Incorporating Principles of Motivational Interviewing For Improved Management of Pediatric Obesity in Primary Care

The purpose of this scholarly project was to increase provider knowledge, confidence, and use of motivational interviewing (MI) techniques when initiating discussions with obese pediatric patients and their parents regarding healthy weight. Although current literature addresses the effectiveness of multi-hour training sessions in learning MI, there is a lack of data regarding the utility of a brief 30-minute educational intervention. This quality improvement project incorporated a pretest/posttest design with an intervention consisting of an in-service educational training, and a change in clinic process. The training provides a brief overview of pediatric obesity with a strong focus on how to implement basic MI techniques in approaching patients and families regarding weight management issues. A clinical form outlining the MI method was provided for clinician reference and collaborative decision making during counseling sessions. Participants included five providers (4 physicians and 1 nurse practitioner) in a suburban pediatric primary care clinic. Knowledge related to MI associated with pediatric obesity was measured using a pretest/posttest instrument which included both multiple choice and short answer format questions. Changes in confidence, attitudes, and use of MI were assessed using self-reported Likert scales. Learner satisfaction and intent to change were evaluated immediately following the presentation. A follow-up questionnaire addressing use and satisfaction with MI was completed three months after the intervention. Quantitative pretest and posttest scores were analyzed using the Wilcoxon signed rank test, and frequency counts and percentages were used to describe follow up questionnaire responses. Results showed a statistically significant (p<0.05) increase in knowledge regarding principles of MI. Although not statistically significant, provider confidence and belief in the use of MI increased for the majority of participants. Provider attitudes towards the importance of treating pediatric obesity remained virtually unchanged. One hundred percent of participants reported they felt the techniques gained from the presentation on MI had been helpful in providing care for pediatric patients, despite only 40% having had the opportunity to use the methods for obesity in practice. This study finds that a brief educational intervention may increase knowledge of MI principles and suggests that pediatric providers find MI techniques are beneficial in improving overall patient care. Future implications include repeating the study in contexts with a larger proportion of obese pediatric patients, which may provide greater opportunity for clinical use of MI techniques.