Behavior change counseling training lacks impact
medwireNews: Training primary care physicians in motivational interviewing techniques does not result in improved positive behavior change among their patients, researchers report in the BMJ.
Patients at practices where clinical staff had taken part in practice-based and online training reported that they were more likely to recall discussing behavior changes with their clinician, to say that they had intended and made attempts to change, and had a greater perception of having made lasting improvements than patients at control practices.
However, among 1827 patients, there was in fact no significant difference in the percentage of patients making beneficial behavior change in terms of alcohol consumption, diet, exercise, or smoking 3 months after consultation (43.6 vs 40.6%; intervention vs control group).
"The lack of lasting change is likely to arise from patient difficulties with adherence to intended plan, suggesting that a single consultation on its own is insufficient to achieve lasting change for important numbers," say Christopher Butler (Cardiff University, UK) and colleagues.
Despite the disappointing findings, the authors report that patients who consulted with trained clinicians said they had been more engaged about a risky health behavior (91.1 vs 55.0%), and were more likely to state an intention to change behavior (72.1 vs 49.3%) than those attending control practices.
At 3 months, more patients in the intervention group reported having attempted to change (39.5 vs 31.8%) and more reported having made sustained change in one of the four behavioral domains studied (34.7 vs 28.1%).
Thus, the researchers suggest that longer-term strategies may improve efficacy. "Additional intervention, such as greater exposure to trained clinicians and structure follow-up or referral of patients, may be required to achieve lasting, measureable changes in behaviour," they add.
Writing in an accompanying editorial, Eileen Kaner and Ruth McGovern from Newcastle University, UK, say that the reasons for the authors' null results are unclear from the study. They note that only half of the clinicians reported adopting their new counseling skills to at least some great extent, indicating the training may not consistently change clinician behavior.
Additionally, they suggest the intervention may not be effective unless built in to ongoing, interactive professional development and that it may need to be supplemented with decision aids to use in practice.
Kaner and McGovern say that further research is urgently needed to reduce premature death in the UK. "Until then, practitioners should heed current available evidence and support patients' lifestyle change for positive health improvement in areas where an effect has been shown," they conclude.
By Kirsty Oswald, medwireNews Reporter