Motivational Interviewing as a Strategy to Impact Outcomes in Heart Failure Patients: A Systematic Review

Pharmacy and physician assistant students experience benefits from an interprofessional education experience incorporating motivational interviewing training

Background

While interprofessional education (IPE) has become commonplace, incorporation of motivational interviewing (MI) using standardized patients (SPs) has been rare, particularly use of a multi-pronged strategy of engagement among pharmacy and physician assistant students.

Objective

The aim of this study was to determine the impact of an IPE MI training intervention that employed students in teams interacting with standardized patients (SPs); specifically, the intervention impact on MI self-efficacy, professional identity formation (PIF) and attitudes toward interprofessional care.

Methods

First-year PharmD students (PGY1) and second-year physician assistant students (PA-S2) underwent a three-hour didactic class session featuring lecture and video simulations followed by an activity where teams of 6-8 students interacted with 5 different standardized patients (SPs). The educational intervention also featured a group debriefing session and written reflection prompted by answering several questions about how they fared with the SPs. Students' completed pre- and post- intervention surveys featuring standardized instrumentation measuring self-efficacy to engage in MI, professional identity formation, and attitudes toward interprofessional education.

Results

Students did not achieve substantive gains in MI self-efficacy, yet reported significant improvements in professional identity formation and attitudes toward interprofessional education. Qualitative comments from the post-intervention survey were positive for interprofessional integration and team dynamics (n = 14), though both PGY1 and PA-S2 students commented that academic year concordance, i.e., matching a PGY1 with a PA-S1, in future simulations could improve self-efficacy and confidence.

Conclusions

An IPE event featuring lecture, interaction with SPs, and an opportunity for mutual self-reflection on one another's roles in patient care might be beneficial to include in pharmacy and PA curriculum, even while such endeavors might be further enhanced using a longitudinal approach.

Historical Gaps in the Integration of Patient-Centric Self-Management Components in HFrEF Interventions: An Umbrella Narrative Review

Background: Chronic disease self-management (CDSM) interventions have shown promise in improving patient outcomes in heart failure (HF), particularly for those with reduced ejection fraction (HFrEF). Patient-centric self-management programs often incorporate key components such as education, self-monitoring, and goal setting. However, the extent to which these components are consistently reported and integrated into studies remains unclear. This umbrella narrative review aims to analyze systematic reviews to assess the consistency of reporting on patient-centric self-management components implemented in trials and studies. Methods: This umbrella narrative review synthesized findings from systematic reviews and meta-analyses published between 2000 and 2023 for CDSM tools in HF. Eligible studies were assessed for the presence and consistency of reporting on education, self-monitoring, and goal setting in self-management interventions for HFrEF. Data extraction focused on the frequency of reporting these components and the gaps in reporting long-term patient outcomes. Results: Among the included systematic reviews, education was the most consistently reported component (100%), while self-monitoring and goal setting were each reported in around 50% of studies. Reporting of long-term outcomes, such as mortality and quality of life, was highly variable and often absent. These inconsistencies highlight significant gaps in the evidence base for CDSM interventions. Conclusions: This review identifies gaps in the consistent reporting of key CDSM components in systematic reviews of HFrEF interventions. The inconsistent inclusion of all three components together and limited reporting of long-term outcomes may hinder the development of a robust evidence base for the adoption of these tools in HF guidelines. Future studies should prioritize comprehensive reporting to strengthen the foundation for patient-centric self-management strategies in HF care. PROSPERO registration number CRD42023431539.

Motivational interviewing for reducing rehospitalisation and improving patient activation among patients with heart failure or chronic obstructive pulmonary disease: a randomised controlled trial

OBJECTIVES

The aim is to evaluate the effects of a motivational interviewing-based intervention, Supporting Patient Activation in Transition to Home, on rehospitalisation and patient activation among patients with heart failure or chronic obstructive pulmonary disease.

DESIGN

A randomised, controlled, analysis-blinded trial was conducted.

SETTING

Participants were recruited from two hospitals in mid-Sweden and the intervention and interviews were conducted post-discharge.

PARTICIPANTS

207 participants with heart failure or chronic obstructive pulmonary disease were recruited. Participants were randomised to receive five motivational interviewing sessions post-discharge (n=103) or a control group (n=104).

OUTCOME MEASURES

Rehospitalisation within 180 days post-discharge was retrieved, and patient activation was assessed using the Patient Activation Measure at baseline, 30, 90 and 180 days post-discharge. We used a generalised estimating equation to assess the difference in the secondary outcome, patient activation, between the intervention group and the control group during the 180-day follow-up.

RESULTS

No statistically significant differences between the groups were found for rehospitalisation (p=0.33 to 0.41) or patient activation over time (B=-1.67, -0.71 and -0.83 (95% CI -5.45 to 2.10, -4.06 to 2.64 and -4.28 to 2.62), respectively).

CONCLUSION

Post-discharge motivational interviewing to decrease rehospitalisation or support patient activation does not seem beneficial for patients with heart failure or chronic obstructive pulmonary disease. The high disease burden may have limited patient participation in the intervention.

TRIAL REGISTRATION NUMBER

NCT02823795.

Audio-Based Care for Managing Diabetes in Adults: A Systematic Review

OBJECTIVES

We compared the effectiveness of audio-based care, as a replacement or a supplement to usual care, for managing diabetes.

BACKGROUND

Diabetes is a chronic condition afflicting many in the United States. The impact of audio-based care on the health of individuals with diabetes is unclear, particularly for those at risk for disparities-many of whom may only be able to access telehealth services through telephone.

METHODS

We used systematic review methods to synthesize available evidence. We systematically searched for English-language articles from 2012 reporting randomized controlled trials of adults diagnosed with diabetes. We abstracted data on clinical outcomes (including A1c), patient-reported health and quality-of-life, health care access and utilization, care quality and experience, and patient safety.

RESULTS

Evidence for replacing in-person care with audio care was limited (n = 2), with low certainty of evidence for greater and comparable effectiveness for A1c and harms, respectively. Supplemental audio care (n = 23) had a positive effect on A1c (pooled mean difference A1c -0.20%; n = 8763; 95% CI: -0.36% to -0.04%), with moderate certainty of evidence. Stratified results indicated that audio interventions supplementing usual care performed more favorably in individuals with A1c ≤ 9%; populations not at risk of disparities; interventions with at least monthly contact; and interventions using remote monitoring tools.

CONCLUSIONS

This evidence base reveals some promise for managing diabetes with audio-based care as a supplement to in-person care. Future studies could further investigate the effectiveness of audio-based care as a replacement and modify interventions to better serve individuals with poor glucose control and those at risk for disparities.

Empowering Trusted Messengers With Motivational Interviewing Skills: Improving Dissemination of Accurate Information to Communities

BACKGROUND

Historical injustices, structural racism, and negative healthcare experiences contribute to Black and Brown communities' distrust of science. Bridging Research, Accurate Information, and Dialogue (BRAID) is a community engagement model that leverages trusted messengers to share accurate, co-created health and science messages to their community through their social networks. In our prior research, trusted messengers reported encountering resistance or "discord" when conveying information about controversial topics such as COVID-19 vaccines and the importance of diversity in clinical trials. Motivational Interviewing (MI) is an evidence-based communication style widely practiced by healthcare providers to guide ambivalent patients toward behavior change. However, MI's application by community members, particularly trusted messengers, as a strategy for enhancing health message dissemination remains unexplored.

PURPOSE

This study used mixed methods to explore the feasibility of training trusted messengers in MI to support the dissemination of public health messages through social networks. Specifically, we sought to understand perspectives on learning MI and use of MI in conversations about clinical trial diversity and research subject protection.

RESEARCH DESIGN

13 trusted messengers completed a MI introductory training.

RESULTS

Eighty-five percent found the training highly valuable, 54% reported high self-efficacy, and 69% expressed a desire for additional training. Qualitative analysis revealed trusted messenger endorsement of MI, recognition of MI's applicability to various contexts, and a sense of empowerment to share accurate information to their communities.

CONCLUSIONS

Our findings suggest that empowering trusted messengers with communication skills can be a practical, feasible, and cost-effective public health strategy for effective dissemination of accurate public health messages.

The Influence of Hybrid Comprehensive Telerehabilitation on Anxiety in Heart Failure Patients: The TELEREH-HF Randomized Clinical Trial

Telerehabilitation for heart failure (HF) patients is beneficial for physical functioning, prognosis, and psychological status. The study aimed at evaluating the influence of hybrid comprehensive telerehabilitation (HCTR) on the level of anxiety in comparison to usual care (UC). The TELEREH-HF study was a multicenter prospective RCT in 850 clinically stable HF participants. Patients underwent clinical examinations, including the assessment of anxiety, at entry and after the 9-week training program (HCTR) or observation (UC). The State-Trait Anxiety Inventory (STAI) was used. 20.3% HCTR and 20.1% UC patients reported high level of anxiety as a state at baseline, with higher STAI results in younger participants (< 63 y.o.) (p = .048 for HCTR; p = .026 for UC). At both stages of the study, patients with lower level of physical capacity (measured by a peak VO2) had shown significantly higher level of anxiety. There were no significant changes in anxiety levels during the 9-week observation for the entire study population, although there were different patterns of change in anxiety (both trait and state) in younger and older groups,with the decrease in younger patients, and the increase-in the older group.Trial registry number NCT02523560 (Clinical Trials.gov), date of registration: August 14, 2015.

Evidence inventory: A patient-centered framework for Centers for Medicare & Medicaid Services to assess the clinical benefit of drugs to inform its maximum fair price negotiation

The Inflation Reduction Act passed in August 2022 empowers the Centers for Medicare & Medicaid Services (CMS) to negotiate maximum fair prices for certain expensive drugs. In the process of determining maximum fair prices, CMS gathers evidence on the clinical benefits of these drugs as compared with their therapeutic alternative(s) from various sources. As patients are the primary beneficiaries of the treatment, we recommend that CMS should embrace an approach that prioritizes patient experience when evaluating such diverse sources of evidence in the assessment of the clinical benefit. Thus, we propose to draw on several existing frameworks to support the concept of "evidence inventory," a patient-centered approach to systematically evaluate benefits of drugs under consideration. This 4-step process to develop an evidence inventory includes the following: (1) Formulate the research question-in a PICO(T) (P = population, I = Intervention or exposure, C = comparator, O = outcome, and T = time frame) format, (2) Synthesize evidence, (3) Evaluate the evidence-using evidence inventory, and (4) Reevaluate evidence as new information become available. Patients and other relevant stakeholders play a critical role in each of these 4 steps. The proposed evidence inventory holds the potential to provide a structured and transparent patient-centered framework for evaluating the clinical benefits of drugs as compared with their therapeutic alternative(s) informing CMS maximum fair price negotiation.

Motivational communication skills to improve motivation and adherence in cardiovascular disease prevention: A narrative review

Lifestyle optimization is one of the most essential components of cardiovascular disease prevention. Motivational counseling provided by health care professionals could promote lifestyle modification. The purpose of the review is to identify possible evidence-based psychological principles that may be applicable to motivational counseling in the prevention of cardiovascular disease. These motivational communication skills promote behavioral change, improved motivation and adherence to cardiovascular disease prevention. A personal collection of the relevant publications. The review identified and summarized the previous evidence of implementation intentions, mental contrasting, placebo effect and nocebo effects and identity-based regulations in behavior change interventions and proposed their potential application in cardiovascular disease prevention. However, it is challenging to provide real support in sustainable CVD-risk reduction and encourage patients to implement lifestyle changes, while avoiding being unnecessarily judgmental, disrespectful of autonomy, or engaging patients in burdensome efforts that have little or no effect on the long run. Motivational communication skills have a great potential for effectuating sustainable lifestyle changes that reduce CVD-related risks, but it is also surrounded by ethical issues that should be appropriately addressed in practice. It is key to realize that motivational communication is nothing like an algorithm that is likely to bring about sustainable lifestyle change, but a battery of interventions that requires specific expertise and long term joint efforts of patients and their team of caregivers.

A Single-Center, Randomized Controlled Trial to Test the Efficacy of Nurse-Led Motivational Interviewing for Enhancing Self-Care in Adults with Heart Failure

BACKGROUND

The role of nurse-led motivational interviewing (MI) in improving self-care among patients with heart failure (HF) is promising, even if it still requires further empirical evidence to determine its efficacy. For this reason, this study tested its efficacy in enhancing self-care maintenance (primary endpoint), self-care management, and self-care confidence after three months from enrollment in adults with HF compared to usual care, and assessed changes in self-care over follow-up times (3, 6, 9, and 12 months).

METHODS

A single-center, randomized, controlled, parallel-group, superiority study with two experimental arms and a control group was performed. Allocation was in a 1:1:1 ratio between intervention groups and control.

RESULTS

MI was effective in improving self-care maintenance after three months when it was performed only for patients (arm 1) and for the patients-caregivers dyad (arm 2) (respectively, Cohen's d = 0.92, p-value < 0.001; Cohen's d = 0.68, p-value < 0.001). These effects were stable over the one-year follow-up. No effects were observed concerning self-care management, while MI moderately influenced self-care confidence.

CONCLUSIONS

This study supported the adoption of nurse-led MI in the clinical management of adults with HF.

Motivational counseling in the prevention of the development and progression of cardiovascular diseases

Despite significant progress in the development of novel methods for the prevention and treatment of cardiovascular diseases, their prevalence remains high, which is largely due to low adherence of patients to drug and non-drug preventive interventions. Motivational counseling (MC) is a unique technology that makes it possible to activate the patient’s desire to change their behavior towards a healthy one. The review presents an analysis of the literature on MC technology and the possibilities of its application in cardiology practice. Research data show the effectiveness of MC in improving the nutrition profile, physical activity, weight loss, smoking cessation, control of glycated hemoglobin in patients with diabetes, improving outcomes in patients with heart failure, increasing adherence to therapy, etc. Conducting MC using telemedicine technologies seems promising. The training of specialists is of paramount importance, since the effectiveness of this type of counseling largely depends on the accuracy of the consultant’s adherence to the essence and technologies of MC.

Effectiveness of motivational interviewing among patients with COPD: A systematic review with meta-analysis and trial sequential analysis of randomized controlled trials

OBJECTIVE

To evaluate the effectiveness of motivational interviewing (MI) for COPD in behavioral changes and health outcomes, and also verify the reliability of results in conjunction with trial sequential analysis and the Grading of Recommendations Assessment, Development, and Evaluation tool.

METHODS

Studies that implemented MI interventions for COPD patients were systematically searched by eight databases from inception to December 2021. Study screening, quality assessment, data extraction, and meta-analysis were conducted according to Cochrane standards.

RESULTS

Twenty-one studies involving 2344 patients were included. The results of meta-analyses indicated that MI made significant improvement in self-efficacy, lung function, quality of life, emotion, and COPD-related admission, but not in self-management and exercise capacity. Subgroup analyses found that the intervention duration was inversely associated with effect size for both self-efficacy and negative emotion severity. The trial sequential analysis showed MI improved patients' lung function and reduced COPD-related hospitalization with certainty, but the findings for exercise capacity need to be confirmed by further research.

CONCLUSIONS

This systematic review suggested the positive effects of MI on self-efficacy, lung function, quality of life, emotion and COPD-related hospitalization. To make a firm conclusion, more well-designed clinical trials with bigger sample sizes required.

PRACTICE IMPLICATIONS

Clinical and community nurses can use MI for COPD to increase healthy behaviors.

TRIAL REGISTRATION

CRD42021278674.

Motivational Interviewing Effects on Positive Airway Pressure Therapy (PAP) Adherence: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

This systematic review and meta-analysis examined Motivational Interviewing (MI) effects on positive airway pressure (PAP) adherence and related outcomes.

METHOD

Medline, CIHANL, Psych Info, Web of Science, PubMed, and Cochrane Database of Systematic Reviews were searched for randomized controlled trials published from peer-reviewed journals in English from 1990 to 2021 that compared objective PAP adherence among adults with obstructive sleep apnea (OSA) in a MI and non-MI intervention. A random effects meta-analysis model was completed at the 1-to-2-week, and 1-, 2-, 3-, and 12-month follow-up, and risk of bias was analyzed with the Cochrane Risk of Bias Tool.

RESULTS

In 10 trials of naïve PAP users and one trial of non-naïve PAP users, 14 to 277 middle-aged adults with moderate-to-severe OSA generally engaged in a brief, individual, face-to-face, MI intervention with standard care or a control condition. Several trials of naïve PAP users demonstrated that MI increased PAP use 1-2.6 hours per night, but a similar number of trials showed comparable conditions. Secondary outcomes were mixed. Among non-naïve PAP users, MI did not significantly increase adherence or secondary outcomes. The meta-analysis of PAP-naïve participants revealed that MI had a small to moderate significant effect on PAP adherence at 1, 2, and 3 months after beginning PAP (Hedges' g = 0.38 to 0.48; 95% CI = 0.04, 0.75) compared to standard care alone.

CONCLUSIONS

Despite heterogeneity, MI moderately increased PAP adherence among PAP-naïve adults with moderate-to-severe OSA, suggesting an effective strategy for short-term (1-3 months) adherence.

Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials

OBJECTIVES

The objective of this systematic review was to explore and report the evidence and gaps in the literature for randomized controlled trials (RCTs) studying the effects of motivational interviewing (MI)-based telehealth interventions on outcomes among persons with diabetes (PWD) or prediabetes.

METHODS

Following a modified Cochrane approach, we searched Pubmed, CENTRAL, CINAHL, PsycINFO, and Clinicaltrials.gov. Included studies were RCTs published in English before March 25, 2021 evaluating MI-based telehealth on outcomes for adults with diabetes or prediabetes.

RESULTS

A total of 21 retained articles captured results for 6436 PWD. Among the most commonly investigated outcomes, 60% of articles documented A1C reductions (ranging from<1% to>3%), 56% documented systolic blood pressure reductions, 57% documented diabetes self-efficacy/empowerment improvements, and 40% documented physical activity improvements. Conversely, diastolic blood pressure, lipid panels, body mass index, depressive symptoms, and quality of life were frequently measured outcomes, where MI-based telehealth yielded minor effects (<30% of articles demonstrating improvements).

CONCLUSIONS

MI-based telehealth seems most effective for improving A1C, systolic blood pressure, diabetes self-efficacy, and physical activity behaviors. Variability in outcome assessment and intervention heterogeneity were key challenges impeding comparisons across retained articles.

PRACTICE IMPLICATIONS

MI-based telehealth interventions demonstrate promising results for improving outcomes in PWD.

A Motivational Interviewing Intervention Improves Physical Symptoms in Patients with Heart Failure: A Secondary Outcome Analysis of the Motivate-HF Randomized Controlled Trial

CONTEXT

Heart failure (HF) patients experience high burden of physical symptoms during their disease trajectory.

OBJECTIVE

To evaluate the effects of Motivational Interviewing (MI) on the burden of physical symptoms in HF patients.

METHODS

We performed a secondary analysis of data from the MOTIVATE-HF randomized controlled trial. A sample of 510 patients (median 74 years, 58% male) and their caregivers (median 55 years, 75.5% female) was randomly allocated to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), and Arm 3 (standard of care). The MI intervention consisted of one face-to-face session plus three telephone calls conducted within two months from enrollment. Symptoms' burden was assessed with the Heart Failure Somatic Perception Scale (HFSPS) with the dimensions of Chest Discomfort, Dyspnea, Early and subtle and Edema. Data were collected at baseline and at 3, 6, 9, and 12 months after enrollment.

RESULTS

At 12 months, Chest Discomfort improved in Arms 1 and 2 vs Arm 3 (Δ: -8.13, 95% CI: -14.61; -1.65). Dyspnea improved in Arms 1 and 2 vs Arm 3 both at 9 and 12 months (Δ: -7, 95% CI: -13.18; -0.82 and -6.78, 95% CI: -13.19; -0.38); HFSPS total score improved in Arm 1 and Arm 2 vs Arm 3 at 9 months (Δ: -4.55, 95% CI: -9.05; -0.05). Over 1 year, Chest Discomfort and HFSPS total score in Arm 2 improved compared to Arm 3 (β= -2.61, 95% CI: -4.21; -1.00, P = 0.0015 and β=-1.35, 95% CI: -2.50; -0.21, P = 0.02).

CONCLUSION

MI reduces the burden of physical HF symptoms, particularly when caregivers are involved in the intervention.

Effects of Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease: a randomized controlled study

Aim. To assess the effects of the Pharmacy Care Program on medication adherence in outpatients with stable coronary artery disease (SCAD).

Material and methods. An open randomized controlled study was conducted in primary care clinic over the period of 2019-2020. All subjects (n=126) were randomized at visit 1 into the multifaceted intervention group (n=63) or control group (n=63) and invited 12 months after to visit 2. Patients of intervention group were included into the Pharmacy Care Program, which consisted of the following components: pharmacist-led counseling, provision of education materials and 7-day pillbox, weekly SMS-reminders. Medication adherence was measured initially and at the end of the study period by means of eight-item Morisky Medication Adherence Scale (MMAS-8) and Self-Efficacy for Appropriate Medication Use Scale (SEAMS).

Results. The implementation of the Pharmacy Care Program improved medication adherence in SCAD outpatients with MMAS-8 median score of 7,0-8,0 (p<0,001) and SEAMS median score of 35,0-36,0 (p=0,017). In the control group, no changes (p=0,123) in MMAS-8 score were revealed, while SEAMS score decreased from 35,0 down to 34,5 (p=0,003). The reduction in systolic blood pressure (p=0,049) and risk of urgent hospital admission (OR=0,28; 95% CI, 0,08-0,99; p=0,041) was registered in the intervention group in contrast to the control group over the 12-month period.

Conclusion. The multicomponent intervention within the Pharmacy Care Program contributed to an increase in the adherence to pharmacotherapy of outpatients with stable CAD.

Motivational interviewing as a new approach to improve outcome through self-care behavioural changes in advanced heart failure patient: a case report

Background

A lack of adherence and inadequate self-care behaviours are common reasons for recurrent hospitalizations among patients with heart failure (HF). Although patients recognize the importance of HF self-care, it is sometimes difficult to correct their behavioural patterns. Motivational interviewing is a communication technique to resolve ambivalence towards changing behaviour, and it has been widely used to promote behavioural changes and improve outcomes in various chronic diseases. We described a case of advanced HF with reduced ejection fraction in which motivational interviewing lead to stabilize the patient’s condition.

Case summary 

A 33-year-old man was diagnosed with dilated cardiomyopathy who experienced repeated episodes of HF requiring hospitalization despite optimal guideline-based HF treatment. Transthoracic echocardiography disclosed a severely reduced left ventricular (LV) contraction (LV ejection fraction 18%) and cardiopulmonary exercise testing disclosed markedly reduced functional capacity and increased ventilatory response (peak VO2 of 10.7 mL/min/kg, predicted peak VO2 of 34.7% and VE/VCO2 slope of 35.2). In this case, poor adherence to self-care such as excessive fluid intake and excessive daily activities after hospital discharge was the main cause of recurrent hospitalization for HF. Despite repeated patient education to correct his diet and lifestyle, he could not change his lifestyle behaviour. However, motivational interviewing dramatically helped stabilize the patient’s condition and prevent HF re-hospitalization.

Discussion 

In general, patients with advanced HF and reduced ejection fraction despite optimal medical therapy should be evaluated to assess their eligibility of cardiac transplantation or palliative care. Motivational interviewing might represent a new therapeutic approach for stabilizing and preventing HF through self-care behavioural changes, even in patients with advanced HF and severely reduced ejection fraction.

Characteristics of Patients Who Do Not Respond to Motivational Interviewing for Heart Failure Self-care

BACKGROUND

Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients.

OBJECTIVE

The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI.

METHODS

This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change <8 points) or MI responder (score change ≥8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]).

RESULTS

Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33-5.00], P = .005) and taking fewer medications (0.83 [0.74-0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25-14.95], P = .021) and higher baseline self-care management (1.06 [1.02-1.09], P < .001), explaining 35% of the variance in HF self-care management.

CONCLUSIONS

Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions.

Efficacy of motivational interviewing on enhancing self-care behaviors among patients with chronic heart failure: a systematic review and meta-analysis of randomized controlled trials

Although motivational interviewing (MI) seems to be promising for enhancing self-care behaviors (i.e., daily disease management and responses to symptoms) in patients with heart failure (HF), no quantitative pooling of effect sizes has been described to summarize and test its efficacy on self-care. Given that self-care behaviors of patients with HF are essential to enhance pharmacological adherence and disease management and optimize clinical outcomes, we sought to perform a systematic review of randomized control trials (RCTs) regarding MI's efficacy on enhancing self-care behaviors among patients with HF, synthesizing MI effects on self-care through meta-analyses. Nine randomized controlled trials were included. MI showed moderate effects on enhancing self-care confidence (Hedge's g = 0.768; 95%CI = 0.326-1.210; P = 0.001) and self-care management (i.e., responses to symptoms) (Hedge's g = 0.744; 95%CI = 0.256-1.232; P = 0.003) and large effects on improving self-care maintenance (i.e., adherence to treatment and symptom monitoring) (Hedge's g = 0.873; 95%CI  = 0.430-1.317; P < 0.001). No significant effects were found for enhancing the self-reported physical functioning (Hedge's g = -0.385; 95%CI = -1.063-0.294; P = 0.267) or the directly assessed physical functioning using the 6-min walking test (Hedge's g = -0.131; 95%CI = -0.981-0.720; P = 0.072). Although future research is still required to identify situation-specific indications regarding how MI should be implemented in relation to specific clinical conditions, this study showed that MI is an effective strategy to improve self-care in patients with HF.

Effectiveness of motivational interviewing on anxiety, depression, sleep quality and quality of life in heart failure patients: secondary analysis of the MOTIVATE-HF randomized controlled trial

Purpose

Anxiety, depression, poor sleep quality and lower quality of life (QOL) are associated with worse outcomes in heart failure (HF) patients. Motivational interview (MI) has been effective in different patient populations to promote self-care. However, its effect on anxiety, depression, sleep quality and QOL in HF patients is unknown. The aim of this study was to evaluate the effect of MI on anxiety, depression, sleep quality and QOL over 12 months from the intervention.

Methods

This was a planned, secondary outcome analysis of the MOTIVATE-HF study, a three-arm randomized controlled trial (1:1:1) evaluating the effect of MI in improving self-care in HF patients. In Arm 1, the patient received MI, while in Arm 2, the patient and the caregiver received MI. Arm 3, the control group, received standard treatment. Endpoints were evaluated with the Hospital Anxiety and Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), the 12-Item Short-Form Health Survey (SF-12) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) every three months for one year.

Results

We enrolled and randomized 510 HF patient and caregiver dyads (155 dyads in Arm 1, 177 dyads in Arm 2, and 178 dyads in Arm 3). A total of 238 HF patients and 235 caregivers completed the 12-month trial. No significant changes were seen in anxiety, depression and sleep quality over time among the three study arms, but disease-specific QOL improved in the intervention groups, especially in Arm 2.

Conclusion

Clinicians may want to include both patients and caregivers when providing MI interventions. Further research is needed to investigate the required intensity of MI to be effective on sleep quality, anxiety and depression (ClinicalTrials.gov Identifier: NCT02894502).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02788-3).

Feasibility and preliminary efficacy of a positive psychology-based intervention to promote health behaviors in heart failure: The REACH for Health study

OBJECTIVE

Most patients with heart failure (HF) struggle to adhere to health behaviors, and existing health behavior interventions have significant limitations. We developed a 12-week, phone-delivered, combined positive psychology (PP) and motivational interviewing (MI) intervention to promote well-being and adherence to physical activity, diet, and medications. In this three-arm, randomized trial, we assessed the feasibility, acceptability, and preliminary efficacy of the intervention compared to treatment as usual and MI-alone conditions in 45 patients with HF and suboptimal health behavior adherence.

METHODS

Participants in the PP-MI or MI-alone conditions completed weekly phone sessions for 12 weeks. Those in PP-MI completed weekly PP exercises and set health behavior goals, while those in the MI-alone condition learned about HF-specific health behaviors and identified potential behavior changes. Primary study outcomes were feasibility (sessions completed) and acceptability (0-10 ratings of PP exercise ease and utility). The intervention's impact on psychological and behavioral outcomes was assessed using mixed effects regression analyses.

RESULTS

Participants in the PP-MI condition completed 73% of sessions and rated PP exercises as easy to complete (mean = 7.5 [SD 1.7] out of 10) and subjectively useful (mean = 7.5 [SD 1.6] out of 10). Compared to the control conditions, PP-MI led to medium effect-size improvements in positive affect (Cohen's d = 0.32-0.77), moderate to vigorous physical activity (d = 0.41-0.74), and medication adherence (d = 0.48-0.78).

CONCLUSION

This PP-MI intervention was feasible, well-accepted, and associated with promising improvements in well-being and health behavior outcomes. Larger trials are needed to examine this intervention's impact on health behavior adherence and other important outcomes (NCT03220204).

Motivational interviewing to improve self-care in heart failure patients (MOTIVATE-HF): a randomized controlled trial

AIMS

Self-care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self-care maintenance (primary endpoint; e.g. taking medications), self-care management (e.g. responding to symptoms) and self-care confidence (or self-efficacy) 3 months after enrolment; (ii) changes self-care over 1 year, and (iii) augments patient self-care if informal caregivers are involved.

METHODS AND RESULTS

Parallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face-to-face MI session with three telephone contacts. Self-care was evaluated with the Self-Care of HF Index measuring self-care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self-care; ≥70 is considered adequate. At 3 months, self-care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self-care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self-care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow-ups. Over 1 year, Arm 2 had the best scores in self-care management.

CONCLUSIONS

MI significantly improved self-care in HF patients. Including caregivers may potentiate the effect, especially in self-care management. ClinicalTrial.gov, identifier: NCT02894502.

Motivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials

OBJECTIVE

This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients.

METHODS

Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior.

RESULTS

Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention.

CONCLUSION

Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate.