Motivational interviewing as an intervention to improve adherence behaviours for the prevention of d

NewsBot · Dec 6, 2018

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Motivational interviewing as an intervention to improve adherence behaviours for the prevention of diabetic foot ulceration - a systematic review.
Binning J, Woodburn J, Bus S, Barn R
SOurce

Diabetic foot ulceration is a major complication associated with high morbidity. Little evidence exists on which interventions are effective at preventing ulceration. Participants who are adherent to self-care behaviours have significantly better outcomes. Motivational interviewing is an intervention that has been used successfully for conditions where adherence is important, such as reduction of obesity and HbA1c levels. A systematic review was conducted to determine whether motivational interviewing is effective at improving adherence for the prevention of Diabetic Foot Ulceration. Electronic searches were run without date or language restrictions in MEDLINE (viaEBSCOhost), CINAHL (viaEBSCOhost), ProQuest (Health & Medical Collection, Nursing & Allied Health Database, PsycINFO, Psychology, PsychArticles), AMED, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, and Web of Science Core Collections. Papers were included if participants had or were at risk of diabetic foot ulceration. Studies required motivational interviewing or a motivational approach as the sole intervention or as a component. Randomised controlled trials and quasi-experimental studies were included if ulceration and/or at least one behavioural outcome was measured before and after the intervention. Five studies met the inclusion criteria. Heterogeneity prevented the pooling of data. One study used motivational interviewing as the sole intervention. This study found a short term positive effect on footwear adherence. The remaining four studies had a motivational component within their interventions. Two of these studies showed the intervention to be effective but both were at a high risk of bias. This review demonstrates an evidence gap. More research is needed.
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NewsBot · Feb 12, 2021

Effects of training podiatrists to use imagery-based motivational interviewing when treating people with diabetes-related foot disease: a mixed-methods pilot study
Tracey Kaczmarek, Jaap J. Van Netten, Peter A. Lazzarini & David Kavanagh
Journal of Foot and Ankle Research volume 14, Article number: 12 (2021)

Background
Self-care in diabetes related foot disease (DFD) is challenging and contributes to poor outcomes. Motivational Interviewing (MI) can engage people in self-care and modifying it by integrating imagery may further improve its outcomes. No previous studies have trained podiatrists in using MI to address DFD self-care. This was the first study on training podiatrists to conduct imagery-based motivational interviewing (MI) when treating people with DFD, and to examine impacts on MI related skills, job satisfaction and subjective experiences in a mixed-methods pilot study.

Methods
Eleven recruited podiatrists (median age: 35 years, 9 female and 2 male) received two 4-h training sessions, and three received subsequent mentoring. MI and imagery skills were rated using validated tools during two clinical sessions per participant at baseline, and 2- and 12-weeks post-training. Job satisfaction was assessed at baseline and 12 weeks. Semi-structured interviews at 12 weeks were analysed using the framework approach.

Results
Significant improvements over time (p = .006–.044) with substantial effect sizes (η2 = .50–.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction was high at baseline and unchanged at follow-up (p = 0.34, η2 = .100). In qualitative interviews, MI training and skills were valued, but significant challenges in using MI when treating people with DFD were reported.

Conclusion
Training podiatrists in MI may have potential but more training, observation and mentoring appear needed to obtain sustained communication changes in practice.
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NewsBot · Feb 13, 2021

Application of protection motivation theory to diabetic foot care Behaviours in Egypt
Sherine Hassan
J Diabetes Metab Disord. 2020 Jun 16;19(2):869-873

Purpose: Foot care behaviours are considered the first line of defense against diabetic foot complications. In general, preventive behaviours are determined by multiple personal, social and psychological factors. The aim of this study was to assess foot care behaviours and their relation to protection motivation theory among a sample of adults with diabetes in Egypt.

Methods: A self-administered questionnaire was used to collect data about foot care practices and protection motivation theory among a random sample of 300 adults with diabetes attending primary health care units in Egypt.

Results: The results demonstrated that the foot care behaviours were inadequate amongst the sample(mean 5.13 ± 1.92 out of 11). Three constructs of protection motivation theory predicted the behaviours, namely: self-efficacy (p = 0.015), perceived seriousness (p = 0.013) and intention to adhere to foot care (p = 0.021). On the other hand, intention to adhere to foot care was correlated with higher levels of self-efficacy and perceived seriousness, and to lower levels of perceived barriers.

Conclusion: There was a low level of foot self-care amongst the sample. Health education programs reinforcing the intention to adhere to foot care behaviours can improve foot care practices among people with diabetes through increasing self-efficacy and perceived seriousness and reducing perceived barriers.
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NewsBot · Aug 29, 2021

The impact of motivational interviewing training for podiatrists treating people with diabetes-related foot disease
Kaczmarek, Tracey (2021)
Thesis

Diabetes-related foot disease (DFD) – which includes foot ulceration and infection - often leads to hospitalisation and amputation without good clinical care and self-care. Motivational interviewing (MI) has shown promise in promoting self-care changes in persons with DFD. This thesis designed, implemented and investigated the effects of a MI-related training course for podiatrists who treat people with DFD on their MI-related skills and experiences in clinical practice. Findings indicated that podiatrists who treat people with DFD can improve their MI-related skills in the short-term following MI-training. However, additional training and support may be required to sustain these effects in the longer-term.
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NewsBot · Sep 14, 2023

This clinical trial was just registered:
The Effect of Motivational Interviewing on Treatment Adherence, Self-Efficacy, and Satisfaction in Individuals With Diabetic Foot Ulcers

The rise in diabetes incidence has led to a corresponding increase in diabetes-related complications. Diabetic foot ulcers, a severe consequence of diabetes, have substantial impacts on patients, the social environment, overall well-being, and nursing procedures. Given this context, there is a clear necessity for interventions that motivate patients to adopt beneficial health behaviors and educate them in effectively managing diabetes-related complications. This study seeks to investigate the impact of Watson's motivational interviewing method, which is grounded in the human care theory, on enhancing treatment adherence, self-efficacy, and satisfaction levels among individuals suffering from diabetic foot ulcers.

Hypotheses of The Research H0: There is no difference in self-efficacy for diabetic foot care, diabetic foot care behavior, treatment adherence, and satisfaction between individuals with diabetic foot ulcers who receive Watson's human care theory-based motivational interviewing and diabetic foot care education, and those who receive standard education.

H1: There is a difference in self-efficacy for diabetic foot care between individuals with diabetic foot ulcers who receive Watson's human care theory-based motivational interviewing and diabetic foot care education and those who receive standard education.

H2: There is a difference in diabetic foot care behavior between individuals with diabetic foot ulcers who receive Watson's human care theory-based motivational interviewing and diabetic foot care education and those who receive standard education.

H3: There is a difference in treatment adherence between individuals with diabetic foot ulcers who receive Watson's human care theory-based motivational interviewing and diabetic foot care education and those who receive standard education.

H4: There is a difference in satisfaction between individuals with diabetic foot ulcers who receive Watson's human care theory-based motivational interviewing and diabetic foot care education and those who receive standard education.
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NewsBot · Dec 28, 2023

Development of a Motivation Communication Training to Aid Diabetes-Specialist Podiatrists With Adherence Discussions
Jennie E Hancox et al
Health Educ Behav. 2023 Dec 14

Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.
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NewsBot · Feb 16, 2024

Motivation communication training programme for healthcare professionals to support adherence in patients with diabetic foot ulcers: Proof of concept study
Jennie E Hancox et al
PLoS One. 2024 Feb 8;19(2)

Patients with diabetic foot ulcers have poor adherence to treatment recommendations. However, the most effective way to support adherence in this population is unknown. This study aimed to assess the preliminary effectiveness of a motivation communication training programme for healthcare professionals working with these patients, using theory and evidence-based strategies.A proof-of-concept study using a non-randomised, controlled before-and-after design. Six podiatrists took part in the motivation communication training programme. Pre-training, observation was undertaken to examine the communication style currently used by podiatrists in routine consultations. Patients' (n = 25) perceptions of podiatrist autonomy support, self-determination for limiting weight-bearing activity and average daily step count were also assessed. Post training, observations and patient measures were repeated with a different group of patients (n = 24). Observations indicated that podiatrists exhibited a more need-supportive communication style (e.g., taking time to understand patients' perspectives) after undergoing the training programme. Patients in the post-training group reported higher levels of autonomy support, while self-determination to limit weight-bearing activity remained unchanged. Although the post-training group had a lower average daily step count, the difference was not statistically significant. This is the first study to investigate implementation of motivation communication strategies in routine consultations with patients with diabetic foot ulcers. Results suggest that training can enhance healthcare professionals' motivation communication skills with potential for addressing adherence issues, however, a larger cluster randomised controlled trial is necessary to confirm this.
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