We have the recipe, but are we following it? Assessing a diabetes prevention program's motivational interviewing fidelity


Behaviour change interventions designed for exercise adherence and diet modification can reduce the risk of developing type 2 diabetes among those living with prediabetes. Training coaches to deliver these programs as intended increases treatment fidelity, an important aspect to assess delivery and intervention success. A strategy used to monitor and evaluate coaches’ skills post-training includes recording and coding regular client-coach encounters. Small Steps for Big Changes (SSBC) is a diabetes prevention program where clients meet for six one-on-one sessions with a coach. SSBC coaches are trained to deliver sessions using motivational interviewing (MI) at a client-centered level. The aim of this study was to assess treatment fidelity of MI skills for SSBC coaches through the use of the Motivational Interviewing Competency Assessment (MICA) tool. One session per client was randomly selected to be coded using the MICA. Preliminary results for nine SSBC coach-client sessions demonstrated a mean MICA score of 4.23/10 (± 1.25) with a score of 6/10 representing client-centered delivery. These results reflect a generally inconsistent use of MI. Presence of intentions and elements of MI were noted. On average, a client-centered approach was not represented in these findings. Strategies to increase coaches’ level of MI may include offering regular booster sessions and creating a community of practice for coaches to ask questions and improve their skills. Future research within SSBC may look to examine if differences in MI levels, used in delivery, influence client outcomes for exercise and diet adherence and type 2 diabetes risk reduction.