Diabetes-related foot disease (DFD), which is one of the main complications of diabetes mellitus, consists of ulceration and infection, and often leads to hospitalisation, amputation and negative impacts on quality of life. The implementation of evidence-based DFD clinical guidelines has led to a reduction in DFD-related hospitalisation and amputation rates in some countries, but DFD remains a top 10 leading cause of the global burden of disability. One of the many factors that contribute to

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... high DFD global burden is insufficient patient engagement with guideline recommended treatment. It is possible that this insufficient engagement may be in part due to the way in which health practitioners communicate with persons with DFD. Instruction is often not enough to elicit behaviour change and if it does, the behaviour change is usually only short-term. However, as with other diabetes-related treatments, sustained motivation and behaviour change is needed for people with DFD to obtain health benefits from their efforts at self-care. Motivational Interviewing (MI) offers an empathic and safe context for people to consider behaviour changes. It has extensive evidence supporting its effects on motivation and improving health-maintaining behaviours in other health conditions, and recent research suggests that integrating mental imagery into MI may further increase its impact. However, the effective clinical application of MI requires that Health Professionals (HPs) acquire MI-related competencies and be able to implement them in routine practice. Research on training podiatrists treating people with DFD to use MI is indicated, but yet to be undertaken. Aims The primary aims of this thesis were to: 1. Undertake a systematic literature review to identify research on MI training for HPs working with persons who have DFD or diabetes. 2. Design and implement a training course in imagery-based MI for podiatrists working with persons with DFD and conduct a mixed methods pilot study to investigate both the effects of this training on the MI-related skills and the experiences of participating podiatrists. The Impact of Motivational Interviewing Training for Podiatrists Treating People with Diabetes-Related Foot Disease iii Methods The systematic review involved a search of PubMed, EMBASE and PsycINFO databases using the terms 'motivational interviewing', 'motivation enhancement', and 'diabetes'. Two assessors independently screened titles, abstracts and full texts for papers reporting the effects of MI training on diabetes HPs outcomes. Outcomes of interest were methods and duration of training, and uptake and maintenance of MI skills. Included papers were independently examined by two assessors for risk of bias, had key data extracted and were summarised. The pilot study involved recruiting eleven podiatrists working with persons with DFD and training them in MI and FIT over two sessions (8 hours in total). At baseline, 2-and 12-weeks post-training, audio recordings of two patient sessions per podiatrist were obtained and rated for their use of MI and FIT skills. Job satisfaction surveys were completed at baseline and 12 weeks post-training, along with a semi-structured interview conducted on the experience of the podiatrist at 12 weeks post-training. Results In the systematic review, 625 unique records were identified and screened, 58 full texts were assessed, and 18 papers were included. Two additional papers were included from forward and backward searches, resulting in a total 20 included papers from 15 unique studies. Outcome measures varied widely between studies and risk of bias scores ranged from 3-8 (out of 10). Eighty percent of studies (12 out of 15) provided 16 hours or more training. All 15 studies reported some improvement in MI skills, with 12 finding improvements in more than 50% of MI skills investigated and three in less than 35%. All studies showed HPs acquired and applied some MI skills post-training. No papers described MI training of podiatrists. In the pilot study, significant improvements over time (p=.006-.044) with substantial effect sizes (η2=.50-.67) were found in three of four global MI related communication skills and two of four MI behaviours. However, effects on these indices were not sustained to 12 weeks, and imagery was rarely used. Job satisfaction remained unchanged from baseline; however, baseline satisfaction was already high. In qualitative interviews, MI training and skills were valued by podiatrists, but significant challenges in using MI when treating people with DFD were reported. The Impact of Motivational Interviewing Training for Podiatrists Treating People with Diabetes-Related Foot Disease iv Conclusions The systematic review showed that training in MI seems to improve the use of some MI skills in diabetes HPs, but studies were heterogeneous, rendering comparisons difficult. A first-ever pilot study indicated podiatrists who treat people with DFD may improve MI-related skills and use them in the short-term following MI-training. However, additional training, support and feedback may be required to obtain sustained effects. Further research studies are now needed to confirm sustained changes in practitioner practice and to investigate subsequent outcomes for people with DFD.