| Problem. Chronic illnesses are among the most prevalent, costly, and preventable of all health problems, contributing to long-term-illness, diminishing quality of life, and potentially hastening the decline of functioning and the ability of patients to remain in the community. Reducing the complications and symptoms of most chronic illnesses requires changes in behavior, the development of self-management competencies, and the willingness of the patient and family to adhere to treatment protocols. There is evidence that structured self-management and behavior change programs improve important outcomes in chronic illnesses. What is not known is the extent to which primary care practitioners use recommended methods arising from such programs. Purpose. An observational study was done to determine whether or not practitioners use motivational techniques when counseling patients with a chronic illness, to catalogue the types of techniques used, and to identify patterns related to patient characteristics. Methods. A descriptive study was conducted. A content analysis guided by Botelho's (1999) six-step approach to motivating patients was devised to analyze primary and secondary source data from 55 audiotaped or videotaped interactions (25 between NPs and patients and 30 between physicians and patients). Transcripts were evaluated per the stated aims and hypotheses. Results . 37.4% of practitioners were found to have used motivational techniques. There was no statistically significant difference in use between the two groups (X12 = 0.024 p = 0.956). Use of all 9 of the identified motivational techniques was observed, and both groups used the techniques of decisional balance and mutual goal setting, interpretation was hindered by small sample size. Implications. The impact of the consistent use of motivational techniques on the ultimate improvement in patient health outcomes clearly needs continued study. Issues related to research methodology, education, and clinical practice are also presented. |
