The effects of motivational interviewing on hypertension management: A systematic review and meta-analysis

Motivational interviewing for improving functional and psychosocial outcomes among stroke survivors

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the benefits and harms of motivational interviewing for functional and psychosocial outcomes in stroke survivors, compared to no intervention, waiting list, or attention controls.

Motivational interviewing intervention for the management of hypertension: a meta-analysis

Background

Improving medication compliance and self-efficacy in hypertensive patients is of significant importance for their prognosis. This meta-analysis aimed to assess the role of motivational interviewing in reducing systolic and diastolic blood pressure, self-efficacy, quality of life and medication adherence in hypertensive patients.

Methods

Two authors searched PubMed, Cochrane Library, Clinicaltrials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database, Weipu and Wanfang Database up to May 28, 2024 for randomized controlled trials (RCTs) evaluating the role of motivational interviewing on hypertensive patients. The search was restricted to articles published in English and Chinese languages. RevMan 5.4 software was used for meta-analysis.

Results

A total of 16 RCTs were included. The meta-analysis findings demonstrate that motivational interviewing could reduce both systolic pressure [MD = -3.26, 95% CI (-5.16, -1.36), P < 0.001] and diastolic blood pressure [MD = -1.78, 95% CI (-3.48, -0.08), P < 0.001] levels in hypertensive patients, while simultaneously enhancing their self-efficacy [MD = 2.92, 95% CI (1.84, 4.00), P = 0.001], quality of life [MD = 6.99, 95% CI (3.25, 10.74), P = 0.003], and medication compliance [OR = 4.30, 95% CI (1.53, 12.10), P = 0.003]. No significant publication bias across the synthesized outcomes were found by Egger regression analyses (all P > 0.05).

Conclusions

Motivational interviewing has been shown to effectively reduce blood pressure in the short term among individuals with hypertension, while simultaneously enhancing their self-efficacy, quality of life, and adherence to medication regimens.

Supporting cardiomyopathy screening behavior in adult survivors of childhood cancer: an eHealth motivational interviewing-framed pilot intervention

PURPOSE

The Healthy Hearts pilot study evaluated the effect of an eHealth motivational interviewing-framed intervention on cardiomyopathy screening-related knowledge, health beliefs, intrinsic motivation, and behavioral action steps among adult survivors of childhood cancer.

METHODS

We consented N = 73 survivors to participate in a single-arm pilot study. Participants completed an online baseline survey (n = 68) assessing knowledge, health beliefs, and intrinsic motivation related to cancer therapy-induced cardiomyopathy and screening echocardiograms. Then, they engaged in two sessions with a fully automated web-based health intervention platform based on motivational interviewing techniques to build motivation. Participants completed an online post-intervention survey (n = 61) re-assessing knowledge, health beliefs, and intrinsic motivation and a 1-month follow-up survey (n = 59) assessing actions taken toward obtaining an echocardiogram and intervention satisfaction.

RESULTS

Participant age averaged 40.5 years (SD = 7.2). Most self-identified as women (n = 42) and non-Hispanic white (n = 62). Paired t-tests revealed statistically significant pre-post changes in several health beliefs and elements of intrinsic motivation. Specifically, we observed decreases in perceived barriers (p < .001) and increases in knowledge (p < .001), perceived benefits (p < .001), self-efficacy (p < .001), perceived importance (p = .001), confidence (p = .02), and intentions (p < .001). By 1-month follow-up, 38.6% of participants had engaged in behavioral action steps (e.g., set echocardiogram appointment). Intervention satisfaction was moderately high (M = 3.9, SD = 0.9, median = 4, min = 2, max = 5).

CONCLUSIONS

Results provide preliminary indications of efficacy of the eHealth motivational interviewing-framed intervention on uptake of screening echocardiograms among adult survivors of childhood cancer.

IMPLICATIONS FOR CANCER SURVIVORS

An eHealth motivational interviewing-framed intervention could increase childhood cancer survivors' ability to receive high-quality support for engaging in cardiomyopathy screening.

Implementation and Reach of Health Coaching Using Motivational Interviewing to Reduce Cardiovascular Disease Risk in Uninsured Illinois Women

CONTEXT

Cardiovascular disease (CVD) is the leading cause of mortality for US women; lack of health insurance contributes to poor control of risk factors and increased mortality. Health coaching including motivational interviewing can support primary and secondary CVD prevention, but among uninsured women, improving health outcomes is dependent on successfully reaching priority populations.

OBJECTIVE

We evaluated the implementation and reach of health coaching with motivational interviewing among clients in the Illinois WISEWOMAN Program (IWP), a CVD screening and risk-reduction program for uninsured women aged 40 to 64.

INTERVENTION

Following CVD screening, motivational interviewing is offered to all IWP clients via four 30-min one-on-one health coaching sessions to offer personalized guidance on setting and achieving health behavior goals.

SETTING

Our analysis included clients from the eight community-based Illinois agencies that implemented IWP from 2019 to 2023.

DESIGN AND MEASURES

We assessed client demographic and baseline health characteristics among all IWP clients, those who participated in health coaching by attending at least one session, and those who completed health coaching by attending at least three of four sessions. We also assessed health coaching participation and completion by agency and examined agency-specific associations between client characteristics and health coaching participation and completion.

RESULTS

Among IWP enrollees (n = 3094), 89.7% participated in at least one health coaching session but only 31.4% completed health coaching by attending at least three sessions. Over 90% of IWP clients participated in at least one health coaching session at 4 IWP agencies. Further, over 85% of health coaching participants completed health coaching at four agencies. Across agencies, no client-level characteristics were consistently associated with health coaching participation or completion.

CONCLUSIONS

High motivational interviewing participation rates support its acceptability among uninsured women, but agency-level community-level barriers likely prevent client engagement in multiple sessions. Reducing CVD risk requires working with partner agencies to address barriers to reaching the priority population.

Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension

PURPOSE OF REVIEW

Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients.

RECENT FINDINGS

DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.

Use of Motivational Interviewing in Older Patients with Multiple Chronic Conditions and Their Informal Caregivers: A Scoping Review

The use of motivational interviewing is relatively new in multiple chronic conditions (MCCs). A scoping review was conducted according to JBI methodology to identify, map and synthesize existing evidence on the use of motivational interviewing to support self-care behavior changes in older patients with MCCs and to support their informal caregivers in promoting patient self-care changes. Seven databases were searched, from database inception to July 2022, for studies that used motivational interviewing in interventions for older patients with MCCs and their informal caregivers. We identified 12 studies, reported in 15 articles, using qualitative, quantitative, or mixed-method designs, conducted between 2012 and 2022, describing the use of motivational interviewing for patients with MCCs. We could not locate any study regarding its application for informal caregivers. The scoping review showed that the use of motivational interviewing is still limited in MCCs. It was used mainly to improve patient medication adherence. The studies provided scant information about how the method was applied. Future studies should provide more information about the application of motivational interviewing and should address self-care behavior changes relevant to patients and healthcare providers. Informal caregivers should also be targeted in motivational interviewing interventions, as they are essential for the care of older patients with MCCs.

Chinese Community Home-Based Aging Institution Elders' Self-Management of Chronic Non-Communicable Diseases and Its Interrelationships with Social Support, E-Health Literacy, and Self Efficacy: A Serial Multiple Mediation Model

Background

The Chinese population is aging, and chronic non-communicable diseases (NCDs) prevalence is correspondingly increasing, along with associated disability and healthcare costs. Although self-management has been associated with social support and is a recognized priority, its mediating variables have not been studied in detail, particularly among old people with chronic diseases.

Purpose

To examine the mediating role of e-health literacy and general self-efficacy in the relationship between social support and self-management of chronic NCDs in Chinese community home-based aging institution residents.

Patients and Methods

A random sample of 289 community home-based aging institution elders (≥60 years) with chronic NCDs in China was recruited. Questionnaire data were recorded on self-reported socio-demographics, self-management, social support, e-health literacy, and general self-efficacy. Pearson's correlation analysis identified the relationship between these factors and self-management. Serial multiple mediation model was used to test the hypothesized relationships.

Results

The self-management mean (±SD) score was 29.39 ± 9.60, and the level of self-management was medium. Social support (r = 0.283; P < 0.001), e-health literacy (r = 0.566; P < 0.001), and general self-efficacy (r = 0.477; P < 0.001) were positively associated with self-management. Furthermore, social support indirectly influenced self-management through three pathways: independent mediation of e-health literacy (effect = 0.234, P < 0.001), independent mediation of general self-efficacy (effect = 0.515, P < 0.001), and chain mediation of e-health literacy and general self-efficacy (effect = 0.075, P < 0.001).

Conclusion

In Chinese community home-based aging institution elders, the relationship between self-reported self-management and social support is positively affected by the independent mediating effect of e-health literacy and general self-efficacy and the serial mediating effect of e-health literacy and general self-efficacy. Targeted self-management programs for elders with chronic NCDs have theoretical support, which could improve the health status and quality of life in this population.