JMIR Publications

ABSTRACT

Background:

Diabetes management remains a global challenge, especially in low- and middle-income countries, where the burden of disease continues to rise. General practitioners (GPs) play a crucial role in facilitating lifestyle changes in patients with type 2 diabetes. However, time constraints, lack of training in behavioral counseling, and limited use of patient-centered approaches hinder effective diabetes care. Motivational interviewing (MI) is a well-established method for promoting behavior change, yet its adoption by GPs remains limited due to insufficient training and support. While brief MI offers a promising solution for time-constrained settings, few studies have examined its impact on GPs’ knowledge and patient outcomes. This study addresses this gap by implementing a structured educational intervention incorporating both interactive and web-based learning, alongside practical guides to support MI in GP routine consultations.

Objective:

To evaluate the effectiveness of a combined educational methods on MI for GPs and GP trainees in improving their knowledge and confidence in the application of MI and its impact on diabetes patient outcomes in a primary care setting in Thailand.

Methods:

A mixed-methods study was used, including a before-and-after two-group design with quantitative assessments of knowledge, confidence, and patient biomarkers, supplemented by semi-structured interviews exploring participants' experiences with MI implementation. The study was conducted in a primary care unit affiliated with a medical school in Khon Kaen Province, Thailand, with three additional primary care units in Nakhon Phanom Province serving as the control group. A total of 32 GPs and GP trainees participated in the MI interactive workshop, with 28 completing pre- and post-tests, and ten providing qualitative feedback. The study group included 149 patients with diabetes, whereas the control group included 167 patients.

Results:

GP trainees who completed the MI training demonstrated a statistically significant increase in knowledge scores (pre-test: 11.46 ± 3.48, post-test: 15.04 ± 2.35; P < .001). Confidence in MI application also improved, particularly in engaging and evoking processes. After six months, patients managed by MI-trained GPs showed significant improvements in HbA1c (mean difference: -0.89, P = .04) and diastolic blood pressure (mean difference: -5.96 mmHg, P < .001) compared to the control group. Qualitative findings highlighted participants' appreciation for MI’s patient-centered approach, particularly brief MI, but revealed challenges in mastering advanced MI techniques and time constraints in clinical practice.

Conclusions:

The MI educational program significantly enhanced GP trainees’ knowledge and confidence in MI and led to measurable improvements in diabetes outcomes. Brief MI has emerged as a practical approach for primary care settings, although challenges remain in skill mastery and integration into routine consultations. Further training and support mechanisms, such as coaching and peer observations, may enhance long-term adoption and impact.