T h e D i a b e t e s E d u c a t o r Volume 30, Number 3 • May/June 2004

4 0 4

Motivational Interviewing and Diet Modification: A Review

of the Evidence

Jeffrey J. VanWormer,

MS
n utrition is a key ele-
ment in the preven-
tion and management
of diabetes and other
associated comorbidities such as
high blood pressure and dyslipi-
demia.1-4 As such, the promotion
that influence eating (eg, environ-
ment, economics, and culture), es-
pecially among individuals who
are not ready to change.
Motivational interview-
ing (MI) has recently emerged as a
promising counseling model for
of healthy eating lies within the
Jackie L. Boucher, health promotion and disease
scope of practice for diabetes edu-
MS, RD, LD, BC-ADM, CDE management.9 This model focuses
cators5 and represents a funda-
on using a nonconfrontational
mental component of diabetes
and person-centered approach to
education.6 One of the most sig-
helping clients resolve ambiva-
nificant challenges for diabetes
lence, reduce resistance, and foster

professional
development
From HealthPartners Center for Health
Promotion, Minneapolis, Minnesota.
Correspondence to Jeffrey
VanWormer, HealthPartners Center for
Health Promotion, PO Box 1309, Mail-
stop 21111H, Minneapolis, MN 55440-
1309 (e-mail: jeff.j.vanwormer@
healthpartners.com).
Reprint requests may be sent
to The Diabetes Educator, 367 West
Chicago Avenue, Chicago, IL 60610-
3025.
educators and other healthcare
professionals involved in nutrition
education is how to initiate
lifestyle counseling.
Researchers and clini-
cians have long alluded to the
complexities involved in diet mod-
ification.7,8 Humans must eat be-
cause food consumption is a
necessary behavior for survival.
Diet modification typically in-
volves “tweaking” a series of ex-
isting behaviors versus adopting a
new one (eg, exercise) or eliminat-
ing an old one (eg, smoking). Due
to these and other factors, dietary
behavior change is commonly ap-
proached with some form of am-
bivalence or resistance.7 Education
is often recognized as a necessary,
but insufficient sole strategy for
addressing the complex factors
commitment to lifestyle change.10
Despite its limited history, MI has
already received much attention as
a helpful counseling model for di-
etitians and diabetes educa-
tors.11,12 The purpose of this article
is to provide a brief overview of
MI and to synthesize and critically
review the literature regarding its
efficacy for diet modification. Im-
plications for diabetes educators
and other healthcare professionals
involved in lifestyle counseling are
discussed based on these findings.
OVERVIEW OF MI
Motivational learning is formally
defined as a client-centered, direc-
tive method for enhancing intrin-
sic motivation to change by
exploring and resolving ambiva-
lence.10 This model was originally
developed for use in the treatment
of substance abuse disorders13 and

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 Professional Development
4 0 6 VanWormer, Boucher
is particularly recommended for
patients in the preaction stages of
behavior change (ie, precontem-
plation, contemplation, and
preparation).14 MI is embodied by
a spirit of collaboration, evoca-
tion, and support for personal au-
tonomy. The MI approach is
distinguished from some other
counseling models in that the
focus is not “I will change you”
but rather “If you wish, I can help
you change.”10 There are 4 guid-
ing principles of MI: (1) express
empathy, (2) develop discrepan-
cies, (3) roll with resistance, and
(4) support self-efficacy.
Expressing empathy in-
volves providing patients with an
atmosphere of respect and ac-
ceptance of their position,10 al-
lowing them to leave the office
feeling, at the very least, that their
concerns have been heard and
understood. This first principle of
MI is chiefly accomplished
through a technique called reflec-
tive listening, whereby patients
are allowed to express their per-
spective and clarify their barriers
while avoiding judgments and/or
criticisms. Expressing empathy
via reflective listening is generally
considered the foundation of MI
and is recommended throughout
the counseling process.
The second principle of
MI involves creating a gap be-
tween patients’ current behavior
and broader goals, thus cultivating
motivation for lifestyle change.10
When such discrepancies are rec-
ognized, a certain level of discon-
tent arises that makes change
more likely to occur. Discrepan-
cies are developed by exploring
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T h e D i a b e t e s E d u c a t o r
Volume 30, Number 3 • May/June 2004
patients’ important life values and In the Figure, some brief
reviewing how their current be- example scripts show how the
haviors affect their ideal lifestyle. general principles of MI may be
Although most patients are al- applied. Although a review of the
ready aware of the discrepancy be- specific counseling techniques in-
tween where they are and where volved in MI is beyond the scope
they would like to be, highlighting of this article, it should be empha-
these differences helps to amplify sized that MI is more than a sim-
the gap and resolve ambivalence. ple collection of skills.10 Some
techniques, such as asking open-
Directly challenging re-
ended questions and affirming
sistance is counterproductive to
progress, are natural to many
lifestyle change because it typically
counselors and clinicians. Others,
results in the patients defending
like agenda setting, reflective lis-
their current state of affairs. Ac-
tening, and scaling questions, are
cording to the third principle of
more in-depth and require at least
MI, resistance should be rolled
some formal training to imple-
with and channeled instead of
ment precisely.9,16,17
confronted.10 This is not to imply
that clinicians can not disagree MI AND DIETARY BEHAVIOR
with their patients’ viewpoint. CHANGE
Rolling with resistance invites pa- A literature search was conducted
tients to consider a new perspec- using the PubMed online database
tive versus having it imposed on (www.ncbi.nlm.nih.gov/entrez/
them. Resistance and ambivalence query.fcgi) to identify relevant arti-
should also be acknowledged as cles on MI and diet modification.
normal components of the behav- Additionally, the ancestry ap-
ior change process and, for the cli- proach18 was employed by search-
nician, should serve as a signal to ing bibliographies of selected
respond differently. studies. The following inclusion
criteria were identified: published
The fourth principle of
in the English language, direct as-
MI, self-efficacy, or one’s confi-
sessment of at least one dietary be-
dence in changing a specific be-
havior, and MI-based counseling
havior under difficult circum-
protocol used as the treatment (in-
stances,15 should be supported
dependent) variable. Given the
whenever possible because it is
novelty of MI in dietary counsel-
one of the best predictors of treat-
ing, no exclusions were placed on
ment outcome. Clinicians can
population, sample size, research
strengthen patients’ self-efficacy
design, or setting. Keywords used
by affirming past success (ie, rein-
in the computer search included
forcement), presenting success sto-
motivational interviewing, diet,
ries of others (ie, modeling), and
and nutrition. The primary out-
expressing their belief in patients’
come of interest was nutrition (eg,
potential to change.
calories, fat, sodium, and fruits/
vegetables). Secondary outcomes
such as treatment adherence and
weight loss were also examined.
 Professional Development
4 0 8 VanWormer, Boucher
SCRIPT EXAMPLES THAT APPLY THE GENERAL PRINCIPLES OF MI
Express Empathy
“Sounds like losing weight and
keeping up on your blood glucose
monitoring is demanding. I think it’s
natural to struggle sometimes with
trying to make so many changes at
once. What is it like for you? Are there
any situations that make it particularly
difficult?”
Support Self-Efficacy
“I see you have been keeping up on
your daily blood glucose monitoring
despite the difficulties adhering to
your diet. It looks like you had a lot of
initial success when you began
making these healthy changes. What
worked so well for you then?
Sometimes a setback can actually be
a good learning experience, and I
have seen many people in your
situation get right back on track.”
Studies were critiqued
using a simplified version of the
American Diabetes Association
(ADA) evidence grading system
(Table 1).19 In this structure, stud-
ies are assigned an evidence grade
of A, B, or C along with a strength
grade of 1, 2, or 3 depending on
methodological quality, support-
ing evidence (ie, favorable out-
comes), and estimated benefit to
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T h e D i a b e t e s E d u c a t o r
Volume 30, Number 3 • May/June 2004
Develop Discrepancies
“So on the one hand, you are not
sticking with your low-calorie diet
because it’s hard to find time to cook,
but on the other hand, you think
losing weight would make you feel
better and help you manage your
blood glucose level. It sounds like
managing diabetes is pretty important
to you. How do you think having a
high BMI affects things overall? Where
does the low-calorie diet fit in here?”
Roll With Resistance
“It can be very frustrating to make all
these changes, especially when you
have a busy schedule and others
giving you had a hard time. I think it’s
completely normal to want to go back
to old habits when times are tough.
May I tell you about some different
options that have worked well for
others trying to lose weight? If you’re
interested, I would also be glad to
help you problem solve around some
of the barriers that are making these
changes difficult.”
other persons at risk. A rating of RESULTS
A1, for example, is considered Twelve unduplicated records were
optimal because it is based on a initially returned from the online
well-designed clinical trial or search. Five publications (4 from
meta-analysis, provides support- PubMed, 1 from bibliographies)
ing evidence for the treatment were identified that met the search
variable, and is estimated to sub- criteria (Table 2)20-24: 4 studies re-
stantially benefit others in the at- cruited adult participants20-23 and
risk population. 1 study involved adolescents.24
One trial involved participants
with hypertension20 and 2 other
trials involved participants with
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VanWormer, Boucher Volume 30, Number 3 • May/June 2004 4 0 9

Table 1.

ADA Evidence Grading System Summary

Evidence Strength
Grade Definitions Recommendation Definition
A 1. Clear evidence from well-conducted, generalizable, randomized 1 Substantial benefit
controlled trials that are adequately powered, including to persons at risk
a. Evidence from a well-conducted multicenter trial
b. Evidence from a meta-analysis that incorporated quality ratings
2. Supportive evidence from a well-conducted, randomized controlled
trial that is adequately powered, including
a. Evidence from a well-conducted trial at 1 or more institutions
b. Evidence from a meta-analysis that incorporated quality ratings
B 3. Supportive evidence from well-conducted cohort studies, including 2 Moderate benefit
a. Evidence from a well-conducted prospective cohort study to persons at risk
b. Evidence from a well-conducted prospective registry
c. Evidence from a meta-analysis of cohort studies
4. Supportive evidence from a well-conducted case-control study
C 5. Supportive evidence from poorly controlled or uncontrolled studies, 3 Uncertain benefit to
including persons at risk
a. Evidence from randomized clinical trials with 1 or more major
or 3 or more minor methodological flaws that could invalidate
results
b. Evidence from observational studies with high potential for bias
c. Evidence from case series or case reports
6. Conflicting evidence with the weight of evidence supporting the
recommendations
7. Expert consensus or clinical experience without support from
research studies
Adapted from the American Diabetes Association.19

hyperlipidemia.21,24 Treatment
typically incorporated MI into a
nutrition education intervention
while comparison groups used
standard care or stepped-down
treatments (ie, self-help or written
information). Dependent mea-
sures varied across studies, with
fat intake representing the most
common outcome.21,23,24
In regard to nutrition, 1
study found a significant reduc-
tion in percent of energy from
fat (-1.3% for the Intensive In-
tervention Program vs +1.4%
for controls),23 1 study observed
a significant reduction in sodi-
um intake (–38 mmol/24 h for
the low-intervention vs +4 fat and cholesterol over time, but
mmol/24 h for controls),20 and an- did not use a control group for
other study noted a significant in- comparison.
crease in both fruit consumption
Two of the 3 studies that
(2.43 servings/d for the MI inter-
examined some facet of treatment
vention vs 1.60 servings/d for con-
adherence (eg, session attendance,
trols) and vegetable consumption
use of materials, or diet self-moni-
(2.67 servings/d for the MI inter-
toring) noted significant advan-
vention vs 2.13 servings/d for con-
tages for MI. Resnicow and
trols).22 Mhurchu and colleagues21
colleagues22 discovered that signif-
found significant reductions over
icantly more participants in the
time on a number of variables, in-
MI intervention used the study
cluding total calories, fat, carbohy-
cookbook and low-fat food
drates, and cholesterol. Results for
preparation practices. Berg-Smith
participants in the MI intervention,
and colleagues24 found a signifi-
however, were not superior to
cant increase in adherence ratings
standard care. Similarly, Berg-
to dietary guidelines between
Smith and colleagues24 found sig-
baseline and posttreatment.
nificant reductions in calories from
Bowen and colleagues23 observed

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 Professional Development
4 1 0 VanWormer, Boucher
a trend toward improved atten-
dance for participants in the MI
group, but did not find a signifi-
cant difference compared with
controls.
Results for weight loss
were mixed. Woollard and associ-
ates20 found a significant advan-
tage for one of the MI conditions
(–1.70 kg for the high intervention
vs +0.05 kg for controls), while
Mhurchu and colleagues21 found
no weight-loss advantages beyond
standard treatment.
Based on the ADA grad-
ing system,19 most of the studies
provided A-level evidence. Of the
2 studies that provided only C-
level evidence, 1 did not include a
control group24 and the other did
not find any significant benefits of
MI beyond standard care.21 The
studies generally recruited large
sample sizes; 4 studies used ran-
domized controlled designs.20-23
Perhaps the most significant
weakness across the investigations
involved the use of self-report in-
struments to assess nutrition. Al-
though self-reports are generally
considered the most practical and
common approach to such assess-
ments, there is some evidence to
question their reliability.25
CONCLUSIONS
Although the evidence base is lim-
ited, it appears that MI used in
combination with nutrition educa-
tion is at least moderately effica-
cious for facilitating diet modifica-
tion, offering an advantage
beyond standard education alone.
Significant benefits were observed
across several variables, including
reduced energy from fat, reduced
sodium intake, and increased fruit
and vegetable consumption. The
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T h e D i a b e t e s E d u c a t o r
Volume 30, Number 3 • May/June 2004
strongest results came from the this point. In addition, clinicians
study by Resnicow and col- need to know more about what
leagues22 in which a large sample impact, if any, MI has on other
recruited through African Ameri- risk factors or disease endpoints.
can churches increased their net Exploring how MI can transcend
fruit and vegetable consumption the traditional clinical counseling
by a mean of 1.1 servings per day environment via other communi-
over 1 year. Multiple self-report cation mediums, such as the Inter-
instruments were used in this net, would also help program
study to improve validity by cor- designers better understand the
roborating different aspects of di- scalability and sustainability of
etary intake. this treatment.
MI seems to create a con- IMPLICATIONS FOR
structive counseling environment DIABETES EDUCATORS
whereby participants are more What Does the Research
likely to adhere to treatment. Suggest?
Most studies used relatively few Diet modification (eg, consistent
MI sessions (median=3) and of- carbohydrate distribution, meal
fered a choice between phone and timing, and reduced fat intake) is
face-to-face contact. This finding one of the most common recom-
suggests that MI is a scalable treat- mendations given to diabetes pa-
ment that can be implemented in tients.26 Although MI has demon-
brief, convenient forms of delivery. strated the potential to modify
important outcomes related to di-
What is less clear, howev-
abetes, such as healthy eat-
er, is whether the positive gains
ing,20,22,23 glycemic control,27 and
achieved in the area of nutrition
others,9 more research is needed to
can be maintained and what im-
decisively conclude that MI is effi-
pact they ultimately have on
cacious in the context of diabetes
health. None of the investigations
education. No investigations to
conducted a follow-up assessment
date were identified that directly
beyond the treatment period,
assessed the effects of MI on nutri-
which was 3 to 5 months in all but
tion in participants with diabetes.
1 study. Furthermore, little data
was available to gauge the impact Is MI Beneficial Across
of these changes on other markers Other Areas of Diabetes
of health improvement, such as Care?
prevention or management of As with nutrition, no studies were
other chronic diseases (eg, dia- identified that used MI to directly
betes, coronary artery disease, and modify other key behaviors within
cancer). a diabetes population, such as ex-
ercise or medication adherence.
FUTURE RESEARCH
Two studies involving MI and pa-
The small number of studies high-
tients with diabetes were discov-
lights several gaps in the literature
ered in the search process, but they
for future research. Given the ab-
were excluded from the review be-
sence of data beyond 1 year, inter-
cause they did not directly assess
ventions using extended follow-up
nutrition. Smith and colleagues27
assessments are most needed at
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4 1 4 VanWormer, Boucher Volume 30, Number 3 • May/June 2004

Table 2.

Motivational Interviewing and Diet Modification Interventions

Study Design Sample Conditions

Woollard J, et Randomized 166 adult hypertensive patients 1. Control: usual general practitioner care
al.20 controlled trial randomized to 1 of 3 conditions; 2. Low intervention: educational manual discussing risk
data for 146 participants (79 factors and behavior modification strategies; one face-to-
males) were available for final face appointment and 5 MI-based phone counseling ses-
analysis sions (15 min) with nurse counselor
3. High intervention: same educational manual with 6
face-to-face MI counseling sessions (45 min) with nurse
counselor

Mhurchu CN, Randomized 121 patients diagnosed with hy- 1. Standard dietary: 3 sessions of lipid-lowering dietary
et al.21 controlled trial perlipidemia randomized to 1 of 2 advice from a clinical dietitian
conditions; data for 97 partici- 2. MI intervention: identical to standard group with addition
pants available for follow-up of MI techniques used during counseling sessions
analysis

Berg-Smith Pretest/ 127 adolescents (aged 13-17) Participants received one face-to-face MI session with a
SM, et al.24 posttest (no with elevated LDL-cholesterol; second follow-up MI session (phone or face-to-face) 1-3
control group) sample recruited from partici- months later
pants who had already received 3
years of dietary counseling in the
DISC Trial

Resnicow K, et Cluster- 1011 African American adults 1. Self-help: diet video, cookbook, quarterly newsletter, di-
al.22 randomized cluster-randomized (from 14 etary cues, and 1 phone call prompting use of materials
controlled trial churches) to 1 of 3 conditions; 2. Self-help plus MI: same as self-help group with addition
data for 861 participants available of 3 MI phone calls (4 total)
for follow-up analysis 3. Comparison: standard nutritional education materials

Bowen D, et Randomized 175 adult women participating in 1. Control: regular WHIDMT group sessions involving di-
al.23 controlled trial the Women’s Health Initiative Diet etary and behavioral skill training
Modification Trial (WHIDMT); data 2. Intensive intervention program (IIP): 3 MI sessions
for 164 participants available for (phone or face-to-face) with a dietitian in addition to regu-
follow-up analysis lar WHIDMT activities

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VanWormer, Boucher Volume 30, Number 3 • May/June 2004 4 1 5

Table 2.

Motivational Interviewing and Diet Modification Interventions (continued)

Treatment &
Assessment Period Outcomes Findings Grade/Comment
Treatment program 1. Blood pressure (systolic Both intervention groups significantly A1: supports the efficacy of MI-
lasted 18 weeks; and diastolic) lowered their systolic and diastolic based (phone and face-to-face)
assessments con- 2. Weight blood pressure compared with con- counseling for reducing blood
ducted at baseline 3. Sodium intake trols: the low intervention group sig- pressure, weight, sodium intake,
and posttreatment 4. Alcohol intake nificantly reduced their salt and and alcohol intake; fairly large
alcohol intake compared with con- sample size but self-report instru-
trols; the high intervention group sig- ment used to measure dietary in-
nificantly reduced their weight take
compared with controls
Treatment lasted 3 1. Lipid profile (total choles- Both groups improved their HDL, C3: well-conducted trial with im-
months; assess- terol, HDL, total/HDL ratio, total/HDL ratio, triglycerides, and provement for both groups over
ments conducted triglycerides) BMI relative to baseline; both groups time; results for lipid profile, nutri-
at baseline and 2. Nutrient intake (energy, fat, also significantly reduced their ener- ent intake, and BMI showed no sta-
posttreatment protein, carbohydrates, fiber, gy, fat, carbohydrate, and cholesterol tistically significant advantage of
alcohol, cholesterol) intake; differences between groups MI over standard care; self-report
3. BMI not significant on any measure instrument used to measure dietary
intake
Treatment lasted 3 1. Dietary intake (total fat, Participants significantly decreased C2: no randomized control group;
months; assess- saturated fat, cholesterol) their calories from fat and dietary results showed some support re-
ments conducted 2. Adherence to dietary guide- cholesterol, improved their dietary garding efficacy of MI (phone and
at baseline and lines. adherence and stage-of-change face-to-face) for reducing energy
posttreatment 3. Stage-of-change for dietary compared with baseline intake, improving treatment adher-
behavior ence, and advancing stage-of-
change; trial involved only
adolescents; self-report instrument
used to measure dietary intake
Treatment program 1. Fruit and vegetable intake MI group significantly increased their A1: supports efficacy of MI-based
lasted 1 year; as- 2. Outcome expectations fruit and vegetable consumption phone counseling for increasing
sessments con- 3. Self-efficacy compared with self-help and com- fruit/vegetable consumption and
ducted at baseline 4. Low-fat and high-fat veg- parison groups; MI participants also treatment adherence; good power
and posttreatment etable preparation practices significantly increased their use of in sample size but self-report in-
5. Portion size knowledge the cookbook and low-fat vegetable strument used to measure dietary
preparation practices compared with intake
the comparison group
Treatment program 1. Fat intake IIP participants significantly reduced A1: supports efficacy of MI (phone
lasted 5 months; 2. Attendance at WHIDMT their fat consumption compared with or face-to-face) for reducing fat in-
assessments con- group sessions controls; IIP participants also tended take; fairly large sample size but
ducted at baseline 3. Self-monitoring of fat intake to show better attendance and self- self-report instrument used to
(–6 months prior monitoring compared with controls measure dietary intake
to start of the in- but differences were not significant
tervention) and 1
year postbaseline

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 Professional Development T h e D i a b e t e s E d u c a t o r

4 1 6 VanWormer, Boucher Volume 30, Number 3 • May/June 2004

found that MI helped obese adults
diagnosed with type 2 diabetes im-
prove their glycemic control.
Roisin and colleagues28 found no
significant advantages in hemo-
globin A1c (A1C), weight, body
mass index, or blood pressure for
an MI-based diabetes counseling
protocol.
At least 1 other clinical
trial is currently underway to as-
sess whether MI can improve nu-
trition and exercise for patients
with diabetes.29 In addition, 2
other trials are investigating how
MI can promote healthy eating
and physical activity in general
populations.30,31 Results from
these investigations will help dia- these lingering questions, several
betes educators and other health- MI-based counseling tools and
care professionals draw stronger protocols have been promoted for
conclusions regarding the utility of use in diabetes education.32-35
MI for modifying diabetes-related Practitioners interested in learning
outcomes. more about how to apply techni-
cal MI skills may find these tools
Should I Use MI in My
helpful given that such techniques
Practice?
are not yet common among
The lack of available studies in pa-
dietetic professionals.36 Interested
tients with diabetes does not per-
readers are referred to the latest
mit recommending MI across all
edition of Miller and Rollnick’s
areas of diabetes education. Based
book, Motivational Interviewing:
on the literature review, however,
Preparing People for Change,10
it appears that MI is a promising
or to the MI Web site (www.
counseling model that can, at the
motivationalinterview.org) for
very least, moderately enhance
more information on training.
diet modification. Despite some of

R E F E R E N C E S

1. Franz MJ, Bantle JP, Cholesterol in Adults 6. Mensing C, Boucher

Beebe CA, et al. Evi- (Adult Treatment Panel J, Cypress M, et al. Na-
dence-based nutrition III). JAMA. 2001;285:2 tional standards for dia-
principles and recom- 486-2497. betes self-management
mendations for the treat- education. Diabetes
4. Chobanian AV, Bakris
ment and prevention of Care. 2000;23:682-689.
GL, Black HR, et al. The
diabetes and related
Seventh Report of the 7. Kumanyika SK, Van
complications. Diabetes
Joint National Committee Horn L, Bowen D, et al.
Care. 2003;26(suppl 1):
on Prevention, Detection, Maintenance of dietary
S51-S61.
Evaluation, and Treat- behavior change. Health
2. Shils ME, Olson JA, ment of High Blood Psychol. 2000;
Shike M, Ross AC. Mod- Pressure: the JNC 7 re- 19(suppl 1):42-56.
ern Nutrition in Health port. JAMA. 2003;289:
8. Sherman AM, Bowen
and Disease. 9th ed. 2560-2573.
DJ, Vitolins M, et al.
Philadelphia: Williams &
5. American Association Dietary adherence: char-
Wilkins; 1999.
of Diabetes Educators acteristics and interven-
3. Executive summary of Task Force. The 1999 tions. Control Clin Trials.
The Third Report of the scope of practice for dia- 2000;21(suppl 5):
National Cholesterol Ed- betes educators and the 206S-211S.
ucation Program (NCEP) standards of practice for
Expert Panel on Detec- diabetes educators. Dia-
tion, Evaluation, and betes Educ. 2000;26:
Treatment of High Blood 519-525.

Downloaded from tde.sagepub.com at UNIV OF PITTSBURGH on March 18, 2015

 Professional Development T h e D i a b e t e s E d u c a t o r

4 1 8 VanWormer, Boucher Volume 30, Number 3 • May/June 2004

9. Resnicow K, Dilorio 15. Bandura A. Self-effi- 20. Woollard J, Beilin L,

C, Soet JE, Ernst D, Bor- cacy: The Exercise of Lord T, Puddey I,

relli B, Hecht J. Motiva- Control. New York: WH MacAdam D, Rouse I. A
tional interviewing in Freeman; 1997. controlled trial of nurse
health promotion: it counseling on lifestyle
16. Doherty Y, Hall D,
sounds like something is change for hypertensives
James PT, Roberts SH,
changing. Health Psy- treated in general prac-
Simpson J. Change
chol. 2002;21:444-451. tice: preliminary results.
counselling in diabetes:
Clin Exp Pharmacol
10. Miller WR, Rollnick the development of a
Physiol. 1995;22:
S. Motivational Inter- training programme for
466-468.
viewing: Preparing Peo- the diabetes team. Pa-
ple for Change. 2nd ed. tient Educ Counsel. 21. Mhurchu CN, Mar-
New York: Guilford Press; 2000;40:263-278. getts BM, Speller V. Ran-
2002. domized clinical trial
17. Miller WR, Mount
comparing the effective-
11. Thorpe M. Motiva- KA. A small study of
ness of two dietary inter-
tional interviewing and training in motivational
ventions for patients with
dietary behavior change. interviewing: does one
hyperlipidaemia. Clin
J Am Diet Assoc. 2003; workshop change clini-
Sci. 1998;95:479-487.
103:150-151. cian and client behavior?
Behav Cognitive Psy- 22. Resnicow K, Jackson
12. VanWormer JJ,
chother. 2001;29: A, Wang T, et al. A moti-
Boucher JL. Motivational
457-471. vational interviewing in-
interviewing and diabetes
tervention to increase
education: fostering 18. White HD. Scientific
fruit and vegetable intake
commitment to change. communication and liter-
through black churches:
In: Arnold L, ed. On The ature retrieval. In: Cooper
results of the Eat for Life
Cutting Edge [newsletter H, Hedges L, eds. The
Trial. Am J Public Health.
of the DCE Practice Handbook of Research
2001;91:1686-1693.
Group of the American Synthesis. New York:
Dietetic Association]. Russell Sage Founda- 23. Bowen D, Ehret C,

2003;24:14-16. tion; 1994:41-55. Pedersen M, et al. Re-

sults of an adjunct di-
13. Miller WR. Motiva- 19. Davidson MB, ed.
etary intervention
tional interviewing with American Diabetes Asso-
program in the Women’s
problem drinkers. Behav ciation: clinical practice
Health Initiative. J Am
Psychother. 1983;11: recommendations 2003.
Diet Assoc. 2002;102:
147-172. Diabetes Care. 2003;
1631-1637.
26(suppl 1):S1-S156.
14.Prochaska JO, Velicer
24. Berg-Smith SM,
WF The Transtheoretical
Stevens VJ, Brown KM,
Model of Health Behavior
et al. A brief motivational
Change. Am J Health
intervention to improve
Promotion. 1997;12:
dietary adherence in
38-48.
adolescents. Health Educ
Res. 1999;14:399-410.

Downloaded from tde.sagepub.com at UNIV OF PITTSBURGH on March 18, 2015

Professional Development
VanWormer, Boucher
25. Kristal AR, Andrilla
CH, Koepsell TD, Diehr
PH, Cheadle A. Dietary
assessment instruments
are susceptible to inter-
vention-associated re-
sponse set bias. J Am
Diet Assoc. 1998;98:
40-43.
26. Leggett-Frazier N,
Swanson MS, Vincent
PA, Pokorny ME, Engelke
MA. Telephone commu-
nications between dia-
betes clients and nurse
educators. Diabetes
Educ. 1997;23:287-293.
27. Smith DE, Kratt PP,
Heckemeyer CM, Mason
DA. Motivational inter-
viewing to improve ad-
herence to a behavioral
weight-control program
for older obese women
with NIDDM. Diabetes
Care. 1997;20:52-54.
28. Roisin P, Stott NCH,
Rollnick SR, Rees M. A
randomized controlled
trial of an intervention
designed to improve the
care given in general
practice to type II diabet-
ic patients: patient out-
comes and professional
ability to change behav-
iour. Fam Pract.
1998;15:229-235.
29. Clark M, Hampson
SE. Implementing a psy-
chological intervention to
improve lifestyle self-
management in patients
with type 2 diabetes. Pa-
tient Educ Counsel.
2001;42:247-256.
30. Moe EL, Elliot DL,
Goldberg L, et al. Pro-
moting Healthy Life-
styles: Alternative
Models’ Effects
(PHLAME). Health Educ
Res. 2002;17:
586-596.
31. Resnicow K, Jackson
A, Braithwaite R, et al.
Healthy Body/Healthy
Spirit: a church-based
nutrition and physical
activity intervention.
Health Educ Res. 2002;
17:562-573.
32. Stott NCH, Rollnick
S, Rees MR, Pill RM. In-
novation in clinical
method: diabetes care
and negotiating skills.
Fam Pract. 1995;12:
413-418.
33. Doherty Y, Roberts
S. Motivational inter-
viewing in diabetes prac-
tice. Diabetic Med.
2002;19(suppl 3):1-6.
Downloaded from tde.sagepub.com at UNIV OF PITTSBURGH on March 18, 2015
T h e D i a b e t e s E d u c a t o r
Volume 30, Number 3 • May/June 2004 4 1 9
34. Heins JM, Delahanty
L. Tools and techniques
to facilitate eating behav-
ior change. In: Coulston
AM, Rock CL, Monsen
ER, eds. Nutrition in the
Prevention and Treatment
of Disease. San Diego:
Academic Press; 2001:
113-115.
35. Welch G, Guthrie
DW. Supporting lifestyle
change with a computer-
ized psychosocial as-
sessment tool. Diabetes
Spectrum. 2002;15:
203-207.
36. Brown SL, Pope JF,
Hunt AE, Tolman NM.
Motivational strategies
used by dietitians to
counsel individuals with
diabetes. Diabetes Educ.
1998;24:313-318.