Abstract
Purpose: The purpose of this scholarly project is to evaluate if motivational interviewing (MI) is an effective method for use in a primary care setting for patients with prediabetes in improving diet habits, decreasing glycated hemoglobin A1c (HbA1c) levels, and increasing percent weight loss.|Background: The prevalence of prediabetes in the United States (U.S.) continues to rise by epidemic proportions. Lifestyle factors such as maintaining a healthy diet, mind, and body can reverse changes in type 2 diabetes (T2DM). The primary care setting has traditionally been the foundation of lifestyle education for individuals with diabetes. Diabetes education is often limited by lack of provider skill set, time, and resources. Motivational interviewing is a technique that can be utilized by nurse practitioners (NPs) to effectively elicit behavior change in the primary care setting. This technique allows the patient to explore his/her feelings about a behavior while the provider promotes behavior change.|Conceptual Model: A theoretical framework that relates to the stated proposal is the Transtheoretical Model (TTM).|Methods: A quality improvement project was completed to study the effectiveness of MI interventions in 16 adults with prediabetes followed at an outpatient clinic. The researcher met with participants for Diabetes Educational Day (DED) with the diabetic educator to go over consent, information of the study, and have the first motivational interviewing session as a group. The first MI session took place at a hospital close by the clinic and was 45 minutes long. Discussion included participants goals for dietary change, action plan, as well as information from American Diabetes Association (ADA) dietary guidelines. Patients filled out a baseline United Kingdom Diabetes Dietary Questionnaire (UKDDQ) to assess patients’ current diets. The researcher then obtained baseline data from patient’s charts on their BMI and HbA1c. The researcher contacted participants thereafter once every two weeks for individual MI sessions. Motivational interviewing sessions lasted 10-15-minute phone calls or 3-6 email exchanges for three months. At three-months the researcher obtained post-intervention baseline collection of the data on each participants HbA1c and BMI. A final UKDDQ was given out to each participant. Baseline UKDDQ score was compared to the post-intervention UKDDQ score with each participant.|Results: Pre-intervention baseline data for body mass index (BMI) was (M = 33.2, SE = 1.1), and three-month follow-up data was (M = 32.1, SE = 1.0). Pre-intervention baseline data for HgA1c was (M = 6.3, SE =.21), and three-month follow-up was (M = 6.1, SE = .21).|Concerning BMI, data showed statistical significance of weight loss at time one than time two, -1.0, BCa 95% CI [-1.9, -0.3], t (20) = 2.8, p = .011. Participants on average decreased BMI with an average of 2.2 lb. weight loss. With regards to HbA1c participants had a higher HbA1c at time one than at time two but did not conclude to show statistical significance, -.2, BCa 95% CI [-.5, .1], t (20) = 1.4, p =.182. Concerning UKDDQ, of the 16 participants 12 completed the post intervention UKDDQ. Results of the Mann-Whitney test showed a difference between the pre and post intervention for patients who completed both, Z = -2.53, p = .011. On average post intervention scores ranked lower on letter grade compared to pre-intervention.|Conclusions: Motivational interviewing is an important intervention as illustrated by this project to affect behavioral changes. This intervention had a statistically significant effect UKDDQ scores and BMI. On the other hand, participants HbA1c over three months was not statistically significant. By screening prediabetic patients of dietary lifestyle early can influence progression of type 2 diabetes (T2DM). The United Kingdom Diabetes Dietary Questionnaire (UKDDQ) can offer tailored patient education on diet specifically in the diabetic population. The effects of motivational interviewing may have lasting effects on participants and the results may be more evident in the long run. Furthermore, research should be conducted in a larger and more diverse populations to have more support of data.