Assessing Physician’s Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test

Abstract

Background Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. Objective The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC—the Motivational Communication Competency Assessment Test (MC-CAT). Methods Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. Results The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (α=.78). Conclusions The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases.

Addressing sex and gender to improve asthma management

“… Confirm diagnosis with spirometry 10 , and use validated measurements of asthma control e.g., asthma control questionnaire or asthma control test, which help to objectively assess the severity of patients’ symptoms and response to treatment 10 . Discussion guides that help patients understand their asthma may prompt conversations to gain insight into their symptoms and daily life limitations so that appropriate support can be offered by HCPs and asthma educators 11 , 12 . …”

“…Discussion guides that help patients understand their asthma may prompt conversations to gain insight into their symptoms and daily life limitations so that appropriate support can be offered by HCPs and asthma educators 11 , 12 .…”

“…Men and women often have different reasons for smoking or not quitting, and motivational communication (Fig. 2 12 ) could be used to understand these reasons and tailor cessation advice.

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“…Good HCP–patient communication is vital, and time spent with patients exploring their concerns, encouraging health behavior changes, and supporting self-management can improve medication adherence and asthma control 11 . Motivational communication is a form of patient-centered behavior-change counseling that focuses on enhancing internal motivation to engage in appropriate self-management behaviors 11 , 12 , 54 . There is evidence that the impact of motivational communication can depend on the gender of the patient and of the HCP 51 .…”

“…Author guidance: Consider undertaking evidence-based training on motivational communication (Fig. 2 ) 12 . As the impact of motivational communication can depend on the gender of the patient and the HCP 51 , training undertaken should try to address this discrepancy.…”