Changes in Physical Therapist Students' Self-Efficacy for Physical Activity Counseling Following a Motivational Interviewing Learning Module

BACKGROUND AND PURPOSEThe lifestyle choices and personal health behaviors of many adults in the United States are contributing to increasing levels of chronic disease and disability.1 There is an urgent need for clinicians across health disciplines to assess the health-related behaviors of their patients and provide support and guidance to help their patients adopt healthier behaviors.2 Physical therapists (PTs) have both the knowledge and the opportunity to promote health and well-being by incorporating lifestyle modification interventions into their treatment programs.3 The American Physical Therapy Association (APTA) strongly supports a role for PTs in prevention, wellness, fitness, and health promotion.4 At the Second Physical Therapy Summit on Global Health, there was international consensus on the need for PTs to evaluate and address the following with their patients: smoking, nutrition, weight control, physical activity/ exercise, sleep, hygiene, stress, and alcohol and other substance abuse.5 Although studies have shown that PTs can effectively counsel patients in behavior change,6 many PTs do not discuss health behaviors with their patients.7,8 In a study of PTs in California, New York, and Tennessee, Rea et al found that only 54% of PTs discussed physical activity with their patients, 19% discussed nutrition and overweight issues, and 17% discussed smoking cessation.8 Rea et al further found that confidence in their counseling skills was the best predictor of whether a PT engaged in discussions about health behaviors with their patients.8 This finding is consistent with Social Cognitive Theory, which suggests that individuals are more likely to engage in a behavior if they have self-efficacy, a belief that they have the ability to successfully engage in that behavior.9Motivational interviewingMotivational interviewing (MI) is a patientcentered counseling technique first introduced by Miller in 1983 to help individuals change their behavior related to excessive alcohol consumption.10 The technique has since been found to be effective in helping individuals change many health-related behaviors, including drug abuse, diet, smoking, exercise, and weight loss.10 The Transtheoretical Model of behavior change, which describes the stages an individual passes through when changing a behavior, is a key theory underlying the MI counseling approach.11 The spirit of MI is collaborative and honors the patient's autonomy, and the counselor is nonjudgmental and nondirective.11 The 4 guiding principles include listening to the patient, understanding the patient's motivation and values, resisting the "righting reflex" or the urge to tell the patient what to do, and empowering the patient. During an MI session, the counselor helps the individual examine their personal values and ambivalence about behavior change and supports their self-efficacy and internal motivation for change.11Training in MIMI has been taught to health professionals across diverse fields of clinical practice including medicine, pharmacy, dentistry, social work, and nursing.12-20 Effective training programs have incorporated a variety of methods including lecture, discussion sessions, videos, role-playing, and practice with real or standardized patients.12,15-21 The duration of MI training sessions have ranged from 2 hours19,21 to 48 hours.15 Although there is support for using a multimodal approach to teaching MI, there does not appear to be consensus regarding the optimal length of training.22The purpose of this case report was to determine if a 4-hour MI multimodal learning module increased PT students' self-efficacy for counseling patients to increase their level of physical activity.CASE DESCRIPTIONMethodsThis learning module was conducted in the fall of 2013 with PT students entering their third year of study in an entry-level doctor of physical therapy educational program. A 1-group pretest-posttest design was employed using a convenience sample. …