Evaluation of the IMPACT study practitioner training intervention: using motivational interviewing to optimize self-management in psoriasis

Psoriasis is a common long-term, immune-mediated skin condition that is exacerbated by unhealthy lifestyle factors including smoking, excess alcohol and obesity. These behavioural factors are also linked to cardiovascular disease and depression,and both are associated with psoriasis. Psoriasis management should therefore address these factors, but previous research shows this is rarely done in practice. Motivational interviewing is an evidence-based approach to supporting patients with behaviour change in a range of long-term conditions, but has not been applied to psoriasis management in the clinical setting.We explored the efficacy, feasibility and acceptability of a motivational interviewing-informed training intervention (‘Pso Well®’: Psoriasis and Well-being) for healthcare professionals who manage psoriasis. This training intervention addresses cur-rent recommendations for psoriasis care to integrate physical,psychological and behavioural aspects, thereby supporting patients to make behavioural changes leading to improved health and quality of life. This study investigated (i) whether participating in the Pso Well® training intervention improves healthcare professionals’ behaviour change skills and knowledge of the behavioural factors related to psoriasis; (ii) whether intervention delivery of this kind is feasible to run within U.K.health settings; and (iii) whether the training content was acceptable to clinicians. Clinicians’ behaviour change skills were assessed before and after training using the Behaviour Change Counselling Index (BECCI) to score audio-recorded practitioner patient actor consultations. A 22-item questionnaire assessed clinician knowledge of behavioural factors related topsoriasis before and after training. Feasibility and acceptability data were explored via semi structured interviews with practitioners following training and were analysed using an inductive thematic analysis approach. Sixty-one practitioners completed the training (35 dermatology nurses, 23 dermatologists and three general practitioners). Practitioners’ BECCI scores increased significantly post-training [t(54) = 837, P < 0001;g2= 056], as did their knowledge scores [t(60) = 430,P < 0001]. Practitioners valued the training because it allowed them to examine and reflect upon their own consultation approach, and because it provided them with the skills and confidence to tackle challenging discussions with patients about lifestyle behaviours. Clinicians also highlighted that the training offers a significant shift in the usual consultation approach, and that they would like further training to consolidate these skills. The Pso Well® training improved healthcare practitioners’behaviour change skills in relation to providing holistic psoriasis management. Clinicians judged the training content to be relevant and useful, although further opportunity for skills consolidation may be needed. Investigation of the impact of the intervention on patient outcomes is now required.