Motivational interviewing to support modifiable risk factor change in individuals at increased risk of cardiovascular disease: A systematic review and meta-analysis

Abstract

Background Programmes using motivational interviewing show potential in facilitating lifestyle change, however this has not been well established and explored in individuals at risk of, yet without symptomatic pre-existent cardiovascular disease. The objective of this systematic review and meta-analysis was to determine the effectiveness of motivational interviewing in supporting modifiable risk factor change in individuals at an increased risk of cardiovascular disease. Methods Systematic review and meta-analysis with results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-related databases were searched for randomised controlled trials from 1980 to March 2020. Criteria for inclusion included; preventive programmes, motivational interviewing principles, modification of cardiovascular risk factors in adults of both genders, different ethnicities and employment status, and having at least 1 or more modifiable cardiovascular risk factor/s. Two reviewers independently extracted data and conducted a quality appraisal of eligible studies using an adapted Cochrane framework. The Cochrane framework supports to systematically identify, appraise and synthesize all the empirical evidence that meets the pre-specified eligibility criteria to answer a specific question. Findings A total of 12 studies met the inclusion criteria. While completeness of intervention reporting was found to be adequate, the application of motivational interviewing was found to be insufficiently reported across all studies (mean overall reporting rate; 68%, 26% respectively). No statistical difference between groups in smoking status and physical activity was reported. A random effects analysis from 4 studies was conducted, this determined a synthesized estimate for standardised mean difference in weight of -2.00kg (95% CI -3.31 to -0.69 kg; p = 0.003), with high statistical heterogeneity. Pooled results from 4 studies determined a mean difference in LDL-c of -0.14mmol/l (5.414mg/dl), which was non-significant. The characteristics of interventions more likely to be effective were identified as: use of a blended approach delivered by a nurse expert in motivational interviewing from an outpatient-clinic. The application of affirmation, compassion and evocation, use of open questions, summarising, listening, supporting and raising ambivalence, combining education and barrier change identification with goal setting are also important intervention characteristics. Conclusions While motivational interviewing may support individuals to modify their cardiovascular risk through lifestyle change, the effectiveness of this approach remains uncertain. The strengths and limitations of motivational interviewing need to be further explored through robust studies.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial

“…This study has several unavoidable limitations including the relatively small sample size, the short follow up duration, and the limited human physiological parameters that were measured. Although the effectiveness of the aerobic exercise training can be evaluated after 12 weeks in most studies [ 15 ], we designed an intervention wherein we combined the training program with motivational interviewing; hence, follow-up on adherence to physical activity recommendations and behavioral change-related outcomes in a longer period (24–48 weeks) with more repeat measures is recommended [ 26 ]. Moreover, although we had evaluated the gold standard outcomes of the cardiorespiratory fitness, other parameters such as physical functioning and quality of life are also important to be addressed.…”

“…This approach is widely used in clinical care including the promotion of smoking cessation [ 23 ], type 2 diabetes self-management [ 24 ], and physical activity promotion in cancer survivors [ 25 ]. According to a systematic review and meta-analysis, motivational interviewing may support individuals to modify their cardiovascular risk through lifestyle modification [ 26 ]. Telephone-based motivational interviewing is also beneficial because it not only improves self-efficacy for physical activity and increases caloric expenditures from physical activity in middle-aged adults over 55 years [ 27 ], but also increases physical activity and reduces metabolic risk [ 28 ].…”

Coronary risk reduction intervention for siblings and offspring of patients with premature coronary heart disease: the CRISO study protocol for a randomised controlled pilot study

“…A recent systematic review with a meta-analysis of preventive programmes highlighted the application of counselling elements to help individuals improve their heart health risk [ 29 ]. These identified elements included: compassion, listening, affirmation, evocation, use of open questions, summarising and resolving ambivalence.…”

“…Barrier change identification and goal setting were also identified as essential elements. It was also suggested that the application of Motivational Interviewing (MI) communication skills; open-ended questions, affirmation, reflection and summarisation (OARS), could be combined with the application of ASCVD risk scores [ 29 ]. Although a recent meta-analysis using risk scores in primary prevention efforts showed no evidence in reducing ASCVD event outcomes, this could be explained by the low event rate in individuals without pre-existent ASCVD.…”

“…However, it would be more practical to focus on modifiable risk factor change or adherence to lifestyle therapies. It is necessary to conduct further research to evaluate factors that enable and motivate individuals at risk, yet without symptomatic pre-existent ASCVD, to support them in adopting healthy lifestyle changes [ 29 , 31 ].…”