A motivational counseling approach to improving heart failure self-care: Mechanisms of effectiveness

Barbara Riegel, Victoria V. Dickson, Linda Hoke, Janet P. McMahon, Brendali F. Reis, Steven Sayers

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Self-care is an integral component of successful heart failure (HF) management. Engaging patients in self-care can be challenging. METHODS: Fifteen patients with HF enrolled during hospitalization received a motivational intervention designed to improve HF self-care. A mixed method, pretest posttest design was used to evaluate the proportion of patients in whom the intervention was beneficial and the mechanism of effectiveness. Participants received, on average, 3.0 ± 1.5 home visits (median 3, mode 3, range 1-6) over a three-month period from an advanced practice nurse trained in motivational interviewing and family counseling. Quantitative and qualitative data were used to judge individual patients in whom the intervention produced a clinically significant improvement in HF self-care. Audiotaped intervention sessions were analyzed using qualitative methods to assess the mechanism of intervention effectiveness. RESULTS: Congruence between quantitative and qualitative judgments of improved self-care revealed that 71.4% of participants improved in self-care after receiving the intervention. Analysis of transcribed intervention sessions revealed themes of 1) communication (reflective listening, empathy); 2) making it fit (acknowledging cultural beliefs, overcoming barriers and constraints, negotiating an action plan); and, 3) bridging the transition from hospital to home (providing information, building skills, activating support resources). CONCLUSION: An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.

Original languageEnglish (US)
Pages (from-to)232-241
Number of pages10
JournalJournal of Cardiovascular Nursing
Volume21
Issue number3
DOIs
StatePublished - 2006

Keywords

  • Heart failure
  • Mixed methods
  • Motivational interviewing
  • Naturalistic decision-making
  • Patient education
  • Self-care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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