Mechanisms of change in self-care in adults with heart failure receiving a tailored, motivational interviewing intervention.
Self-care is challenging but we previously demonstrated that motivational interviewing (MI) was effective in improving heart failure (HF) self-care.



To identify the mechanisms of intervention effectiveness by elucidating the MI techniques used and the relationship between the techniques and changes in self-care.



Audiotaped sessions (first and subsequent sessions) from 8 participants were transcribed verbatim and coded to evaluate changes in self-care. Using a sequential mixed method design, quantitative and qualitative self-care data were triangulated; congruence was 97%. The MI techniques used and mechanisms of intervention effectiveness were identified from the qualitative data.



Three MI techniques used were related to improved self-care: 1) reflection and reframing, 2) genuine empathy, affirmation, and humor, and 2) individualized problem solving. These techniques stimulated openness to goal setting, positive self-talk, perceived ability to overcome barriers, and change talk. The mechanisms by which the techniques achieved the desired outcomes were the development of discrepancy and self-efficacy, which are consistent with the principles of MI.



This study contributes to clarifying the mechanism by which MI facilitates behavioral change.



Using MI to discuss self-care can help to overcome barriers and engage HF patients in goal setting for behavior change.
Edith Clemmer Steinbright Professor of Gerontology School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: briegel@nursing.upenn.edu.
Barbara
B
Riegel
Associate Professor, Rory Meyers College of Nursing, New York University, New York, NY, USA.
Victoria Vaughan
VV
Dickson
YMCA of Greater New York City, New York, NY, USA.
Lydia Elena
LE
Garcia
School of Nursing, Columbia University, New York, NY, USA.
Ruth
R
Masterson Creber
Post-doctoral Fellow School of Nursing, University of Washington Seattle, WA, USA.
Megan
M
Streur
D000328:Adult; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D062405:Motivational Interviewing / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D036301:Qualitative Research; D012648:Self Care / Q000379:methods*; D013637:Tape Recording
Behavioral change; Counseling; Motivational interviewing; Patient compliance; Self-management