Is the Scale for Measuring Motivational Interviewing Skills a valid and reliable instrument for measuring the primary care professionals motivational skills?: EVEM study protocol.

BACKGROUND: Lifestyle is one of the main determinants of people's health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors' communication skills, and more specifically the Motivational Interviewing. METHODS/DESIGN: The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. - SCOPE: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change (Pearson product-moment correlation coefficient). DISCUSSION: The verification of the hypothesis that EVEM is a valid and reliable tool for assessing motivational interviewing would be a major breakthrough in the current theoretical and practical knowledge, as it could be used to assess if the providers put into practice a patient centered communication style and can be used both for training or researching purposes. TRIALS REGISTRATION Dislip-EM study: NCT01282190 (ClinicalTrials.gov).

Effectiveness of Motivational Interviewing in improving lipid level in patients with dyslipidemia assisted by general practitioners: Dislip-EM study protocol.

BACKGROUND: The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. METHODS/DESIGN: An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. DISCUSSION: Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential for primary care professionals to help their patients change their lifestyle and improve their health. This study will provide scientific evidence on the effectiveness of Motivational interviewing, and will be performed under strict control over the data collected, ensuring the maintenance of therapeutic integrity. TRIALS REGISTRATION: ClinicalTrials.gov (NCT01282190).

[Priorities in health promotion according to primary care health professionals: a Delphi study]. / Prioridades en promoción de la salud según los profesionales de atención primaria: un estudio Delphi.

OBJECTIVES: To find out the opinions of primary care professionals on prevention activities in clinical practice, as well as the perceived obstacles to carrying them out and ways of overcoming them. PARTICIPANTS: A total of 129 professionals participated, including primary care doctors, nurses, technicians, primary care service managers, and public health professionals. DESIGN: Delphi questionnaire sent by e-mail. SETTING: Primary care in Catalonia, Spain. MAIN MEASUREMENTS AND RESULTS: Two rounds were made with response rates of 48.9% and 67.4%, respectively. Convergence of over 40% was obtained in all the questions after the second round. The main problems for prevention in clinical practice were lack of time, lack of training and the attitudes of the professionals themselves towards prevention. To improve implementing prevention in the practice, the professionals pointed out, training in communication skills, advice methodology and the use of clinical practice guidelines. CONCLUSIONS: Health professionals pointed out some specific needs in training which could help to improve the inclusion of prevention activities. On the other hand, it was noted that the attitudes of the professionals themselves towards prevention need to be improved.

Prioridades en promoción de la salud según los profesionales de atención primaria: un estudio Delphi / Priorities in health promotion according to primary care professionals: a Delphi study

Objetivos. Conocer las opiniones de los profesionales de atención primaria sobre las actividades preventivas en la práctica clínica, así como los obstáculos percibidos por los profesionales para realizarlas y las posibles formas de superarlos. Participantes. En total participaron 129 profesionales, entre los que se incluían médicos de atención primaria, profesionales de enfermería, técnicos y responsables de gestión de servicios de atención primaria, y profesionales de salud pública. Diseño. Cuestionario Delphi enviado por correo electrónico. Emplazamiento. Atención primaria en Cataluña. Mediciones y resultados principales. Se realizaron dos rondas en las que se obtuvieron tasas de respuesta del 48,9 y el 67,4%, respectivamente. Tras la segunda ronda se obtuvo una convergencia superior al 40% en todas las preguntas. Los principales problemas para la prevención en la práctica fueron la falta de tiempo, la falta de formación y las propias actitudes de los profesionales hacia la prevención. Para mejorar la implementación de la prevención en la práctica, los profesionales señalaron la formación en habilidades de comunicación, metodología del consejo y la utilización de guías de práctica clínica. Conclusiones. Los profesionales apuntan algunas necesidades específicas en la formación que pueden contribuir a mejorar la integración de las actividades preventivas. Por otro lado, se detecta la necesidad de mejorar las actitudes de los propios profesionales hacia la prevención

Objectives. To find out the opinions of primary care professionals on prevention activities in clinical practice, as well as the perceived obstacles to carrying them out and ways of overcoming them. Participants. A total of 129 professionals participated, including primary care doctors, nurses, technicians, primary care service managers, and public health professionals. Design. Delphi questionnaire sent by e-mail. Setting. Primary care in Catalonia, Spain. Main measurements and results. Two rounds were made with response rates of 48.9% and 67.4%, respectively. Convergence of over 40% was obtained in all the questions after the second round. The main problems for prevention in clinical practice were lack of time, lack of training and the attitudes of the professionals themselves towards prevention. To improve implementing prevention in the practice, the professionals pointed out, training in communication skills, advice methodology and the use of clinical practice guidelines. Conclusions. Health professionals pointed out some specific needs in training which could help to improve the inclusion of prevention activities. On the other hand, it was noted that the attitudes of the professionals themselves towards prevention need to be improved