Date Available

4-26-2023

Year of Publication

2023

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Deidra Beshear

Committee Member

Dr. Angela Grubbs

Abstract

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this site.

Methods: The design of this study was a quasi-experimental posttest intervention design guided by the PDSA model for improvement. The study took place in two phases at a women’s health primary care clinic. In phase one, providers at the clinic were surveyed assessing current nutrition counseling practices for patients with type two diabetes. The primary provider measure includes survey responses. In phase two, a brief motivational interviewing intervention was carried out for eligible patients at the clinic. Participant demographics and body mass index were collected at baseline. The primary patient measure is a diet modification SMART goal identified during the intervention. Secondary patient measure includes subjective evaluation of the intervention.

Results: Nearly 80% of providers reported having adequate knowledge of MI and felt that MI is useful for eliciting behavior change in patients with T2DM. About 50% of providers reported feeling confident in using MI in their practice. Barriers to delivering nutrition counseling included time and one provider desired more information about MI. Three of the four patient participants identified a SMART goal during the intervention. The intervention was delivered in less than six minutes for three of the four patient participants and less than ten minutes for one patient participant. Patient participant SMART goals included increasing vegetable servings, portion control, and cooking at home. None of the participants completed the follow up survey.

Conclusions: The findings from this study support that a brief motivational interviewing intervention can be feasible for primary care providers to deliver and an effective method for delivering nutritional counseling and facilitating nutritional goal setting for patients with type two diabetes and body mass index greater than 30. Additional PDSA cycles are needed before full implementation. Study limitations are presented and practice recommendations are discussed.

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