Utilizing motivational interviewing to enhance diabetes self-management

The Chronic Care Model (CCM) is an integrated approach to the management of chronic diseases such as diabetes. Elements include: decision support, clinical information systems, patient self-management, and delivery system design. A major challenge for patients who try to self-manage their disease is adherence to the required lifestyle changes over the long term. Typically, patients who complete diabetes self-management education classes do not maintain the behavior changes. This presentation will describe an innovative pilot study designed to address long-term patient self-management which utilizes motivational interviewing (MI) by lay-trained, health advisors who have well-controlled diabetes and live in the same rural communities where the patients they are assisting live. The lay health coaches will be integrated as part of the “team-based care” delivered to these patients. MI represents a general and practical approach for changing behaviors by enhancing and facilitating a person's own internally-motivated change process. The MI advisor utilizes techniques including agenda setting, personalized feedback, reflective listening, exploring the pros and cons of change, supporting client self-efficacy, eliciting “self-motivational statements” (problem recognition, intention to change, optimism about change), generating solutions to potential barriers to change, and identifying social supports for change. Of critical importance, MI emphasizes the individual's personal choice regarding change. This pilot study is a novel application of MI by trained lay health coaches, who function as an extension of the health care team in order to provide the dedicated time and support to the patient with diabetes, and supervised by a nurse certified diabetes health educator.