Effect of motivational interviewing on self-care of people with heart failure: a randomized clinical trial

Flores, Paula Vanessa Peclat; Rocha, Pablo Alvarez; Figueiredo, Lyvia da Silva; Guimarães, Thais Medeiros Lima; Velasco, Nathália Sodré; Cavalcanti, Ana Carla Dantas

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Revista da Escola de Enfermagem da USP

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Original Article • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019013703634 copy

Effect of motivational interviewing on self-care of people with heart failure: a randomized clinical trial^* * Extracted from the thesis: “Efeito da entrevista motivacional no autocuidado do paciente com insuficiência cardíaca: ensaio clínico randomizado”, Universidade Federal Fluminense, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Cardiovasculares, 2018.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the effect of motivational interviewing on self-care for people with chronic heart failure.

Method:

A multicenter randomized clinical trial, which divided people into an intervention group (n=59) and a control group (n=59), followed for 60 days in centers of Brazil and Uruguay. The intervention group received three consultations per motivational interviewing, with an interval of 30 days, and the control group maintained conventional follow-up in specialized clinics. The data were assessed using the Self-Care of Heart Failure Index 6.2, before and after intervention in each of the centers. They were analyzed using the mean, median, t-test, correlation analysis using the Spearman coefficient and effect of the intervention by Cohen’s d.

Results:

One hundred and eighteen people completed the study. In view of the assessment of the effect of the motivational interviewing on self-care, compared to conventional follow-up, a medium effect on maintenance and management (Cohen’s d=0.6723; 0.5086) and high on self-care confidence (Cohen’s d=0.9877).

Conclusion:

Motivational interviewing was effective in improving self-care in patients with heart failure, being a feasible strategy to be implemented in specialized clinics. Brazilian Registry of Clinical Trials (Registro Brasileiro de Ensaios Clínicos): RBR-6fp5qt.

DESCRIPTORS
Heart Failure; Motivational Interviewing; Self Care; Cardiovascular Nursing; Clinical Trial

Variables	Brazil = 57			Uruguay = 61
Variables	Intervention (n=28)	Control (n=29)	P value	Intervention (n=31)	Control (n=30)	P value
Sex. Female^* * n (%);	18(64.3)	11(37.9)	0.047	14(45.2)	13(43.3)	0.886
Age^† † median (interquartile range 25-75);	68(59-74.5)	59(51-64)		65(56-72)	64(57-72)
Retired^* * n (%);	15(53.6)	10(34.5)	0.697	13(41.9)	13(43.3)	0.472
Elementary School^* * n (%);	6(21.4)	6(20.7)	0.083	14(45.2)	13(43.3)	0.217
Married^* * n (%);	17(60.7)	21(72.4)	0.120	16(51.6)	13(43.3)	0.228
LV EF^† † median (interquartile range 25-75);	55(40-71)	57(34-67)	0.552	30(28-35)	35(30-43)	0.057
NYHA I^I^* * n (%);	17 (60.7)	17(58.6)	0.697	19(61.3)	12(40.0)	0.248
Non-ischemi^c^* * n (%);	13(46.4)	8(27.6)	0.012	25(80.6)	20(66.7)	0.380
Smoking^* * n (%);	2(7.1)	2(6.9)	1.000	3(9.7)	5(16.7)	0.709
Alcoholism^* * n (%);	5(17.9)	2(6.9)	0.253	3(9.7)	2(6.7)	0.611
Self-care scores ^‡ ‡ mean ± standard deviation.
Maintenance	48.3±19.0	43.2±11.4	0.220	62.9±14.5	63.9±15.2	0.796
Manegement	45.8±24.4	46.3±19.3	0.953	41.4±23.6	46±20.1	0.624
Confidence	51.8±22.2	58.2±20.7	0.282	67.6±17.5	63.6±21.8	0.427

Self-care subscales	Multicentric – Pre (n=118)			Multicentric – Post (n=118)			Effect
Self-care subscales	Control^* * Mean ± standard deviation; (n=59)	Intervention^* * Mean ± standard deviation; (n=59)	P value^† † T-Student test;	Control^* * Mean ± standard deviation; (n=59)	Intervention^* * Mean ± standard deviation; (n=59)	P value^† † T-Student test;	Cohen’ d
Maintenance	56.30 ±18.78	53.08 ±16.1	0.322	56.97 ±17.2	69.02 ±13.9	<0.001	0.6723
Manegement^‡ ‡ pre- (control n=23 and intervention=30) and post-management (control n=09 and intervention=20)	45.86 ±22.1	44.00 ±21.1	0.756	63.88 ±21.9	74.00 ±17.0	0.187	0.5086
Confidence	57.73 ±22.6	63.1 ±19.9	0.172	54.93 ±22.1	73.31 ±16.8	<0.001	0.9807

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Paula Vanessa Peclat Flores, Rua Dr. Celestino, 74, 3° andar CEP: 24020-091 – Niterói, RJ, Brazil paulapeclat@gmail.com