Magill Nicholas, Graves Helen, de Zoysa Nicole, Winkley Kirsty, Amiel Stephanie, Shuttlewood Emma, Landau Sabine, Ismail Khalida
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
BMC Fam Pract. 2018 May 10;19(1):60. doi: 10.1186/s12875-018-0742-5.
Competencies in psychological techniques delivered by primary care nurses to support diabetes self-management were compared between the intervention and control arms of a cluster randomised controlled trial as part of a process evaluation. The trial was pragmatic and designed to assess effectiveness. This article addresses the question of whether the care that was delivered in the intervention and control trial arms represented high fidelity treatment and attention control, respectively.
Twenty-three primary care nurses were either trained in motivational interviewing (MI) and cognitive behavioural therapy (CBT) skills or delivered attention control. Nurses' skills in these treatments were evaluated soon after training (treatment arm) and treatment fidelity was assessed after treatment delivery for sessions midway through regimen (both arms) using the Motivational Interviewing Treatment Integrity (MITI) domains and Behaviour Change Counselling Index (BECCI) based on consultations with 151 participants (45% of those who entered the study). The MITI Global Spirit subscale measured demonstration of MI principles: evocation, collaboration, autonomy/support.
After training, median MITI MI-Adherence was 86.2% (IQR 76.9-100%) and mean MITI Empathy was 4.09 (SD 1.04). During delivery of treatment, in the intervention arm mean MITI Spirit was 4.03 (SD 1.05), mean Empathy was 4.23 (SD 0.89), and median Percentage Complex Reflections was 53.8% (IQR 40.0-71.4%). In the attention control arm mean Empathy was 3.40 (SD 0.98) and median Percentage Complex Reflections was 55.6% (IQR 41.9-71.4%).
After MI and CBT skills training, detailed assessment showed that nurses had basic competencies in some psychological techniques. There appeared to be some delivery of elements of psychological treatment by nurses in the control arm. This model of training and delivery of MI and CBT skills integrated into routine nursing care to support diabetes self-management in primary care was not associated with high competency levels in all skills.
ISRCTN75776892 ; date registered: 19/05/2010.
作为过程评估的一部分，在一项整群随机对照试验的干预组和对照组之间，比较了初级保健护士提供的支持糖尿病自我管理的心理技术能力。该试验注重实际应用，旨在评估有效性。本文探讨了干预组和对照组提供的护理是否分别代表了高保真治疗和注意力控制。
23名初级保健护士接受了动机性访谈（MI）和认知行为疗法（CBT）技能培训，或提供注意力控制。在培训后不久（治疗组）评估护士在这些治疗中的技能，并在治疗方案进行到一半时（两组），基于与151名参与者（占参与研究人员的45%）的咨询，使用动机性访谈治疗完整性（MITI）领域和行为改变咨询指数（BECCI）评估治疗保真度。MITI全球精神分量表测量了MI原则的表现：唤起、协作、自主/支持。
培训后，MITI MI依从性中位数为86.2%（四分位间距76.9 - 100%），MITI同理心均值为4.09（标准差1.04）。在治疗过程中，干预组的MITI精神均值为4.03（标准差1.05），同理心均值为4.23（标准差0.89），复杂反射百分比中位数为53.8%（四分位间距40.0 - 71.4%）。在注意力控制组，同理心均值为3.40（标准差0.98），复杂反射百分比中位数为55.6%（四分位间距41.9 - 71.4%）。
经过MI和CBT技能培训后，详细评估表明护士在某些心理技术方面具备基本能力。对照组的护士似乎也提供了一些心理治疗要素。这种将MI和CBT技能培训及应用整合到常规护理中以支持初级保健中糖尿病自我管理的模式，并未使所有技能都达到高能力水平。
ISRCTN75776892；注册日期：2010年5月19日。
