Effectiveness of Motivational Interviewing on Improving Care for Patients With Type 2 Diabetes in China
Condition: Diabetes Mellitus, Type 2
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      n 2015, the International Diabetes Federation estimated that there were nearly 110 million
      diabetes mellitus (DM) patients in China, which was the highest number recorded in the world.
      China's DM-related costs, ranked second highest globally, were estimated to be US$51 billion.
      In response to the rising patient numbers and costs, the Chinese government has invested
      heavily in primary healthcare since 2009, with the goal of improving chronic disease
      management in the primary care settings. A key part of the primary care improvement program
      prioritizes health education as a route to lifestyle modification. Although the content and
      modes of delivery vary enormously, most of the programs focused on providing information
      rather than facilitating patient change. The impacts of traditional patient education on
      lifestyle modification and changes in psychological status have been reported to be
      suboptimal. These may be related to the poor understanding of the educational content or lack
      of means for making changes as a result of low socioeconomic status and poor educational
      level. It is therefore necessary to rethink and explore a more structured, patient-centered
      approach to health education at improving the outcomes of DM control.

      Motivational interviewing (MI) is a collaborative, patient-centered counseling approach that
      aims to elicit behavior change. Counselors use empathy and other techniques to create an
      atmosphere to help patients to explore the discrepancies between the goals and their current
      behavior. The focus of MI is to find and resolve the ambivalence, improve patients'
      perception of the importance of behavior change, and support them to make the change. MI
      provides a structural framework with guiding principles that can be easily followed by the
      primary care doctors. Some studies show that MI can contribute to improve healthy eating,
      weight control and increases in physical activity, but most research focused on intermediate
      outcome measures and did not evaluate the readiness to change. MI can be utilized by a
      variety of healthcare providers, which makes it adaptable for different culture and clinical
      settings. However, the effectiveness of MI in Chinese diabetic patients remains uncertain.

      MI has been delivered using different methods. These methods have varied and included a
      single one-to-one session with a therapist, multiple group sessions, and the incorporation of
      MI into daily clinical practice. Furthermore, in yet another study, MI education program
      produced a significantly greater change in patients' perceived competence in dealing with
      diabetes than the control group. In this study, the investigators adopted the group MI
      approach and developed a patient empowerment program (PEP) utilizing the techniques and
      framework of MI. The investigators compared this to the most common form of DM education in
      China, i.e., when health professionals (nurses, doctors, dietitians or pharmacists) give a
      lecture on DM to patients and their carers in a hospital lecture theatre in a didactic
      manner.
    

Detailed description: 
      Background: To assess the effects of a motivational interviewing (MI)-based patient
      empowerment program (PEP) on type 2 diabetes mellitus (DM) patient self-management compared
      to traditional diabetes health education.

      Methods: Two hundred and twenty-five patients, recruited from community health centers (CHCs)
      and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen,
      were randomly assigned to the intervention or control groups. Patients in the intervention
      group (n=117) received a four-session PEP in small groups over one month by trained nurses
      and doctors. The control group (n=108) received the traditional lecture-style health
      education on DM. All the patients were followed up for three months. Outcomes included
      problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient
      enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle
      behaviors were assessed at baseline, post-activity and three months.
    

Intervention name(s): Experimental: Motivational interviewing Placebo Comparator: Traditional lectures
Intervention type(s): Behavioral
Intervention description(s): Patients in the intervention group (n=117) received a four-session patient empowerment program in small groups over one month by trained nurses and doctors. he control group received traditional lectures that consisted solely of conveying healthcare information to patients.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two hundred and twenty-five patients, recruited from community health centers (CHCs) and the family medicine clinic in the University of Hong Kong-Shenzhen Hospital in Shenzhen, were randomly assigned to the intervention or control groups. Patients in the intervention group (n = 117) received a four-session PEP in small groups over 1 month by trained nurses and doctors. The control group (n = 108) received the traditional lecture-style health education on DM. All the patients were followed up for 3 months. Outcomes included problem areas in diabetes (PAID) that measures diabetes-related emotional distress, patient enablement index (PEI), mental health, patient satisfaction respectively as well as lifestyle behaviors were assessed at baseline, post-activity and 3 months.
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Diabetes Mellitus, Type 2; Motivational interviewing; Patient empowerment; Self-management; China