A Comparison of the Effects of Teach-Back and Motivational Interviewing on the Adherence to Medical Regimen in Patients with Hypertension

Improving Therapeutic Adherence and Reducing Therapeutic Inertia in the Management of People with Cardiometabolic Diseases: A Call-to-Action from the Middle East

Hypertension, dyslipidemia, and type 2 diabetes are highly prevalent and poorly controlled cardiometabolic diseases in the Middle East. Therapeutic non-adherence and therapeutic inertia are major contributors to this suboptimal disease control. Regardless of the cardiometabolic disease, evidence-based solutions may be used to improve therapeutic non-adherence and overcome inertia, and thereby help to alleviate the heavy burden of cardiovascular disease in the Middle East. Such solutions include the routine and early use of single-pill combinations, educational initiatives for patients, and multidisciplinary team-based care. This article highlights these and other potential solutions for therapeutic non-adherence and inertia, as discussed at the 2024 Evidence in the Cardiometabolic Environment (EVIDENT) Summit. There is now a 'call-to-action' from healthcare providers and other stakeholder groups to ensure that the solutions discussed at this meeting are implemented within health systems in the Middle East to significantly improve cardiovascular outcomes.Infographic available for this article.

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.

The feasibility of motivational interviewing on adherence to care practices, emotional intelligence, and dispositional optimism among patients with permanent pacemakers

AIMS

Motivational interviewing (MI) has been recognized as highly effective for treating chronic diseases and various conditions, with encouraging results demonstrating its effectiveness in promoting health behaviour change. The current study was proposed to evaluate the feasibility of MI on adherence to care practices, emotional intelligence (EI), and dispositional optimism among patients with permanent pacemakers.

METHODS AND RESULTS

This study was a parallel arm randomized controlled trial. Seventy clients with permanent pacemakers were randomly allocated to a six-session MI intervention (n = 35) or a waiting list control group (n = 35). A statistically significant improvement in the mean scores of adherence to care practices, EI, and dispositional optimism, along with a significant reduction in pessimism, was registered among the study group compared with the control group.

CONCLUSION

Following the intervention for 1- and 2-month follow-up measurements, there were statistically significant improvements in self-care practice adherence. After 1 month of intervention, there were statistically significant gains in EI and dispositional optimism, but at the 2-month follow-up measurement, this improvement had somewhat lessened. The findings suggest that MI may be a feasible and practical approach for improving adherence to care practices, EI, and dispositional optimism in patients with permanent pacemakers.

REGISTRATION

ClinicalTrials.gov: NCT05883514.

Motivational interview and teach back: effectiveness on the rate of hand hygiene compliance in ICU Nurses

Introduction

Hand hygiene in nurses is the most effective factor in controlling nosocomial infections. The objective of this study was to assess the effectiveness of motivational interviews and teach-back on the rate of hand hygiene compliance in Intensive Care Unit nurses.

Methods

A quasi-experimental study with pre-test and post-test design was performed. Three Intensive Care Units with 88 nurses were randomly divided into three study groups. The control group received only the usual hospital teaching in hand hygiene, the experimental groups 1 and 2, in addition to the usual teaching, they received motivational interview and teach back in five weekly sessions, respectively. The rate of hand hygiene compliance in nurses was measured by Hand Hygiene Practices Inventory.

Results

There was a statistically significant difference for the rate of hand hygiene compliance before and after the intervention in the study groups with p < 0.001. In comparison before and after, in experimental group 1, the rate of hand rub increased from 8% to 18.5% and the rate of hand wash from 1.5% to 22%; and in the experimental group 2, these values increased from 4% to 19.5% in hand rub and from 3.5% to 17% in hand wash, respectively. However, in the control group, the rate of hand hygiene compliance before and after the test did not show a statistically significant difference with p > 0.05.

Conclusions

Motivational interview and teach back methods were effective in promoting hand hygiene compliance in nurses and thus improve the control of nosocomial infections.

The impact of teach-back training method (TBTM) on treatment adherence in hemodialysis patients: a randomized controlled trial

Introduction

Ensuring adherence to treatment is vital for individuals undergoing haemodialysis. The demanding treatment frequency and duration often present challenges for patients in maintaining a consistent routine. Non-adherence can result in adverse health effects and an increased risk of hospitalization. This study aimed to evaluate the impact of teach-back training on treatment adherence among haemodialysis patients.

Method

A randomized controlled trial involved 60 end-stage kidney disease patients undergoing haemodialysis. Participants were randomly assigned to either the control or intervention group. Data were collected using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), assessing adherence in four dimensions: HD incidence, medication use, fluid restriction, and diet recommendations. The intervention group received feedback-based training on diet and fluid restriction during four 45-60-min sessions, while the control group received regular indoor training.

Result

Following the intervention, significant differences in mean scores for HD frequency, medication use, and fluid restriction were observed between the two groups (P<0.001). However, there was no significant difference in the mean score for food recommendations (P=0.108).

Conclusion

The teach-back training method (TBTM) is an effective communication strategy that enhances treatment adherence in haemodialysis patients. This intervention has the potential to improve patient outcomes and overall quality of life by simplifying medical information and encouraging patient engagement.

The effect of education based on a health belief model and motivational interviews on cardiovascular disease risk factors and healthy lifestyle behaviour changes in patients with essential hypertension: A randomized controlled trial

OBJECTIVE

To determine the effects of "Health Belief Model (HBM)-based education" and "education and motivational interviews (MIs)" by comparing the two methods on cardiovascular disease (CVD) risk factors and healthy lifestyle behaviour changes of patients diagnosed with essential hypertension.

METHODS

The study was a single-centre, single-blind, parallel-group, 6-month follow-up, randomized controlled trial. It was conducted on 80 individuals (40 in the study group, 40 in the control group). Both groups received HBM-based education and an educational booklet on healthy lifestyle behaviour changes at the beginning of the study. Additionally, the study group underwent a total of 6 MIs.

RESULTS

The decrease in the study group's 10-year Framingham CVD risk scores (mean difference 5,33) compared to the baseline values was higher than that observed in the control group (mean difference 3,95). Over the six-month follow-up period, the study group's knowledge of CVD risk factors increased, and healthy lifestyle behaviour improved.

CONCLUSION

HBM-based education and an educational booklet, either alone or in combination with MI, supported patients with essential hypertension in lowering their CVD risk through lifestyle modifications.

PRACTICE IMPLICATIONS

Healthcare professionals within primary healthcare settings can use HBM-based health education and short-term MIs to reduce CVD risk and improve health outcomes.

Motivational interviewing to support medication adherence in adults with chronic conditions: Systematic review of randomized controlled trials

OBJECTIVES

To systematically review published randomized controlled trials (RCTs) assessing the efficacy of MI to support medication adherence in adults with chronic conditions.

METHODS

A systematic review (PROSPERO-CRD42020025374) was performed by searching in Pubmed/MEDLINE, PsycINFO, The Cochrane Library and Web of Science. Studies were included for the following: RCTs assessing the impact of MI on medication adherence among adults with chronic diseases. Two reviewers conducted independent screening of records and full-text articles published until July 2020. Quality was assessed with the Risk of Bias 2 tool for RCTs.

RESULTS

From 1262 records identified, 54 RCTs were included. The MI interventions were delivered alone or in combination with other interventions, and varied in mode of delivery (e.g. face-to-face, phone), exposure level (duration, number of sessions), and provider characteristics (profession, training). Most interventions were developed in infectious diseases (n = 16), cardiology (n = 14), psychiatry (n = 8), and endocrinology (n = 7). Medication adherence showed significant improvement in 23 RCTs, and other clinical outcomes were improved in 19 RCTs (e.g. risky behaviors, disease symptoms).

CONCLUSIONS

MI is an approach to medication adherence support with an increasing evidence base in several clinical domains and further potential for adaptation to different settings.

PRACTICE IMPLICATIONS

In further studies, particular attention should focus on methodological issues such as the populations of patients to include - patients with suboptimal adherence, the evaluation of fidelity to the MI spirit and components, and a sound measurement of medication adherence and clinical outcomes.