Improving Communication Skills Through Motivational Interviewing – A Convergent Parallel Mixed Method Study

Abstract: Context: Behavior change plays a significant role in the management of chronic diseases such as diabetes. Patients need to resolve their ambivalence towards behavior change through the support of an evidence-based approach such as Motivational Interviewing (MI). However, MI is not integrated into postgraduate medical curricula in the Philippines, limiting opportunities for students to develop patient-centered communication skills. Aims: To compare the students’ communication skills before and after MI training and describe their perceptions of learning MI. Settings and Design: This study was conducted at the Institute for Studies on Diabetes Foundation, Inc. (ISDFI), Philippines, using a convergent parallel mixed-methods design. Methods: All Certificate in Diabetes Management students (N=18) underwent a three-session MI Training. Before and after the training, a 20-minute standardized patient encounter audio recording was assessed using the Motivational Interviewing Treatment Integrity tool. Reflective papers were analysed using thematic analysis and subsequently mapped to Mezirow’s Transformative Learning Theory domains (content, process, and premise reflection). Quantitative and qualitative data were integrated through a joint display. Statistical analysis: Wilcoxon Signed Ranks Test was utilized for pre and post training comparisons. Results: Significant improvements were observed in the technical and relational MI scores, complex reflections, and reflection-to-question ratios. Qualitative findings showed progression from descriptive to transformative reflections, indicating enhanced awareness of ambivalence and stronger commitment to patient-centered care. Improved MITI scores aligned with collaboration, confidence, persistence, and professional identity. Conclusions: This study provides preliminary evidence that structured MI training may enhance communication competence and foster reflective learning among postgraduate diabetes practitioners.