Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial

Abstract

Objective The purpose of this study was to test the efficacy of a tailored motivational interviewing (MI) intervention versus usual care for improving HF self-care behaviors, physical HF symptoms and quality of life. Methods This is a single-center, randomized controlled trial. Participants were enrolled in the hospital. Immediately after discharge, those in the intervention group received a single home visit and 3–4 follow-up phone calls by a nurse over 90 days. Results A total of 67 participants completed the study (mean age 62 ± 12.8 years), of which 54% were African American, 30% were female, 84% had class III/IV symptoms, and 63% were educated at a high school level or less. There were no differences between the groups in self-care maintenance, self-care confidence, physical HF symptoms, or quality of life at 90 days. Conclusion Patients who received the MI intervention had significant and clinically meaningful improvements in HF self-care maintenance over 90 days that exceeded that of usual care. Practice Implications These data support the use of a nurse-led MI intervention for improving HF self-care. Identifying methods to improve HF self-care may lead to improved clinical outcomes.

Heart failure disease management: a systematic review of effectiveness in heart failure with preserved ejection fraction

“…All of the interventions were directed to patients, with three including carers. Eleven of the study interventions were delivered primarily by nurses with relevant experience or additional training, 17,20,21,25,26,[28][29][30][31]33,34 six were multi-disciplinary, 18,19,22,27,32,35 and in one, it was unclear. 23 All studies included some component of education, behavioural or psychosocial support, and self-management support.…”

“…Home visits were used in 11 studies. 20,21,23,25,[28][29][30][31][32][33][34] Outpatient or clinical visits were included in all but two studies. 26,27 The majority of studies were judged to be high in intensity and complexity based on delivery of multiple components using different methods of delivery and high frequency of contact, and five were judged to be moderate.…”

“…30,32 Usual care was variably described across studies, and efforts to standardize usual care were made in only four studies. 25,26,29,33 Controlling for patient contact as a confounding variable was only described in one study. 26 Stewart et al 28 tested multi-disciplinary comprehensive care delivered by either outpatient clinic or home visits.…”

“…There was significant variability in the self-care outcome measures employed: the most frequently employed (n = 5) was the Self-Care of Heart Failure Index 15 followed by the European Heart Failure Self-Care Behaviours Questionnaire (n = 3). 36 Of the studies assessing effect on self-care (n = 9), four reported a statistically significant positive effect, 23,26,33 two reported improvements that were not significant, 20,25,30 and one reported no impact, 27 and in two studies, the effect could not be ascertained from the publication. 22,28 The effect of disease management programmes on conditionspecific quality of life Heart failure quality of life was measured by either the Minnesota Living with Heart Failure Questionnaire 37 (n = 5) or the Kansas City Cardiomyopathy Questionnaire (KCCQ) 38 (n = 4).…”

Teaching students to teach patients: A theory-guided approach

“…Incorporating MI techniques into discharge teaching helps patients who often face a lack of motivation and other hurdles in illness and the challenges of recovery, such as avoiding, overcoming, or adjusting to the limitations and disabilities associated with chronic illnesses. [52,53] Patients with a variety of medical and psychological diagnoses have been found to successfully change health behaviors when MI was used. [50] Use of MI increases patient engagement and patient confidence to change.…”