Response to the Letter to the Editor

Finally, Adams et al. maintain that we did not take into account objective observation to ensure nurses ' fi delity to the principles of MI. In a separate paper [6], we reported MI skills based on 340 videos of nurse consultations. We believe that this activity informs us regarding the nurses ' fi delity, because we rated actual behaviour. Few studies have reported on actual MI behaviour so extensively. Nevertheless, it was demonstrated that the nurses improved only minimally in their MI skills. As suggested above more education and a more tailored setting might improve MI skills. In short, just like Adams et al. we were wondering why our comprehensive programme showed no effect on diabetes management. The video study indicated that the nurses hardly practised MI during the intervention period, but the other explanations could have contributed to our study outcome as well. No identifi able Hb1Ac or lifestyle change after a comprehensive diabetes programme including motiva-tional interviewing: A cluster randomised trial. education and training course in motiva-tional interviewing infl uence: GPs ' professional behaviour – ADDITION Denmark .[3] seling in primary care: Opportunities and challenges for changing practice .[4] tional interviewing improves weight loss in women with type 2 diabetes. [6] Weijden T , Grol R. Minimal improvement of nurses ' motivational interviewing skills in routine diabetes care one year after training: A cluster randomized trial. Adams et al. have some concerns about the interpretation of the results of our trial. In the paper " No identifi able HbA1c or lifestyle change after a comprehensive diabetes programme including motiva-tional interviewing: A cluster randomized trial " [1] we considered several options to explain our fi nd-ings which relate to the unease. First of all, we stated that the level of diabetes management in The Netherlands was perhaps too high to expect results that could be attributed to our programme. Second, we discussed that our education programme could be insuffi cient. We based our training programme on the study of Rubak et al. in general practices, which showed a positive effect of motivational interviewing (MI) on professional behaviour [2]. Our nurses did receive reminders and feedback, and although the participation at the follow-up meeting was low (37%), all nurses received three quarterly telephone follow-ups from the research team and they could call the research team at any time for information and questions. In the discussion section , we argued that …