A Motivational Interviewing Toolkit for Providers to Address Weight Among Pregnant Women

The obesity epidemic poses a substantial public health challenge in the United States and worldwide. More than one-half of all pregnant women in the United States are overweight or obese. Overweight and obesity during pregnancy carry significant short and long-term maternal and fetal risks. However, pregnancy is an ideal time to be addressing healthy behavior changes with overweight and obese women, as it is a time of high motivation and consistent interaction with healthcare providers. The current approach of prenatal care providers is to educate and counsel patients regarding exercise and diet, though evidence suggests that this has minimal effect on behavior change. Prenatal care providers need a more effective tool to motivate overweight and obese clients to improve their health behaviors. Motivational interviewing (MI) has been shown to be just such a tool. In fields as varied as contraceptive uptake, substance abuse, and exercise, motivational interviewing has been shown to reduce client ambivalence and improve health behaviors. The purpose of this project was to create a motivational interviewing toolkit for prenatal care providers to more effectively address health behaviors with overweight and obese pregnant women during prenatal visits. The toolkit includes sections on the foundational principles and spirits of motivational interviewing; the core skills, including the fundamental skill of reflective listening; how to recognize, evoke, and respond to change talk; and finally how to help patients make change plans. The toolkit closes with some important tips and cautions, scripts for addressing weight in prenatal care, and a list of additional resources, including a bibliography, links to online videos of motivational interviewing in action, and further training options. A journal article about motivational interviewing's efficacy in producing change in medical settings was appended to the toolkit to assure providers that the practice is evidence-based. The motivational interviewing toolkit was reviewed by content experts in the fields of prenatal obesity and motivational interviewing and revised according to their feedback. Additionally, the BirthCare Healthcare Midwives in Salt Lake City, Utah, were trained in its use, and their feedback was elicited to improve the ease of use and applicability of the toolkit in prenatal visits. An article with details on how prenatal care providers can integrate motivational interviewing into their practice with overweight and obese clients was also written and submitted for publication to further disseminate key elements of the toolkit to a wider audience. Given the research, it is recommended that motivational interviewing be integrated into health sciences curricula to improve new practitioners' skills in communicating with patients about behavior change. Future DNP students might continue this project by examining how to most effectively integrate it into the DNP curriculum and examining outcomes of training current providers. The obesity epidemic is one of the most significant healthcare challenges of our day. By providing prenatal care providers with the effective behavior change tool of motivational interviewing, this toolkit aims to address this significant public health problem of overweight and obesity among pregnant women.