The management of type 2 diabetes is demanding and complex from the patient's perspective and requires considerable lifestyle and health behavior change. The diabetes educator has a primary role in the provision of behavior change support. However, few educators receive training in communication skills and behavior change counseling. Moreover, there is a paucity of practical, teachable behavioral methods that can be used in busy clinic settings. Motivational Interviewing (MI) is a theory-based approach to behavior change counseling in diabetes. Rollnick et al.'s MI model posits that patient self care motivation is related to two distinct dimensions that must be measured and explored by the educator: patient perceptions of the importance of behavior change and patient self-efficacy that behavior change can be achieved. MI has recently been shown to be effective in brief interventions that target patient motivation in diabetes and other chronic illnesses. Further, computerized assessment tools and structured interview protocols have both been shown to be effective mechanisms for delivering behavior change interventions in busy clinic settings. We have developed a computerized MI-based assessment tool and a structured MI-based interview protocol to help diabetes educators deliver an MI intervention to poorly controlled patients with type 2 diabetes. In the proposed randomized, controlled trial there will be 3 active conditions: 1) incorporates both our computerized MI assessment tool and MI interview protocol; 2) uses the computerized assessment alone; 3) uses the interview protocol alone. We expect all active interventions to be superior to our attention control condition in reducing our primary outcome (HbAlc) over the 12-month intervention period, and the combined condition to be superior to either intervention delivered alone. Secondary endpoints will be diabetes quality of life and treatment satisfaction. N=296 adult type 2 patients will be randomized to one of the 4 study conditions and be followed-up at 6 and 12-months. Educator training in MI will involve an intensive one-month training period and monitoring and training during the interventions using standardized procedures and assessments. A contribution of our research will be our careful attention to issues of adherence to the treatment conditions by the study educators. Importantly, we will specifically examine the role of theoretical mediators in a series of hierarchical regression analyses. ? ?
| Zagarins, Sofija E; Allen, Nancy A; Garb, Jane L et al. (2012) Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms. J Behav Med 35:299-304 |
| Welch, Garry; Zagarins, Sofija E; Feinberg, Rebecca G et al. (2011) Motivational interviewing delivered by diabetes educators: does it improve blood glucose control among poorly controlled type 2 diabetes patients? Diabetes Res Clin Pract 91:54-60 |
| Leyva, Bryan; Zagarins, Sofija E; Allen, Nancy A et al. (2011) The relative impact of diabetes distress vs depression on glycemic control in hispanic patients following a diabetes self-management education intervention. Ethn Dis 21:322-7 |
