title: A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.
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).
  
  
  CONCLUSIONS
  An intervention that incorporates the core elements of motivational interviewing may be effective in improving HF self-care, but further research is needed.
authors.affiliation: School of Nursing, Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA 19104-6096, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Victoria V
authors.initials: VV
authors.lastname: Dickson
authors.forename: Linda
authors.initials: L
authors.lastname: Hoke
authors.forename: Janet P
authors.initials: JP
authors.lastname: McMahon
authors.forename: Brendali F
authors.initials: BF
authors.lastname: Reis
authors.forename: Steven
authors.initials: S
authors.lastname: Sayers
mesh_terms: D003142:Communication; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009723:Nurse-Patient Relations; D010353:Patient Education as Topic / Q000379:methods*; D015143:Philadelphia; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D012944:Social Support; D013663:Teaching / Q000379:methods; D016896:Treatment Outcome