Motivational interviewing to improve self‐care in heart failure patients (MOTIVATE‐HF): a randomized controlled trial

Abstract

Aims Self-care, an essential component of heart failure (HF) treatment, is inadequate in most patients. We evaluated if motivational interviewing (MI) (i) improves patient self-care maintenance (primary endpoint; e.g. taking medications), self-care management (e.g. responding to symptoms) and self-care confidence (or self-efficacy) 3 months after enrolment; (ii) changes self-care over 1 year, and (iii) augments patient self-care if informal caregivers are involved. Methods and results Parallel randomized controlled trial (1:1:1). A sample of 510 patients (median 74 years, 58% male) and caregivers (median 55 years, 75% female) was randomized to Arm 1 (MI only for patients), Arm 2 (MI for patients and caregivers), or Arm 3 (usual care). The intervention in Arms 1 and 2 consisted of one face-to-face MI session with three telephone contacts. Self-care was evaluated with the Self-Care of HF Index measuring self-care maintenance, management, and confidence. Scores on each scale range from 0 to 100 with higher scores indicating better self-care; ≥70 is considered adequate. At 3 months, self-care maintenance improved 6.99, 7.42 and 2.58 points in Arms 1, 2, and 3, respectively (P = 0.028). Self-care maintenance was adequate in 18.4%, 19.4%, and 9.2% of patients in Arms 1, 2 and 3, respectively (P = 0.016). Over 1 year, self-care maintenance, management, and confidence scores in Arms 1 and 2 were significantly higher than in Arm 3 in several follow-ups. Over 1 year, Arm 2 had the best scores in self-care management.Conclusions MI significantly improved self-care in HF patients. Including caregivers may potentiate the effect, especially in self-care management. ClinicalTrial.gov, identifier: NCT02894502.

Effectiveness of motivational interviewing on health‐service use and mortality: a secondary outcome analysis of the MOTIVATE‐HF trial

“…A sample of 1032 of patients and their caregivers was assessed for eligibility, and 510 were enrolled and randomized to the intervention (Arm 1 = MI for patients only; Arm 2 = MI for patients and caregivers) or control group (Arm 3). Baseline characteristics and participants' attrition at each follow‐up are presented in the primary study 15 . Briefly, patients (median age = 74 years) were mostly male (58%), retired (76.2%), NYHA Class II (61.9%), and had ischemic HF (33.6%).…”

“…At 3, 6, 9, and 12 months from enrolment, there were 406, 301, 254, and 238 patients in all three arms, respectively. Reasons for loss at each follow‐up were due to refusal to continue the study or death 15 …”

“…For this purpose, we randomly audiotaped 48 face‐to‐face intervention sessions in Arm 1 and 97 sessions in Arm 2 (equivalent to 50 patient and 47 caregiver audiotapes). The mean technical component score was 2.4 (SD = 0.5), and the mean relational component score was 2.8 (SD = 0.8) 15 . We also assessed the extent to which the interventionists were adherent to the protocol regarding the telephone calls.…”

Intervenção educativa para o autocuidado de adultos com insuficiência cardíaca: estudo piloto

“…desistiram. Essa taxa de atrito é comparável à relatada em três estudos que examinaram a viabilidade de intervenções para promoção do autocuidado em doenças crônicas, 13,7%;15%; 20% (Gimbel et al, 2020;Vellone et al, 2020;Okwose et al, 2019) respectivamente, medidas da mesma forma que neste estudo.…”

“…Isso pode ter contribuído para os resultados, principalmente no autocuidado de gerenciamento. A educação centrada no paciente promove a melhora do autocuidado em pessoas com IC (Vellone et al 2020).…”