| Objective: This study is a pilot randomized controlled trial designed to investigate the effect of motivational interviewing(MI) on the self-care behaviors of patients with chronic heart failure(CHF), trying to explore effective ways and methods for the disease self-management of patients with chronic heart failure.Method: All the recruited participants were hospitalized at the cardiology department of the third hospital of Hebei Medical University from May 2014 to May 2015. During this period, 158 chronic heart failure patients were admitted to the hospital. Of these, 72 patients were screened for eligibility based on our criteria. Subjects were randomly divided into the intervention and control groups, according to the random table number. During the research, 6 patients withdrew from the study because of the exacerbation of the disease and other factors.4 patients did not complete the telephone follow-up after discharge(no one answered the phone). Finally, 62 patients completed the intervention period and follow-up: 29 patients in the intervention group and 33 patients in control group. Baseline demographic and clinical information, including age, sex, education degree, number of previous hospitalizations and New York Heart Association(NYHA) functional class of both groups was collected on day 1 or 2 after admission. The Self-Care of Heart Failure Index(SCHFI) questionnaire was applied to the patients by the investigators. It was filled in by the investigators according to the patient’s answers, and self-care behaviors were evaluated. During hospitalization, every patient in the intervention group received 4 sessions of motivational interviewing with each session lasting 15 to 20 minutes by the investigator. The primary content was pointing out patient’s wrong behaviors and concepts present, guiding the patients to help them realize the problems in their self-care behaviors; encouraging patients to talk about difficulties when changing behaviors and guiding patients to think about ways of solving these problems; helping the patient’s to evaluate the various options for behavior change; helping them to build solutions for changing behaviors. The control group patients received conventional health education by an experienced senior cardiology nurse during their hospitalization, including basic knowledge of chronic heart failure, risk factor control, adequate exercise, limiting diet and liquids, symptom monitoring, regular checks, medication adherence, side effects and usage of common drugs. At 2, 4, and 8 weeks post-discharge, two groups’ patients received a telephone follow-up call. The intervention group received telephone follow-up call following the motivational interviewing principles, the main contents were providing feedback about changing behaviors on health status, life and work, among others, confirming the goals achieved and encouraging patients to talk about the obstacles and difficulties in the process of changing behaviors; encouraging patients to continue to implement the plan and reinforced their commitment to change behaviors to promote the completion of self-care plans. The control group patients received conventional telephone follow-up. The main focus was answering the questions of patients, strengthening the health education knowledge and encouraging patients to improve self-care behaviors. In the last telephone follow-up call, patients filled out the SCHFI questionnaire again to evaluate the self-care behaviors after the intervention. Data were analyzed using SPSS 13.0 for Windows. Means and standard deviation were used to describe measurement data, expressed as?x±s. For the comparison of patients’ baseline characteristics between the two groups, χ2 test was used; and scores of self-care behaviors comparisons between two groups were performed using t test. Scores of self-care behaviors of the two groups of patients before and after the intervention were calculated to investigate the effect of motivational interviewing on the self-care behaviors of patients with chronic heart failure.Results: 1The average age of the total sample(n=62) was 59.94 ± 6.93 years. The characteristics of two group patients(intervention group [n=29], control group [n=33]) were similar. Difference between the two groups in baseline characteristics including age, sex, times of previous hospitalizations, educational level and NYHA functional was not statistically significant(P>0.05); 2 The self-care behavior scores of both groups were low before the intervention, the intervention group was 79.00±48.80; the control group was 88.68±29.26. There was no statistically significant differences for each subscale score and total score(P>0.05);3 After the intervention, the scores of self-care behaviors in the two groups were all improved, the scores were155.13±35.65 and 115.44±22.82 in intervention group and control group. The difference was statistically significant compared with the baseline scores(P<0.01);4 The increase in self-care behaviors in the intervention group was 76.13±22.67 and in control group was 26.76±14.97.The raising of self-care behaviors in intervention group was more obvious in than control group, which had the extremely significant difference(P<0.01).Conclusions: This study showed that self-care behavior scores of chronic heart failure patients are generally low, reflecting that their self-care ability needs to be improved. Our results showed that motivational interviewing is effective in improving the self-care behaviors and self-management ability of the disease in patients with chronic heart failure. Compared with traditional health education, motivational interviewing had a more significant effect. Consequently, promoting the application of the motivational interviewing in the management of patients with chronic heart failure has an important significance. |
