Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

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


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.

Available for download on Wednesday, April 29, 2026