Search

Purpose We tested whether an online intervention combined with a patient feedback report improved physicians' use of motivational interviewing (MI) techniques when discussing weight with overweight and obese adolescents. Methods We randomized 46 pediatricians and family physicians and audio recorded 527 patient encounters. Half of the physicians received an individually tailored, online intervention. Then, all physicians received a summary report detailing patient's weight-related behaviors. We coded MI techniques and used multilevel linear mixed-effects models to examine arm differences. We assessed patients' motivation to change and perceived empathy after encounter. Results We found arm differences in the Intervention Phase and the Summary Report Phase: Empathy ( p < .001), MI Spirit ( p < .001), open questions ( p = .02), and MI consistent behaviors ( p = .04). Across all three phases (Baseline, Intervention, and Summary Report), when physicians had higher Empathy scores, patients were more motivated to change diet ( p = .03) and physical activity ( p = .03). In addition, patients rated physicians as more empathic when physicians used more MI consistent techniques ( p = .02). Conclusions An individually tailored, online intervention coupled with a Summary Report improved physicians' use of MI, which improved the patient experience. [ABSTRACT FROM AUTHOR]

Objective: We developed an online intervention to teach physicians both MI (addressed in outcomes paper) and the 5 A's (Ask, Advise, Assess, Assist, and Arrange) when discussing weight with overweight/obese adolescents.Methods: We audio recorded 527 encounters between adolescents and physicians and coded the 5 A's during weight/BMI discussions. Half of physicians were randomized to receive a tailored, intervention that included their own audio-recorded clips. To examine arm differences, we used multilevel linear mixed-effects models for sum of 5 A's and generalized estimating equations (GEE) models with a logit link for each of the A's separately.Results: Intervention arm physicians used more A's than control physicians (estimated difference=0.6; 95%CI(0.2,1.0);p=0.001). Intervention physicians used Assess (p=0.004), Assist (p=0.001) and Arrange (p=0.02) more when compared to control arm physicians.Conclusion: An online intervention increased physicians' use of the 5 A's when discussing weight with overweight adolescents. These results are promising as the online intervention improved performance for the three A's that are infrequently used (Assess, Assist, and Arrange) yet have the most impact.Practice Implications: A tailored online program can increase physicians' use of the 5 A's behavioral counseling approach in clinical practice with adolescents. [ABSTRACT FROM AUTHOR]

Objectives Excessive gestational weight gain (GWG) puts women and children at risk of obesity. We piloted an SMS-texting intervention to promote healthy GWG among overweight and obese women. Methods We recruited 35 women and randomized them in a 2:1 fashion to: a tailored SMS-texting intervention (Preg CHAT) vs. a generic texting intervention (Txt4baby). Preg CHAT texts provided personalized feedback based on women's intake of sweetened beverages, fruits and vegetables, fast food, daily steps taken, and weight. We abstracted women's weights from charts and surveyed women at baseline and 32 weeks gestation. Results Few women refused the study; many (30%) did not complete the study, however. Of those in the Preg CHAT arm, 86% responded to texts, and 80% said they would recommend this program to a friend. For women who completed the surveys ( n = 23), those in the Preg CHAT arm had a mean gain of 6 less pounds than women in the Txt4Baby arm (95% CI −15.9, 4.0; p = 0.24). Conclusions This pilot study shows feasibility, acceptability, and potential efficacy of a low-intensity and disseminable intervention to help overweight and obese women reduce GWG. Practice implications An SMS texting program might help overweight women reduce excessive GWG. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the theoretical basis, use, and satisfaction with Teen CHAT, an online educational intervention designed to improve physician–adolescent communication about healthy weight. Methods: Routine health maintenance encounters between pediatricians and family practitioners and their overweight adolescent patients were audio recorded, and content was coded to summarize adherence with motivational interviewing techniques. An online educational intervention was developed using constructs from social cognitive theory and using personalized audio recordings. Physicians were randomized to the online intervention or not, and completed post-intervention surveys. Results: Forty-six physicians were recruited, and 22 physicians were randomized to view the intervention website. The educational intervention took an average of 54min to complete, and most physicians thought it was useful, that they would use newly acquired skills with their patients, and would recommend it to others. Fewer physicians thought it helped them address confidentiality issues with their adolescent patients. Conclusion: The Teen CHAT online intervention shows potential for enhancing physician motivational interviewing skills in an acceptable and time-efficient manner. Practice implications: If found to be effective in enhancing motivational interviewing skills and changing adolescent weight-related behaviors, wide dissemination will be feasible and indicated. [Copyright &y& Elsevier]