Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Razel Milo, PhD, DNP, MSN, FNP-C, AAOPM-BC

Abstract

Background: Despite America’s persistent focus on health, over 40% of the US population is obese. A significant obstacle to mitigating disease in those with obesity is inspiring lasting behavioral change. Motivational Interviewing (MI) is highly effective yet under-utilized for catalyzing personal change inertia. Recent meta-analyses demonstrated statistically significant improvement in BMI, A1C, and blood pressure. Objectives: This evidenced-based project (EBP) aimed to develop nurse practitioner (NP) skills in deploying fidelity-based MI, resulting in increased adherence to lifestyle interventions. Implementation: This EBP project implemented MI into routine primary care through a self-paced healthcare provider MI certification and a 45-minute skill practice session. Self-efficacy and provider MI fidelity were measured utilizing the Learning Self-Efficacy Scale (L-SES) and Motivational Interviewing Treatment Integrity (MITI 4.2.1) before, during, and at the end of three months. Results: Reflections to questions ratio (RQ) and change talk (CT) scores were monitored via recorded motivational interviews. The truncated mean RQ ratio improved by 50%, and mean CT scores increased by 20% post-intervention, indicating increased MI competency. Conclusions: Self-paced internet training, practice, and monitoring of fidelity improved nurse practitioner MI proficiency. Mastering MI skills can improve outcomes in obese patients with comorbidities such as diabetes and hypertension.

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Available for download on Wednesday, April 29, 2026

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