肥満と減量療法のジャーナル

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Improving Sustainment of Weight Loss: Implementation of Motivational Interviewing in a Retail Health Setting

Christy Swinson and Stephanie Hodges

Objective: The aim of this quality improvement project was to implement the use of motivational interviewing in the retail health setting to achieve quality patient outcomes. The use of motivational interviewing was to provide a comprehensive method to address nutrition, diet, exercise, sleep, and medication adherence. The overall goal of the quality improvement measure was to identify a larger amount of weight loss for patients in a 3-month period, decreased waste circumference, and increased patient satisfaction with provider interactions, improved blood pressure readings, and overall sustainment of weight loss.

Method: Dorothea Elizabeth Orem’s self-care theory of nursing was utilized as the conceptual framework for facilitating sustained weight loss in the retail health setting. Motivational interviewing and peer coaching were the interventions being integrated to further improve lifestyle choices. The acronym FRAMES (Feedback, Responsibility, Advice, Menu, Empathy) was utilized as a method to guide discussions throughout patient encounters.

Results: The findings from the QI project did confirm that the use of motivational interviewing had a positive influence on overall weight loss and waist circumference. There was not a significant difference in the systolic or diastolic blood pressure measurements or overall BMI. There were a total of 36 patients that did not follow up for three consecutive visits. This group consisted of 7 males and 29 females. The racial breakdown of this group was 17 Caucasians, 14 African Americans, 4 Native American, and 1 Hispanic. The group that did not follow up as instructed had lower readiness for change results. This implies that those patients that arrive to the clinic motivated to adopt healthy lifestyle behaviors are more likely to remain committed to the program.

Conclusions: This quality improvement project serves to inform community leaders and stakeholders about the prevalence of obesity, devastating costs, and negative impact on population health. An evidence-based tool of motivational interviewing has been implemented as a solution to the epidemic of obesity. Collaborative efforts between key stakeholders, community leaders, schools, and churches are imperative to combat this problem. Based on the review of literature, low economic cost to implement this quality improvement measure, and patient benefits, motivational interviewing should be adopted by outpatient and inpatient providers.