title: Training Primary Care Physicians to Employ Self-Efficacy-Enhancing Interviewing Techniques: Randomized Controlled Trial of a Standardized Patient Intervention.
abstract: Primary care providers (PCPs) have few tools for enhancing patient self-efficacy, a key mediator of myriad health-influencing behaviors.
  
  
  
  To examine whether brief standardized patient instructor (SPI)-delivered training increases PCPs' use of self-efficacy-enhancing interviewing techniques (SEE IT).
  
  
  
  Randomized controlled trial.
  
  
  
  Fifty-two family physicians and general internists from 12 primary care offices drawn from two health systems in Northern California.
  
  
  
  Experimental arm PCPs received training in the use of SEE IT training during three outpatient SPI visits scheduled over a 1-month period. Control arm PCPs received a single SPI visit, during which they viewed a diabetes treatment video. All intervention visits (experimental and control) were timed to last 20 min. SPIs portrayed patients struggling with self-care of depression and diabetes in the first 7 min, then delivered the appropriate intervention content during the remaining 13 min.
  
  
  
  The primary outcome was provider use of SEE IT (a count of ten behaviors), coded from three audio-recorded standardized patient visits at 1-3 months, again involving depression and diabetes self-care. Two five-point scales measured physician responses to training: Value (7 items: quality, helpfulness, understandability, relevance, feasibility, planned use, care impact), and Hassle (2 items: personal hassle, flow disruption).
  
  
  
  Pre-intervention, study PCPs used a mean of 0.7 behaviors/visit, with no significant between-arm difference (P = 0.23). Post-intervention, experimental arm PCPs used more of the behaviors than controls (mean 2.7 vs. 1.0 per visit; adjusted difference 1.7, 95 % CI 1.1-2.2; P < 0.001). Experimental arm PCPs had higher training Value scores than controls (mean difference 1.05, 95 % CI 0.68-1.42; P < 0.001), and similarly low Hassle scores.
  
  
  
  Primary care physicians receiving brief SPI-delivered training increased their use of SEE IT and found the training to be of value. Whether patients visiting SEE IT-trained physicians experience improved health behaviors and outcomes warrants study. CLINICALTRIALS.
  
  
  
  NCT01618552.
authors.affiliation: Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA, 95618, USA. afjerant@ucdavis.edu.|Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA. afjerant@ucdavis.edu.
authors.forename: Anthony
authors.initials: A
authors.lastname: Jerant
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.|Department of Internal Medicine, Division of General Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Kravitz
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.|Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tancredi
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.|Department of Internal Medicine, Division of General Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.|Department of Sociology, Sonoma State University, Rohnert Park, CA, USA.
authors.forename: Debora A
authors.initials: DA
authors.lastname: Paterniti
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Lynda
authors.initials: L
authors.lastname: White
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Baker-Nauman
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Dionne
authors.initials: D
authors.lastname: Evans-Dean
authors.affiliation: Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Chloe
authors.initials: C
authors.lastname: Villarreal
authors.affiliation: Sutter Medical Foundation, Sacramento, CA, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Ried
authors.affiliation: Sutter Medical Foundation, Sacramento, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hudnut
authors.affiliation: Department of Family and Community Medicine, University of California Davis School of Medicine, 4860 Y Street, Suite 2300, Sacramento, CA, 95618, USA.|Center for Healthcare Policy and Research, University of California Davis School of Medicine, Sacramento, CA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Franks
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D016544:Patient Simulation; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods*; D012648:Self Care / Q000523:psychology; D020377:Self Efficacy
keywords: continuing professional development; health behavior; patient engagement; physician behavior; primary care