针对有发生足部溃疡高风险的糖尿病患者，足病医生应用动机性访谈的态度和经验：一项混合方法研究。
Attitudes and experiences towards the application of motivational interviewing by podiatrists working with people with diabetes at high-risk of developing foot ulcers: a mixed-methods study.
机构信息
Department of Psychology, Health and Technology, Centre for eHealth Research and Wellbeing, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
ACHIEVE, Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
出版信息
J Foot Ankle Res. 2022 Aug 19;15(1):62. doi: 10.1186/s13047-022-00567-y.
BACKGROUND
Podiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists' attitudes and experiences towards MI.
METHODS
Eighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice.
RESULTS
The MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p = 0.008 and change talk, p = 0.008), on one of five core MI-adherent behaviours (affirmation, p = 0.041) and on one of the other behaviour counts (simple reflections, p = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value.
CONCLUSIONS
The MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice.
TRIAL REGISTRATION
Netherlands Trial Register NL7710. Registered: 6 May 2019.
背景
足病医生是促进高危糖尿病足溃疡患者进行适当足部自我护理的关键专业人员。然而，仅仅告知患者足部自我护理的好处不足以实现行为改变。动机性访谈（MI）是一种有前途的以患者为中心的沟通方式，可以帮助在医疗保健提供者和患者之间建立工作联盟，以改善足部自我护理。本研究旨在观察和分析接受过 MI 培训和未接受过 MI 培训的足病医生与患者进行咨询时 MI 的应用，并探讨足病医生对 MI 的态度和经验。
方法
18 名足病医生（中位年龄：28.5 岁，10 名女性，8 名男性）接受了为期三天的 MI 基础培训，4 名足病医生（中位年龄：38.5 岁，4 名女性）未接受 MI 培训。为了观察和评估日常临床实践中的 MI 保真度，对接受过 MI 培训和未接受过 MI 培训的足病医生的音频记录进行了动机性访谈治疗完整性代码评分。对接受过 MI 培训的足病医生进行了个体、半结构化、深入的访谈，以探讨他们对 MI 的态度和经验。对这些数据源进行了三角剖分，以描述对足病医生进行 MI 培训对其临床实践的影响。
结果
与未接受 MI 培训的足病医生相比，接受 MI 培训的足病医生在四项与 MI 相关的整体沟通技巧中的两项（同理心，p=0.008 和改变谈话，p=0.008）、五项核心 MI 一致行为中的一项（肯定，p=0.041）和其他行为计数中的一项（简单反射，p=0.008）得分更高。足病医生在访谈中主要报告了他们对合作和培养改变谈话的态度和经验。此外，他们还提到了使用 MI 的促进因素和障碍，并表示他们是否认为 MI 具有附加价值。
结论
与未接受 MI 培训的足病医生相比，接受 MI 培训的足病医生在临床实践中更熟练地运用 MI 的原则，而后者则没有达到这一水平。这一成就与他们接受的基本 MI 培训相符。这项多方法研究表明，足病医生可以有效地接受培训，在日常临床实践中应用 MI。
试验注册
荷兰试验注册 NL7710。注册日期：2019 年 5 月 6 日。
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