciplines, is widely used as an adjunct to pharmacological and surgical treatment in people with rheumatic diseases. However, the evidence for the clinical- and cost-effectiveness of such interventions is limited, and the majority of those who receive rehabilitation are back to their initial health status six to 12 months after discharge.

Methods/design

To evaluate the goal attainment, health effects and cost-effectiveness of a new rehabilitation programme compared to current traditional rehabilitation programmes for people with rheumatic diseases, a stepped-wedge cluster randomized trial will be performed. Patients admitted for rehabilitation at six centres in the south-eastern part of Norway will be invited to participate. In the trial, six participating centres will switch from a control (current rehabilitation programme) to an intervention phase (the new rehabilitation programme) in a randomized order. Supported by recent research, the new programme will be a supplement to the existing programme at each centre, and will comprise four elements designed to enhance and support lifestyle changes introduced in the rehabilitation period: structured goal-planning, motivational interviewing, a self-help booklet and four follow-up telephone calls during the first five months following discharge. The primary outcome will be health-related quality of life and goal attainment, as measured by the Patient Generated Index directly before and after the rehabilitation stay, as well as after six and 12 months. Secondary outcomes will include self-reported pain, fatigue, a global assessment of disease activity and motivation for change (measured on 11-point numeric ratings scales), health-related quality of life as measured by the Short Form 36 Health Survey (SF-36) and utility assessed by the SF6D utility index.

The main analysis will be on an intention to treat basis and will assess the clinical- and cost-effectiveness of the structured goal planning and tailored follow-up rehabilitation programme for patients with rheumatic diseases.

Discussion

The findings will constitute an important contribution to more cost-effective- and evidence-based rehabilitation services for people with rheumatic diseases.

Trial registration

ISRCTN91433175.

Hope and fatigue in chronic illness: The role of perceived stress

Fatigue is a debilitating symptom of chronic illness that is deleteriously affected by perceived stress, a process particularly relevant to inflammatory disease. Hopefulness, a goal-based motivational construct, may beneficially influence stress and fatigue, yet little research has examined these associations. We assessed the relation between hope and fatigue, and the mediating effect of stress, in individuals with fibromyalgia, arthritis, and inflammatory bowel disease. Covarying age, sex, and pain, stress partially mediated the association between hope and fatigue; those with greater hope reported less stress and consequent fatigue. Therapeutically, bolstering hope may allow proactive management of stressors, resulting in less fatigue.

Physician counseling of overweight patients about preventive health behaviors

BACKGROUND

Numerous studies show that many primary care physicians (PCPs) do not discuss preventive health behaviors related to diet and exercise with their overweight patients.

PURPOSE

To investigate whether certain counseling approaches by PCPs in their clinical encounters with patients are associated with improvements in care and resource utilization.

METHODS

A total of 2205 patients in a large HMO were surveyed, during November and December 2010, about their health behaviors and perceptions of their interactions with their PCPs. Survey responses from each patient were matched with 48 months of patient-specific medical claims data, from October 2008 through September 2012, capturing the frequency and monetary costs of health care utilization. A series of regression analyses, completed in June 2013, focused on four dependent variables: patients' intentions to improve diet and activity, patients' satisfaction with their physicians, visits to healthcare providers, and health plan spending on treatment.

RESULTS

For each finding, the degree of physician-patient discussion of preventive health behaviors was strengthened when (1) physicians expressed confidence in patients' ability to improve diet and exercise and (2) patients had confidence that their physician could facilitate improvement of these behaviors.

CONCLUSIONS

The associations between physician counseling and subsequent key improvements for overweight patients are strengthened by the physician's confidence in the patient's ability to engage in preventive health behaviors and the patient's confidence in the physician's ability to help in implementing these behaviors. Cultivating such mutual confidence is instrumental in optimizing physicians' influence on overweight patients' health behaviors.

Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial

OBJECTIVE

To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA).

METHODS

Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up.

RESULTS

123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)).

CONCLUSION

This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time.

PRACTICE IMPLICATIONS

Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out.

In-center hemodialysis attendance: patient perceptions of risks, barriers, and recommendations

Missed hemodialysis treatments lead to increased morbidity and mortality in the end-stage renal disease population. Little is known about why patients have difficulty attending their scheduled in-center dialysis treatments. Semistructured interviews with 15 adherent and 15 nonadherent hemodialysis patients were conducted to determine patients' attitudes about dialysis, health beliefs and risk perception regarding missed treatments, barriers and facilitators to hemodialysis attendance, and recommendations to improve the system to facilitate dialysis attendance. Average time on dialysis was 2.5 years for the nonadherent group and 7.3 years in the adherent group. In both groups, patients felt that dialysis is life-saving and a necessity. A substantial number of patients in both groups understood that missing hemodialysis treatments is dangerous and several patients could clearly communicate the risk of skipping. The most common barriers to hemodialysis were inadequate or unreliable transportation (mentioned in both groups) and a lack of motivation to get to dialysis or that dialysis is not a priority (typically mentioned by the nonadherent group). Facilitators to hemodialysis attendance included explanations from the health care team regarding the risk of skipping and relationships with other dialysis patients. Patient recommendations to improve dialysis attendance included continued education about the risk of poor attendance and more accessible transportation. Patients did not feel that home dialysis would improve adherence. Hemodialysis patients must adhere to a complex and burdensome regimen. Through the elucidation of barriers and facilitators to hemodialysis attendance and through specific patient recommendations, at least three interventions may be further investigated to improve hemodialysis attendance: Improvement of the transportation system, education and supportive encouragement from the health care team, and peer support mentorship.

Patients' responses to the communication of vascular risk in primary care: a qualitative study

AIM

To examine the perspectives of patients identified as being at 'high risk' of cardiovascular events, with particular reference to the potential responses to risk messages.

BACKGROUND

Systematic population screening for cardiovascular disease (CVD) aims to identify those at high risk and provide medication and lifestyle support. In the United Kingdom, this takes the form of the National Health Service Health Check.

METHODS

We conducted a qualitative interview study. In 2011 we interviewed 37 patients, from seven UK primary care practices, who were at high risk of developing CVD.

FINDINGS

Risk messages were delivered via face-to-face consultations or by letter and were relayed in either a 'downplaying' or 'serious warning' style. Patients' accounts of receiving information about risk revealed two broad response styles: 'committed' (active resistance; commitment to change) and 'non-committed' (procrastination; downplaying and fatalism). Responses to risk messages are usually assumed to be due to individual characteristics but they may be explained by an interaction between the way risk is communicated and the patient's response style.

Development of a behaviour change communication tool for medical students: the 'Tent Pegs' booklet

OBJECTIVE

To describe the development and validation of a behaviour change communication tool for medical students.

METHODS

Behaviour change techniques (BCTs) were identified within the literature and used to inform a communication tool to support medical students in discussing health-related behaviour change with patients. BCTs were organized into an accessible format for medical students (the 'Tent Pegs' booklet) and validated using discriminant content validity methods with 11 expert judges.

RESULTS

One-sample t-tests showed that judges reliably mapped BCTs onto six of the seven Tent Pegs domains (confidence rating means ranged from 4.0 to 5.1 out of 10, all p≤0.002). Only BCTs within the 'empowering people to change' domain were not significantly different from the value zero (mean confidence rating=1.2, p>0.05); these BCTs were most frequently allocated to the 'addressing thoughts and emotions' domain instead.

CONCLUSION

BCTs within the Tent Pegs booklet are reliably allocated to corresponding behaviour change domains with the exception of those within the 'empowering people to change' domain.

PRACTICE IMPLICATIONS

The existing evidence-base on BCTs can be used to directly inform development of a communication tool to support medical students facilitate health behaviour change with patients.

Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions

BACKGROUND

Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed.

METHODS

Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field.

RESULTS

In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population.

DISCUSSION

The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.

The interaction between dietary and life goals: using goal systems theory to explore healthy diet and life goals

Objective: To examine the types of life and dietary goals individuals report and how these goal domains interact as framed by goal systems theory. Methods: This work is a cross-sectional survey study. Measures included the incidence of common life and dietary goals and how these goals interact with and facilitate each other. Results: The results of a quantitative survey (n = 46 participants), which was informed by two focus groups (n = 17 participants), showed that participants are trying to achieve several different life (e.g. achieving financial success) and dietary goals (e.g. eating more fruits and vegetables, drinking more water, and losing weight) and that these two types of goals interact to both facilitate and conflict with each other. Having a life goal of exercising was significantly associated with healthy eating goals when compared with other life goals (p's < .05), suggesting these goals may be linked and help to facilitate one another. Being in the maintenance phase with the goal of healthy eating was associated with participants feeling like they were more successful in their other non-diet-related health goals (p < .05), suggesting maintenance of goals can facilitate success in achieving other goals. Conclusions: Life goals can have an impact on a person's ability to achieve and maintain dietary and other health goals. Health educators may help to facilitate long-term behavior change by examining a person's life goals as well as dietary goals.

Training professionals’ communication and motivation skills to improve spinal cord injury patients’ satisfaction and clinical outcomes: Study protocol of the ESPELMA trial

Acute spinal cord injury leaves patients severely impaired and generates high levels of psychological distress among them and their families, which can cause a less active role in rehabilitation, worse functional recovery, and less perceived satisfaction with the results. Additionally, rehabilitation professionals who deal with this psychological distress could ultimately experience higher stress and more risk of burnout. This article presents the study protocol of the ESPELMA project, aimed to train rehabilitation professionals in the clinical management of acute spinal cord injury–associated psychological distress, and to measure the impact of this training on the patients’ perceived satisfaction with treatment.

How to attain expertise in clinical communication?

Several factors complicate the attainment of expertise in clinical communication. Medical curricula and postgraduate training insufficiently provide the required learning conditions of deliberate practice to overcome these obstacles. In this paper we provide recommendations for learning objectives and teaching methods for the attainment of professional expertise in patient education. Firstly, we propose to use functional learning objectives derived from the goals and strategies of clinical communication. Secondly, we recommend using teaching and assessment methods which: (1) contain stimulating learning tasks with opportunities for immediate feedback, reflection and corrections, and (2) give ample opportunity for repetition, gradual refinements and practice in challenging situations. Video-on-the-job fits these requirements and can be used to improve the competency in patient education of residents and medical staff in clinical practice. However, video-on-the-job can only be successful if the working environment supports the teaching and learning of communication and if medical staff which supervises the residents, is motivated to improve their own communication and didactic skills.

Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

BACKGROUND

Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

METHODS/DESIGN

This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants' motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs.

DISCUSSION

This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

TRIAL REGISTRATION

The protocol for this study is registered with the Netherlands Trial Registry NTR2415.

Hispanic Overweight and Obese Children

Through Value Enhanced Nutrition Assessment and other techniques, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) engages clients to set their own nutrition goals. A case series of 30 Hispanic children (2-4.5 years) at ≥85th body mass index (BMI) percentile and their caregivers were followed through an urban WIC clinic. The dyads received either standard counseling ( n = 15) or motivational interviewing (MI; n = 15) by one bilingual WIC nutritionist during 4 regularly scheduled visits over 6 months. Repeated measurements of anthropometric data, dietary patterns, and physical activity were obtained at each visit. Longitudinal bivariate analyses of caregiver concerns and goal selection were conducted along with mean comparisons of anthropometric and food frequency measures. Participation in counseling sessions as rated by the nutritionist was assessed by comparing Wilcoxon rank-sum scores. After counseling, children lost an adjusted mean weight of 0.878 kg (95% confidence interval = 0.280-1.717). A decline in median BMI of more than 3 percentiles ( P = .042) was observed with both counseling approaches. Caregiver-reported vegetable intake of children increased an average of one additional serving in the MI-counseled group by visit 3 ( P = .013) despite MI recipient caregivers being scored as significantly more distracted than standard WIC participants in the first visit ( P = .036). MI is a viable option for WIC counseling to improve diet and health outcomes in participants, particularly in addressing child BMI status and vegetable intake. Public health professionals should examine scalability of the MI approach among larger samples of WIC participants and other innovative techniques to improve client focus during counseling.

Reducing pediatric overweight: nurse-delivered motivational interviewing in primary care

The purpose of this study was to test the Let's Go 5-2-1-0 program delivered through motivational interviewing by nurses with 4-18-year-old overweight children and parents in primary care (PC). A quasi-experimental design allocated 60 control families to standard clinical care (SCC) and 70 families to SCC plus the 5-2-1-0 intervention. Drop-out rates were 9 and 35% at 6 months and 25 and 41% at 12 months, respectively for control and intervention participants. BMI percentile trended (p = .057) toward decline (M change = -3.0 versus -1.5) for intervention children at 6 months (n = 52 control, 44 intervention), and nonsignificantly (p = 0.14) for both groups (43 control, 40 intervention) at 12 months (controls -1.9, intervention -4.6). Intervention effects were found for self-reported daily fruit/vegetable consumption, physical activity, and screen time. Satisfaction was high. Further study of the PC nursing intervention is warranted.

The 40-Something randomized controlled trial to prevent weight gain in mid-age women

Background

Obesity prevention is a major public health priority. Despite the health risks associated with weight gain, there has been a distinct lack of research into effective interventions to prevent, rather than treat, obesity particularly at high risk life stages such as menopause in women. This paper describes the rationale for and design of a 2-year randomized controlled trial (RCT) (the 40-Something Study) aimed at testing the feasibility and efficacy of a relatively low intensity intervention designed to achieve weight control in non-obese women about to enter the menopause transition.

Methods and design

The study is a parallel-group RCT consisting of 12 months of intervention (Phase 1) and 12 months of monitoring (Phase 2). Non-obese pre-menopausal healthy females 44–50 years of age were screened, stratified according to Body Mass Index (BMI) category (18.5-24.9 and 25–29.9 kg/m²) and randomly assigned to one of two groups: motivational interviewing (MI) intervention (n = 28), or a self-directed intervention (SDI) (control) (n = 26). The MI intervention consisted of five consultations with health professionals (four with a Dietitian and one with an Exercise Physiologist) who applied components of MI counselling to consultations with the women over a 12 month period. The SDI was developed as a control and these participants received print materials only. Outcome measures were collected at baseline, three, 12, 18 and 24 months and included weight (primary outcome), waist circumference, body composition, blood pressure, plasma markers of metabolic syndrome risk, dietary intake, physical activity and quality of life. Analysis of covariance will be used to investigate outcomes according to intervention type and duration (comparing baseline, 12 and 24 months).

Discussion

The 40-Something study is the first RCT aimed at preventing menopausal weight gain in Australian women. Importantly, this paper describes the methods used to evaluate whether a relatively low intensity, health professional led intervention will achieve better weight control in pre-menopausal women than a self-directed intervention. The results will add to the scant body of literature on obesity prevention methods at an under-researched high-risk life stage, and inform the development of population-based interventions.

Trial registration

ACTRN12611000064909