A motivational counseling approach to improving heart failure self-care: mechanisms of effectiveness.
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.
Riegel
Barbara
B
School of Nursing, Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA 19104-6096, USA. briegel@nursing.upenn.edu
Dickson
Victoria V
VV
Hoke
Linda
L
McMahon
Janet P
JP
Reis
Brendali F
BF
Sayers
Steven
S
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