Effects of telephone-based motivational interviewing in lifestyle modification program on reducing metabolic risks in middle-aged and older women with metabolic syndrome: A randomized controlled trial

Evidence for motivational interviewing in educational settings among medical schools: a scoping review

BACKGROUND

Motivational interviewing (MI) is a person-centred approach focused on empowering and motivating individuals for behavioural change. Medical students can utilize MI in patient education to engage with patients' chronic health ailments and maladaptive behaviours. A current scoping review was conducted to 1) determine the types of MI (conventional, adapted, brief and group MI) education programs in medical schools, delivery modalities and teaching methods used; 2) classify educational outcomes on the basis of Kirkpatrick's hierarchy; and 3) determine the key elements of MI education via the FRAMES (feedback, responsibility, advice, menu of options, empathy, self-efficacy) model.

METHODS

This scoping review was conducted via the framework outlined by Arksey and O'Malley. Two online databases, CINAHL and MEDLINE Complete, were searched to identify MI interventions in medical education. Further articles were selected from bibliography lists and the Google Scholar search engine.

RESULTS

From an initial yield of 2019 articles, 19 articles were included. First, there appears to be a bimodal distribution of most articles published between the two time periods of 2004--2008 and 2019--2023. Second, all the studies included in this review did not use conventional MI but instead utilized a variety of MI adaptation techniques. Third, most studies used face-to-face training in MI, whereas only one study used online delivery. Fourth, most studies have used a variety of interactive experiences to teach MI. Next, all studies reported outcomes at Kirkpatrick's Level 2, but only 4 studies reported outcomes at Kirkpatrick's Level 3. According to the FRAMES model, all studies (n=19; 100%) reported the elements of responsibility and advice. The element that was reported the least was self-efficacy (n = 12; 63.1%).

CONCLUSION

Our findings suggest that motivational interviewing can be taught effectively in medical schools via adaptations to MI and a variety of teaching approaches. However, there is a need for further research investigating standardized MI training across medical schools, the adequate dose for training in MI and the implementation of reflective practices. Future studies may benefit from exploring and better understanding the relationship between MI and self-efficacy in their MI interventions.

Development and Evaluation of a Blended Self-Management Program for Metabolic Syndrome in Patients With Rheumatic Diseases

Rheumatic diseases are known to be associated with the development of metabolic syndrome, which increases mortality rates due to cardiovascular complications. Although a variety of self-management programs for rheumatic diseases have been developed, few have concentrated on metabolic syndrome. This study aimed to develop and verify a blended (a mixture of telephone and online interventions) metabolic syndrome self-management program. The program was developed in four stages: analysis to identify program contents, website design, website development, and validity testing. A quasi-experimental nonequivalent control group, pretest-posttest design was adopted to verify the program effectiveness in 54 patients with rheumatic disease. The program was initially implemented via telephone for 4 weeks and then self-administered via a web-based platform for 20 weeks. Indices of metabolic syndrome and self-management and quality of life scores were measured as outcome variables. Data were collected three times: before intervention, after 4 weeks of telephone interventions, and after 20 weeks of online self-interventions. The devised program had a significant overall effect on metabolic syndrome indices, metabolic syndrome-related self-management behaviors, and quality of life. Detailed analysis showed the program effectively reduced body mass index, waist circumference, systolic blood pressure, and blood glucose levels and improved metabolic syndrome self-management behaviors. Based on our findings, it can be expected that the use of this program may retard or prevent the progression of metabolic syndrome by improving some metabolic syndrome indices and metabolic syndrome-related self-management behaviors, which are key components of care in rheumatic disease patients with metabolic syndrome. This web-based program appears to be beneficial in public health care settings because it is cost-effective, readily available, and may provide long-term support.

Effectiveness of behavioural interventions with motivational interviewing on physical activity outcomes in adults: systematic review and meta-analysis

OBJECTIVE

To evaluate the effectiveness of behavioural interventions that include motivational interviewing on physical activity outcomes in adults.

DESIGN

Systematic review and meta-analysis.

STUDY SELECTION

A search of seven databases for randomised controlled trials published from inception to 1 March 2023 comparing a behavioural intervention including motivational interviewing with a comparator without motivational interviewing on physical activity outcomes in adults. Outcomes of interest were differences in change in quantitative measures of total physical activity, moderate to vigorous physical activity (MVPA), and sedentary time.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and assessed risk of bias. Population characteristics, intervention components, comparison groups, and outcomes of studies were summarised. For overall main effects, random effects meta-analyses were used to report standardised mean differences (SMDs) and 95% confidence intervals (CIs). Differential effects based on duration of follow-up, comparator type, intervention duration, and disease or health condition of participants were also examined.

RESULTS

129 papers reporting 97 randomised controlled trials totalling 27 811 participants and 105 comparisons were included. Interventions including motivational interviewing were superior to comparators for increases in total physical activity (SMD 0.45, 95% CI 0.33 to 0.65, equivalent to 1323 extra steps/day; low certainty evidence) and MVPA (0.45, 0.19 to 0.71, equivalent to 95 extra min/week; very low certainty evidence) and for reductions in sedentary time (-0.58, -1.03 to -0.14, equivalent to -51 min/day; very low certainty evidence). Evidence for a difference in any outcome compared with comparators of similar intensity was lacking. The magnitude of effect diminished over time, and evidence of an effect of motivational interviewing beyond one year was lacking. Most interventions involved patients with a specific health condition, and evidence of an effect of motivational interviewing to increase MVPA or decrease sedentary time was lacking in general population samples.

CONCLUSIONS

Certainty of the evidence using motivational interviewing as part of complex behavioural interventions for promoting total physical activity in adults was low, and for MVPA and sedentary time was very low. The totality of evidence suggests that although interventions with motivational interviewing increase physical activity and decrease sedentary behaviour, no difference was found in studies where the effect of motivational interviewing could be isolated. Effectiveness waned over time, with no evidence of a benefit of motivational interviewing to increase physical activity beyond one year.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020219881.

The effect of nurse-led motivational interviewing based on the trans-theoretical model on promoting physical activity in healthy older adults: A randomized controlled trial

AIM

The aim of this study was to evaluate the effect of motivational interviewing based on the trans-theoretical model promoting physical activity in older adults.

METHODS

A randomized controlled trial study was conducted with 117 older adults (intervention group: 58, and control group: 59) between April and November 2019. The data were collected via a questionnaire, trans-theoretical model scales, the Physical Activity Scale for the Elderly, the Katz Activities of Daily Living scale and a pedometer. The 24-week intervention consisted of regular motivational interviewing. The control group received usual care at the family health centre.

RESULTS

Following the intervention, the Intervention Group showed significant improvements Exercise Processes of Change Scale, Exercise Self-Efficacy Scale and Perceived Benefits of the Decisional Balance Scale for Exercise. There was a significant difference between the groups in terms of stages of change. In the Intervention Group, 81.5% were in the contemplation stage in the pre-test, while in the post-test, 70.4% had transitioned to the action stage. In contrast, in the control group, 62.5% were in the contemplation stage initially, but in the post-test, only 9.3% had reached the action stage. The mean number of step counts increased significantly in favour of the Intervention Group, as did the Physical Activity Scale for the Elderly total score.

CONCLUSION

The trial indicated that after the trans-theoretical model-based motivational interviewing, the stages of change among the older adults improved, as did their exercise behaviours. It is recommended that the trans-theoretical model and motivational interviewing be used by nurses to improve healthy lifestyle stage behaviours in older adults.

Effectiveness of Trans-Theoretical Model-Based Health Education Intervention in the Promotion of Lifestyle Changes among Adults with Metabolic Syndrome: A Randomized Controlled Trial

Background

Evidence revealed that, 60% of deaths in the underdeveloped nations are linked to adoption of unhealthy lifestyles. The Trans-theoretical Model (TTM) has been considered a useful interventional approach in smoking cessation, drug addiction and weight control. However, its effectiveness in improving changes in dietary pattern, physical activity and alcohol consumption has not been reported.

Purpose

The study aimed at evaluating the effectiveness of the TTM-based health education intervention in the promotion of lifestyle changes among adults with metabolic syndrome.

Methods

This was an experimental design where 352 participants with metabolic syndrome were allocated to intervention and control groups. The participants were randomly assigned to receive either standard CVD care or a TTM stage-based lifestyle modification intervention for 12-months. Lifestyle patterns were assessed at baseline and endpoint. The mean difference of the subtotal TTM concept scores between pre and post intervention was evaluated using paired t-test. The chi-square test of independence was used to detect between group differences in the categorical data.

Results

Most of the participants were in the pre-action stage of change for their dietary intake patterns and physical activity habits at the baseline assessment with no difference between the groups. The intervention group's total level of change toward adopting a healthy lifestyle was markedly (p < 0.001) improved than the control group at the endpoint. The mean scores for the intervention group's stage of change, self-efficacy, and pros and cons of decisional balance all improved significantly (p < 0.001) from the baseline. The mean scores for the control group's pros and cons of decisional balance and stage of change also considerably (p < 0.05) improved from baseline to the endpoint.

Conclusion

The TTM- based health education intervention was effective in improving the participants' lifestyles that includes diet and physical activity. Health care providers, particularly nurses should implement TTM staged-matched educational intervention for individuals who are at risk for cardiovascular diseases.

A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching

Objective

To collect health and wellness coaching (HWC) literature related to treatment of obesity and Type 2 Diabetes (T2D) for systematic assessment using a novel rubric.

Data Source

Pubmed, CINAHL, and PsychInfo.

Study Inclusion and Exclusion

Given 282 articles retrieved, only randomized and controlled trials meeting a HWC criteria-based definition were included; studies with intervention <4 months or <4 sessions were excluded.

Data Extraction

Rubric assessment required details of two theoretical frameworks (i.e., study design and HWC intervention design) be extracted from each included paper.

Data Synthesis

Data were derived from a 28-item rubric querying items such as sampling characteristics, statistical methods, coach characteristics, HWC strategy, and intervention fidelity.

Results

29 articles were reviewed. Inter-rater rubric scoring yielded high intraclass correlation (r = .85). Rubric assessment of HWC literature resulted in moderate scores (56.7%), with study design scoring higher than intervention design; within intervention design, T2D studies scored higher than obesity.

Conclusions

A novel research design rubric is presented and successfully applied to assess HWC research related to treatment of obesity and T2D. Most studies reported beneficial clinical findings; however, rubric results revealed moderate scores for study and intervention design. Implications for future HWC research are discussed.

Identification of Risk Groups for and Factors Affecting Metabolic Syndrome in South Korean Single-Person Households Using Latent Class Analysis and Machine Learning Techniques: Secondary Analysis Study

BACKGROUND

The rapid increase of single-person households in South Korea is leading to an increase in the incidence of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases, due to lifestyle changes. It is necessary to analyze the complex effects of metabolic syndrome risk factors in South Korean single-person households, which differ from one household to another, considering the diversity of single-person households.

OBJECTIVE

This study aimed to identify the factors affecting metabolic syndrome in single-person households using machine learning techniques and categorically characterize the risk factors through latent class analysis (LCA).

METHODS

This cross-sectional study included 10-year secondary data obtained from the National Health and Nutrition Examination Survey (2009-2018). We selected 1371 participants belonging to single-person households. Data were analyzed using SPSS (version 25.0; IBM Corp), Mplus (version 8.0; Muthen & Muthen), and Python (version 3.0; Plone & Python). We applied 4 machine learning algorithms (logistic regression, decision tree, random forest, and extreme gradient boost) to identify important factors and then applied LCA to categorize the risk groups of metabolic syndromes in single-person households.

RESULTS

Through LCA, participants were classified into 4 groups (group 1: intense physical activity in early adulthood, group 2: hypertension among middle-aged female respondents, group 3: smoking and drinking among middle-aged male respondents, and group 4: obesity and abdominal obesity among middle-aged respondents). In addition, age, BMI, obesity, subjective body shape recognition, alcohol consumption, smoking, binge drinking frequency, and job type were investigated as common factors that affect metabolic syndrome in single-person households through machine learning techniques. Group 4 was the most susceptible and at-risk group for metabolic syndrome (odds ratio 17.67, 95% CI 14.5-25.3; P<.001), and obesity and abdominal obesity were the most influential risk factors for metabolic syndrome.

CONCLUSIONS

This study identified risk groups and factors affecting metabolic syndrome in single-person households through machine learning techniques and LCA. Through these findings, customized interventions for each generational risk factor for metabolic syndrome can be implemented, leading to the prevention of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases. In conclusion, this study contributes to the prevention of metabolic syndrome in single-person households by providing new insights and priority groups for the development of customized interventions using classification.

Effectiveness of a 12-week tele-exercise training program on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity

BACKGROUND

Exercise has positive impacts on cardiometabolic health. However, evidence regarding the effectiveness of tele-exercise training on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity remains limited.

AIMS

The aim of this study was to assess whether an assumed increase in physical activity (PA) after a 12-week tele-exercise training program improved cardiorespiratory fitness and heart rate recovery of patients with cardiometabolic multimorbidity.

METHODS

A parallel-group randomized controlled trial was conducted. Eligible patients with cardiometabolic multimorbidity (n = 83) were randomized 1:1 to either an experimental group (EG, received a 12-week tele-exercise training program with 3 sessions/week and 30 min/session and weekly remote monitoring for maintenance of exercise) or a control group (CG, usual care only). PA, cardiorespiratory fitness, and heart rate recovery were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

RESULTS

Sixty-eight participants (81.9%) completed the study, and 83 were included in the intention-to-treat analysis. The EG with higher vigorous-intensity PA (β = 714, p = .037), walking behavior (β = 750, p = .0007), and total amount of PA (β = 1748, p = .001) after the intervention had significantly elevated cardiorespiratory fitness, including VO2peak (β = 3.9, p = .042), workload (β = 17.9, p = .034), and anaerobic threshold (β = 2.1, p = .041), and increased one-min heart rate recovery (β = 5.3, p = .025), compared with the CG.

LINKING EVIDENCE TO ACTION

A 12-week tele-exercise training program was effective for increased PA, elevated cardiorespiratory fitness, and improved heart rate recovery for patients with cardiometabolic multimorbidity. These findings highlight the feasibility of better delivering lifestyle interventions for cardiometabolic health management.

Temporal Changes in Metabolic Syndrome Indices and Factors of Metabolic Syndrome Development in Patients With Rheumatic Disease: A Prospective Cohort Study

Patients with rheumatic disease have a high prevalence of metabolic syndrome. The purpose of this study was to investigate temporal changes in metabolic syndrome indices and to identify factors influencing metabolic syndrome development. A prospective cohort study design was adopted. The study participants were 68 outpatients with a rheumatic disease at an outpatient clinic of a university hospital. Data on demographics, health-related characteristics, steroid use, serum C-reactive protein levels, and metabolic syndrome indices were collected between December 2017 and March 2021. Temporal changes in body mass indices, serum triglyceride, and cholesterol levels were significant. Body mass indices, diastolic blood pressure, serum triglyceride, high-density lipoprotein, and fasting blood glucose levels at time of diagnosis were found to influence metabolic syndrome development. Temporal changes in serum triglyceride, cholesterol, and fasting blood glucose levels were significantly influenced by inflammatory status. The findings demonstrate the importance of controlling inflammatory activities in the context of inhibiting the progression of metabolic syndrome and rheumatic diseases.

Efficacy of a multidimensional self-management intervention on low-education women with metabolic syndrome: a cluster randomized controlled trial

Low-education women, a substantially older population, are subject to increased risks of metabolic syndrome and consequent cardiometabolic diseases; early detection and effective management were urgently needed. Ninety-nine women with metabolic syndrome, age 61 and education ≤ 6 years, from four community units were randomly assigned to either a self-management intervention (n = 51) or a control arm (n = 48). The intervention consisted of five dimensions, physical activity and diet modifications (daily exercise classes and two nutrition courses), goal setting, coaching and peer support, problem-solving, and self-monitoring. The control arm received an education leaflet. Assessments were performed at baseline, six months, and 18 months. Compared with the control, the intervention participants improved the overall rate of meeting the recommended servings for six health foods, including vegetables, dairy products, and nuts (except whole grains, fruits, and protein); the rate of meeting regular leisure-time physical activity; and criteria biomarkers-waist circumference, fasting blood glucose, high-density lipoprotein cholesterol (except blood pressure and triglycerides); as well as body weight and body mass index; consequently decreased the number of risk factors and rate of metabolic syndrome. In conclusion, the multidimensional self-management intervention improved physical activity, healthy eating, and metabolic syndrome risks among low-education women with metabolic syndrome.

Dosing of Health and Wellness Coaching for Obesity and Type 2 Diabetes: Research Synthesis to Derive Recommendations

Health and wellness coaching (HWC) is an effective intervention for lifestyle disease such as obesity and type 2 diabetes. The evolving HWC profession needs recommendations to guide clinical practice, particularly the appropriate dose of coaching. The purpose of this paper was to systematically review and synthesize HWC literature to derive HWC programming recommendations. Of 102 papers retrieved, 88 were retained with data extracted determining HWC session number, frequency, duration, program length, and total coaching load. Differential analysis yielded no statistical difference in programming variables for randomized control trials and other designs, nor for studies with significant findings v. those not finding statistical significance, allowing these data to be pooled. The HWC intervention for obesity was slightly more intense (15 sessions over 7-8 mo) than the diabetes programming (12 sessions over 9-10 mo). On average, HWC programming applied in the peer-reviewed literature was 12-15 sessions of 35-40 min duration over 7-9 months. These recommendations for HWC programming variables are put forth as initial practice guidelines and should be examined with comparative effectiveness study for optimization. HWC best practice guidelines for other patient groups (e.g., heart disease, cancer, and chronic pain) should also be studied once an adequate literature data base is available.

Primary and secondary cardiovascular disease prevention interventions targeting lifestyle risk factors in women: A systematic review and meta-analysis

Background and aims

Over seven million women die from cardiovascular disease (CVD) annually. While lifestyle modification is recommended for CVD prevention, there are no systematic reviews evaluating the effectiveness of interventions targeted to women. The primary aim of this systematic review is to determine the efficacy of primary and secondary CVD prevention interventions targeting lifestyle risk factors in women.

Methods

Six electronic databases were searched up to January 2022. Eligible studies included randomized controlled trials of primary or secondary CVD prevention interventions targeting CVD lifestyle risk factors (diet, physical activity, sedentary behavior, smoking, alcohol, sleep, and weight management) in women (≥18 years) that reported CVD risk markers or lifestyle risk factors. Meta-analyses were conducted on CVD risk markers and body mass index (BMI), and the level of evidence was applied to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria and reported.

Results

Thirty-five RCTs were included (24 primary and 11 secondary prevention). Meta-analyses demonstrated that lifestyle CVD prevention interventions achieved statistically significant reductions in BMI at ≤ 6 months (0.95 kg/m2, 95% CI = 0.54 to 1.35, p < 0.0001), 12 months (0.61 kg/m2, 95% CI = 0.07 to 1.16, p = 0.03) and >12 months (0.58 kg/m2, 95% CI = 0.01 to 1.16, p = 0.05), and systolic blood pressure (mmHg) at ≤ 6 months (3.51, p < 0.001).

Conclusions

Lifestyle interventions are important for the prevention of CVD in women, specifically to reduce systolic blood pressure in the short term (≤ 6 months) and BMI long term (>12 months).

Systematic review registration

https://osf.io/bkwqm, identifier: osf-registrations-bkwqm-v1.

Lifestyle Factors Associated with Metabolic Syndrome in Urban Cambodia

This study aimed to identify lifestyle factors associated with metabolic syndrome (MetS) in urban Cambodia. In this cross-sectional study, we used existing health checkup data from a private hospital in Phnom Penh, Cambodia. The participants comprised 5459 Cambodians aged ≥20 years who underwent health checkups between 2017 and 2019. The harmonized diagnostic definition was used as the MetS criteria. The prevalence of MetS was 56.6% overall, 60.4% in men and 52.6% in women. The lifestyle factor significantly associated with MetS in both sexes were "eating quicker than others", (men: odds ratio [OR]= 2.25, 95% confidence interval [CI] = 1.68-3.03, women: OR = 1.92, 95%CI = 1.41-2.60), "walking faster than others", (men: OR = 0.78, 95% CI = 0.67-0.92, women: OR = 0.75, 95% CI = 0.62-0.89) and "drinking alcohol" (men: OR = 1.33, 95% CI = 1.10-1.61, women: OR = 1.33, 95% CI = 1.09-1.62). Other significant associations with MetS for men was "eating speed is normal", (OR = 1.73, 95%CI = 1.30-2.31), and, for women, "eating food after dinner at least 3 days a week", (OR = 1.25, 95%CI = 1.01-1.55), "skipping breakfast at least 3 days a week", (OR = 0.83, 95%CI = 0.69-0.99) and "getting enough rest from sleep" (OR = 1.19, 95% CI = 1.01-1.42) were significantly associated with MetS. Lifestyle interventions through health education and guidance may be effective in preventing MetS in Cambodia.

Actively incorporating lifestyle modifications into daily life: The key to adherence in a lifestyle intervention programme for metabolic syndrome

Introduction

Lifestyle modifications are the first-line interventions for metabolic syndrome (MetS) management. The effectiveness of lifestyle interventions depends mostly on participants' adherence to the interventions. The current study was to explore the experiences of MetS patients in attending lifestyle intervention program (LIP) and the factors that influenced their adherence to the interventions.

Methods

A descriptive qualitative study was designed following the COREQ guideline. Face-to-face semi-structured individual interviews were conducted with a purposive sample from the participants who attended the LIP using the data saturation principle. Content analysis of transcripts was conducted following the methods proposed by Graneheim and Lundman.

Results

The study recruited 27 participants, including 13 males and 14 females. Four themes were identified: (i) the positive and beneficial experiences of attending the LIP, including incorporating lifestyle modifications into daily life, improved physical and psychological health, and empowerment; (ii) facilitators of adherence, including individualized lifestyle education, regular follow-ups, and adequate interpersonal support; (iii) barriers to adherence, including personal resistance, competing demands, and contextual factors; (iv) suggestions for future interventions: with multidisciplinary team, longer term intervention, and more efficient approaches. The findings also indicated that young-to-middle aged patients faced more conflicts with role-related commitments, and were open for e-approaches in lifestyle interventions.

Conclusion

The LIP provided positive and beneficial experiences for the participants. Actively incorporating lifestyle modifications into daily life is the key to maintain participants' adherence to the LIP. Culturally appropriate and psycho-behavioral strategies should be adopted to overcome personal and contextual barriers. Special attentions should be paid for the young-to-middle aged population in MetS management.

Impact of motivational interviewing as a follow-up to an exercise intervention among women with or at risk for metabolic syndrome: A randomized controlled trial

OBJECTIVES

Women have a higher prevalence of metabolic syndrome than their male counterparts, and interventions should target women with or at risk for metabolic syndrome. The objective of this study was to compare two intervention strategies on long-term outcomes following the completion of an exercise intervention.

METHODS

Twenty-six women (M age = 43.35 ± 9.03) with at least one risk factor for metabolic syndrome were randomized into either a motivational interviewing group (n = 10) or self-regulation-based mobile messaging control group (n = 16) as a 12-week follow-up to a 10-week, 30-session exercise intervention. Outcomes of interest were body fat percentage, bone mineral density, waist circumference, systolic blood pressure, diastolic blood pressure, triglycerides, high-density cholesterol, and fasting blood glucose.

RESULTS

Mixed ANOVAs revealed a significant effect for group × time for body fat percentage F(1, 24) = 8.30, p = 0.01,η p 2  = 0.26, bone mineral density F(1, 24) = 6.68, p = 0.02,η p 2  = 0.22, waist circumference F(1, 24) = 10.35, p = 0.01,η p 2  = 0.30, triglycerides F(1, 24) = 5.06, p = 0.03,η p 2  = 0.17, and systolic blood pressure F(1, 24) = 5.39, p = 0.03,η p 2  = 0.18 all in favor of the motivational interviewing group after 12 weeks when compared to the self-regulation-based mobile messaging group. No significant effect for group × time was noted for diastolic blood pressure p = 0.36,η p 2  = 0.04, high-density cholesterol p = 0.08,η p 2  = 0.12, or fasting blood glucose p = 0.85,η p 2  = 0.01 when comparing the motivational interviewing and self-regulation-based mobile messaging groups.

CONCLUSIONS

Motivational interviewing may be a more impactful solution to extend the effects of exercise intervention studies compared to a self-regulation-based mobile messaging control group. Future interventions should focus on increasing sample size, utilizing more objective measures of body composition, utilizing booster sessions, and increasing the length of follow-up periods.

Effects of helping relationships on health-promoting lifestyles among patients with chronic kidney disease: A randomized controlled trial

BACKGROUND

Healthy behaviors can slow the progression of chronic kidney disease. Professional healthcare providers deliver education, physical exercise programs, motivation consultations, and stage-tailored strategies for improving health behaviors, but their effectiveness reported mixed. The helping relationships of significant others based on the transtheoretical model have been shown to be beneficial in facilitating and practicing health-promoting behaviors. However, few studies have examined the effects of helping relationships on health-promoting behaviors among patients with chronic kidney disease.

OBJECTIVES

The aim of this study was to examine the effects of the intervention strategies of significant others in their helping relationships with patients to advance stages of exercise and diet behaviors, and to improve health-promoting lifestyles.

DESIGN

A randomized controlled study.

SETTINGS

Two outpatient nephrology clinics in southern Taiwan.

PARTICIPANTS

Sixty participants in each of the two groups.

METHODS

Patients were randomly assigned to either the intervention group (n = 60) whose significant others received strategies for helping relationships for 12 months, or the control group (n = 60). The Stage of Change of Exercise and Diet Behaviors, and Health Promoting Lifestyle Profile-II Chinese version were assessed at baseline and 3, 6, 9, and 12 months after receiving the helping relationship interventions tailored to stage of change from significant others.

RESULTS

Generalized estimating equation analyzes revealed that the intervention group, when compared to the control group, had significantly advanced stages of change in exercise and diet, and improvement in health-promoting lifestyle over time. Adult children and spouses were the most common significant others to help patients practice healthy behaviors, compared to previous studies where professional healthcare providers were the significant others.

CONCLUSIONS

Individualized plans for healthy behaviors should take into consideration patients' readiness for adopting stage-tailored strategies of helping relationships of significant others to adhere to the health-promoting lifestyle. To promote a healthier lifestyle, significant others, such as spouses and adult children, should be included in treatment programs.

Temperamental and Personality Traits as Factors Related to Changes in Health Behaviors and Quality of Life in Patients With Metabolic Syndrome in Poland

Lifestyle changes in diet and physical activity are necessary for managing metabolic syndrome. The aim of this longitudinal study was to examine temperamental and personality traits as moderators of lifestyle changes prompted by motivational intervention. The sample consisted of 50 patients aged 22–65years (M=45.26; SD=9.79) who fulfilled the diagnostic criteria for metabolic syndrome and were undergoing treatment at the Military Institute of Medicine in Warsaw. There were two measurements: an initial measurement and a second 15months after motivational counseling. Each patient completed the questionnaires: Formal Characteristics of Behavior – Temperament Inventory, NEO Five Factor Inventory, Inventory of Health Behavior, and Short Form Survey SF-36. Body Mass Index (BMI), Fat Mass, Fat-free Mass, Intracellular Water, and Basal Metabolic Rate (BMR) were also measured. Data were analyzed using dependent samples t-tests to detect the changes in consecutive measurements, the hierarchical regression analysis was used to investigate temperamental and personality traits as predictors of change, the cluster analysis was used to extract the subgroups of patients with distinct profiles of temperamental and personality traits, and the analysis of variance was used to analyze extracted profiles as potential moderators of change. Three subgroups were extracted using k-means clustering: patients with higher Neuroticism, Perseveration, and Emotional Reactivity; patients higher Extraversion, Briskness, Sensory Sensitivity, Endurance, Activity, and Conscientiousness; and patients with lower Perseveration. All patients improved significantly in terms of physical quality of life (QoL), health behaviors, BMI, BMR, and Fat-free Mass (p<0.05). Regression analysis found that higher Sensory Sensitivity, lower Perseveration, and higher Agreeableness fostered positive change (p<0.05). Patients with higher Neuroticism, Perseveration, and Emotional Reactivity also improved in terms of their Emotional Quality of Life and Health Practices, reaching parity with other patients, which was verified on the basis of statistically significant interaction (p<0.05). The temperamental and personality trait profiles moderated the changes in health practices and emotional QoL. Motivational counseling was effective for patients diagnosed with metabolic syndrome in general, but patients with higher Neuroticism, Perseveration, and Emotional Reactivity benefited even more, as they were in poorer psychological condition before the motivational intervention.

Transitioning a home-based, motivational interviewing intervention among families to remote delivery during the COVID-19 pandemic: Key lessons learned

OBJECTIVE

This study examined the experiences, learnings, and strategies of Health Educators (HE) as they transitioned from a home-based model for motivational interviewing (MI) to remote delivery during COVID-19. The overall goal of this paper is to identify key lessons learned to help inform future delivery of remote MI delivery.

METHODS

HE perceptions and experiences regarding the transition from in-person to remote delivery of MI for 21 families were captured through a video recorded discussion. Thematic analysis was used to identify themes and subthemes and key learnings from the transition experience.

RESULTS

Five themes were identified including: 1) Impact of COVID-19 on families; 2) Scheduling, no-shows, and cancellations; 3) Preference of online video versus phone; 4) Building rapport with remote delivery; 5) HE work satisfaction. Based on these results, several key learnings were identified to improve remote MI-counseling, including using online video platforms versus phone calls, providing families the necessary information and technical support to improve acceptability, using specific strategies to enhance rapport and child engagement, and asking probing questions to elicit deeper reflection.

CONCLUSION

Specific considerations regarding rapport building including more frequent check-ins to demonstrate commitment to the family's success, and effective communication strategies including asking more probing questions that elicit complex reflection can support successful transition of MI-counseling from in-person to remote delivery among families with young children.

PRACTICE IMPLICATIONS

Our practice recommendations based on key learnings from MI practitioners during the transition from in-person to remote MI-counseling can support healthcare professionals looking to transition MI-counseling services to remote delivery.

Effects of Intradialytic Exercise on Dialytic Parameters, Health-Related Quality of Life, and Depression Status in Hemodialysis Patients: A Randomized Controlled Trial

Exercise is fundamentally important in managing chronic diseases and improving health-related quality of life (HRQL). However, whether intradialytic exercise is safe through assessment of changes in dialytic parameters and has a positive impact on HRQL and depression status of hemodialysis patients requires further research with diverse racial and cultural populations to identify. This study aimed to evaluate the effects of intradialytic exercise on dialytic parameters, HRQL, and depression status in hemodialysis patients. A randomized controlled trial was conducted at a medical center in Northern Taiwan. Sixty-four hemodialysis patients were recruited using stratified random sampling. Participants were randomized into an experimental group (EG, n = 32) or a control group (CG, n = 32). The EG received a 12-week intradialytic exercise program while the CG maintained their usual lifestyles. Dialytic parameters, HRQL, and depression status were collected at baseline and at 12 weeks. The results indicated no differences in the dialytic parameters from the baseline between both groups. However, the EG had increased HRQL (ß = 22.6, p < 0.001) and reduced depression status (ß = −7.5, p = 0.02) at 12 weeks compared to the CG. Therefore, a 12-week intradialytic exercise regime is safe and effective in improving HRQL and reducing depression status for hemodialysis patients.

Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic

In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training’s effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs’ ratings strongly indicated that providers’ application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.

Lifestyle-related education and counseling resource utilization and cardiovascular biomarkers in midlife women with low physical activity

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3% of high-risk midlife women participated in lifestyle-related resources.

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Lifestyle-related resource use was associated with more physical activity.

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Lifestyle-related resource use was associated with lower weight in obese women.

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Lifestyle-related resource use was associated with lower glucose in some women.

Health plan-based resources are promising avenues for decreasing cardiovascular disease risk. This study examined associations of lifestyle-related resource utilization within a healthcare delivery system and cardiovascular biomarkers among midlife women with low physical activity. Midlife women (45-55 years old) with <10 min/week of reported physical activity at a primary care visit within a large integrated healthcare delivery system in Northern California in 2015 (n = 55,393) were identified. Within this cohort, subsequent lifestyle-related health education and individual coaching resource utilization, and the next recorded physical activity, weight, systolic blood pressure, plasma glucose, HDL and LDL cholesterol measures up to 2 years after the index primary care visit were identified from electronic health records. We used a multilevel linear model to estimate associations. About 3% (n = 1587) of our cohort had ≥1 lifestyle-related resource encounter; 0.3% (n = 178) had ≥ 4 encounters. Participation in ≥4 lifestyle-related resource encounters (compared to none) was associated with 51 more minutes/week of physical activity (95% CI: 33,69) at the next clinical measurement in all women, 6.2 kg lower weight (95% CI: −7.0,-5.5) at the next measurement in women with obesity, and 8–10 mg/dL lower plasma glucose (95% CI: −30,14 and −23,2, respectively) at the next measurement in women with diabetes or prediabetes. Our results support the sustained utilization of health plan-based lifestyle-related resources for improving physical activity, weight, and plasma glucose in high-risk midlife women. Given the observed low utilization, health system-wide efforts may be warranted to increase utilization of lifestyle-related resources in this population.

Can Motivational Interviewing Make a Difference in Supporting Employees to Deal with Elevated Blood Pressure? A Feasibility Study at the Workplace

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses ('health coach') has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the 'health coach' in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial

The presence of multimorbidity in middle-aged and older adults, which reduces their physical activity and quality of life, is a global health challenge. Exercise is one of the most important health behaviors that individuals can engage in. Previous studies have revealed that aerobic exercise training is beneficial for healthy middle-aged and older adults and those with various chronic diseases, but few studies have designed individualized aerobic exercise training for individuals with multimorbidity. Although individuals with multimorbidity are considerably less adherent to physical activity interventions, telephone-based motivational interviewing may help in strengthening motivation and promoting behavioral change for increasing physical activity and health-related physical fitness. This study aimed to examine whether a 12-week individualized aerobic exercise training in a rehabilitation center combined with telephone-based motivational interviewing is effective in promoting physical activity and health-related physical fitness among middle-aged and older adults with multimorbidity. A randomized controlled trial was conducted. Forty-three participants (aged > 40) were recruited and randomly assigned to the intervention group, comparison group, or control group. The participants’ physical activity and health-related physical fitness were assessed at baseline and at 12 weeks. The results indicated that after individualized aerobic exercise training combined with telephone-based motivational interviewing, the participants reported increased total physical activity (F_in = 481.3, p = 0.011), vigorous-intensity physical activity (F_in= 298.9, p = 0.007), dominant and nondominant hand grip (kg) (F_in = 1.96, p = 0.019; F_in = 2.19, p = 0.027, respectively), FEV₁/FVC (F_in = 0.045, p = 0.043), VO₂ max (ml/kg/min) (F_in = 5.30, p = 0.001), VO₂ max predicted (%) (F_in = 21.6, p = 0.001), work (watts) (F_in = 22.5, p = 0.001), and anaerobic threshold (L/min) (F_in = 0.165, p = 0.011). Twelve weeks of individualized aerobic exercise training in the rehabilitation center combined with telephone-based motivational interviewing can increase the total physical activity, vigorous physical activity, and cardiorespiratory fitness of middle-aged and older adults with multimorbidity.

Economic Analysis of Brief Motivational Intervention Following Trauma Related to Drugs and Alcohol

BACKGROUND

Very few studies have conducted an economic assessment of brief motivational intervention (BMI) in patients experiencing traumatic injuries related to alcohol and/or substance use. Furthermore, findings concerning the potential long-term economic benefits of BMI applied in nursing are promising but very scarce.

OBJECTIVE

The purpose of this study was to analyze the costs and benefits associated with the application of a BMI program by nursing staff to patients hospitalized for trauma related to substance use.

METHODS

An analysis of costs and benefits was conducted in a nonrandomized study of a retrospective cohort of patients. An intervention and follow-up (of 10-52 months) of patients between 16 and 70 years of age admitted for traumatic injuries in University Hospital of Granada were carried out with a cohort of 294 patients (intervention = 162 vs. no intervention = 132) between 2011 and 2016. The National Health Service's perspective on the use of medical resources and the costs associated with intervention and recidivism was considered. A cost analysis with a 5-year time frame and a subsequent analysis of sensitivity were conducted.

RESULTS

Direct medical costs associated with trauma recidivism were significantly lower in patients who received BMI, as compared to patients who did not receive it, &OV0556;751.82 per patient (95% CI &OV0556;13.15 to &OV0556;1,490.48) in the first year. The cost-benefit ratio of &OV0556;74.92 at 4 years reflects National Health Service savings for each euro invested in BMI.

DISCUSSION

The implementation of BMI programs in nursing care may be profitable from an economic standpoint, justifying the inclusion of these programs in hospitals both because of their efficacy and the potential savings incurred by the health system. This study addresses the lack of evidence regarding the economic implications linked to the effectiveness of the intervention to reduce substance use and trauma recidivism. Results identify BMI delivered in hospitals by nurses as a technique that offers the potential for reducing costs linked to trauma recidivism. The research has important practical implications for hospital nurses and doctors.

Motivational interviewing to support modifiable risk factor change in individuals at increased risk of cardiovascular disease: A systematic review and meta-analysis

BACKGROUND

Programmes using motivational interviewing show potential in facilitating lifestyle change, however this has not been well established and explored in individuals at risk of, yet without symptomatic pre-existent cardiovascular disease. The objective of this systematic review and meta-analysis was to determine the effectiveness of motivational interviewing in supporting modifiable risk factor change in individuals at an increased risk of cardiovascular disease.

METHODS

Systematic review and meta-analysis with results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-related databases were searched for randomised controlled trials from 1980 to March 2020. Criteria for inclusion included; preventive programmes, motivational interviewing principles, modification of cardiovascular risk factors in adults of both genders, different ethnicities and employment status, and having at least 1 or more modifiable cardiovascular risk factor/s. Two reviewers independently extracted data and conducted a quality appraisal of eligible studies using an adapted Cochrane framework. The Cochrane framework supports to systematically identify, appraise and synthesize all the empirical evidence that meets the pre-specified eligibility criteria to answer a specific question.

FINDINGS

A total of 12 studies met the inclusion criteria. While completeness of intervention reporting was found to be adequate, the application of motivational interviewing was found to be insufficiently reported across all studies (mean overall reporting rate; 68%, 26% respectively). No statistical difference between groups in smoking status and physical activity was reported. A random effects analysis from 4 studies was conducted, this determined a synthesized estimate for standardised mean difference in weight of -2.00kg (95% CI -3.31 to -0.69 kg; p = 0.003), with high statistical heterogeneity. Pooled results from 4 studies determined a mean difference in LDL-c of -0.14mmol/l (5.414mg/dl), which was non-significant. The characteristics of interventions more likely to be effective were identified as: use of a blended approach delivered by a nurse expert in motivational interviewing from an outpatient-clinic. The application of affirmation, compassion and evocation, use of open questions, summarising, listening, supporting and raising ambivalence, combining education and barrier change identification with goal setting are also important intervention characteristics.

CONCLUSIONS

While motivational interviewing may support individuals to modify their cardiovascular risk through lifestyle change, the effectiveness of this approach remains uncertain. The strengths and limitations of motivational interviewing need to be further explored through robust studies.

Motivational Counseling to Reduce Sedentary Behaviors and Depressive Symptoms and Improve Health-Related Quality of Life Among Women With Metabolic Syndrome

Background

Motivational interviewing, as a counseling approach, could promote not only behavioral changes but also individuals' psychological adaptation. Previous studies provide evidence that motivational interviewing focused on increasing physical activity decreases the risk of metabolic syndrome in women. Its effects on sedentary behaviors, depressive symptoms, and health-related quality of life (HRQL) remain unknown.

Objectives

The aim of this study was to evaluate whether a 12-week motivational counseling program reduces sedentary behaviors and depressive symptoms and improves HRQL in Taiwanese women.

Methods

A randomized controlled study was conducted. Participants (n = 115) were randomly assigned into 3 groups: experimental group (received a brochure on lifestyle modification combined with 12 weeks of motivational counseling), comparison group (received a lifestyle modification brochure), and usual care group (UCG). Outcome variables were measured at baseline and at 12 weeks post intervention by the International Physical Activity Questionnaire, Beck Depression Inventory, and Medical Outcomes Short Form-36 Health Survey. Generalized estimating equations were applied to analyze the intervention effects of groups by interaction of group and time.

Results

Women in the experimental group not only reduced (P < .001) weekly sitting time by 374 minutes but also decreased (P < .05) depressive symptoms, as well as had greater overall HRQL including 8 subscales as compared with the UCG. As compared with the UCG, the women in the comparison group had no change in sedentary behaviors, but they had reduced depressive symptoms and improvement on some HRQL subscales.

Conclusions

Motivational counseling that incorporates behavioral change principles is effective in reducing sedentary behaviors and depressive symptoms and improving HRQL for women with metabolic syndrome.

Effect of electronic health interventions on metabolic syndrome: a systematic review and meta-analysis

OBJECTIVE

We aimed to examine whether eHealth interventions can effectively improve anthropometric and biochemical indicators of patients with metabolic syndrome (MetS).

DESIGN

Systematic review and meta-analysis.

METHODS

PubMed, the Web of Science, Embase, Medline, CINAHL, PsycINFO, the Cochrane Library, the Chinese National Knowledge Infrastructure, the Wanfang and Weipu databases were comprehensively searched for papers that were published from database inception to May 2019. Articles were included if the participants were metabolic syndrome (MetS) patients, the participants received eHealth interventions, the participants in the control group received usual care or were wait listed, the outcomes included anthropometric and biochemical indicators of MetS, and the study was a randomised controlled trial (RCT) or a controlled clinical trial (CCT). The Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included articles. The meta-analysis was conducted using Review Manager V.5.3 software.

RESULTS

In our review, seven RCTs and two CCTs comprising 935 MetS participants met the inclusion criteria. The results of the meta-analysis revealed that eHealth interventions resulted in significant improvements in body mass index (standardised mean difference (SMD)=-0.36, 95% CI (-0.61 to -0.10), p<0.01), waist circumference (SMD=-0.47, 95% CI (-0.84 to -0.09), p=0.01) and systolic blood pressure(SMD=-0.35, 95% CI (-0.66 to -0.04), p=0.03) compared with the respective outcomes associated with the usual care or wait-listed groups. Based on the included studies, we found significant effects of the eHealth interventions on body weight. However, we did not find significant positive effects of the eHealth interventions on other metabolic parameters.

CONCLUSIONS

The results indicated that eHealth interventions were beneficial for improving specific anthropometric outcomes, but did not affect biochemical indicators of MetS. Therefore, whether researchers adopt eHealth interventions should be based on the purpose of the study. More rigorous studies are needed to confirm these findings.

Effects of telephone-based health coaching on patient-reported outcomes and health behavior change: A randomized controlled trial

OBJECTIVE

Telephone based health coaching (TBHC) seems to be a promising approach to foster self-management in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany.

METHODS

Patients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen's single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation.

RESULTS

Of the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant between-group comparisons regarding these changes supported the findings. Standardized effect sizes were small. TBHC did not show any effect on mental QoL, health status, alcohol, smoking, adherence, measuring blood sugar, foot monitoring, anxiety, depression and distress. Campaign-specific subgroup effects were detected for 'foot monitoring by a physician' and 'blood sugar measurement'.

CONCLUSION

TBHC interventions might have small effects on some patient reported and behavioral outcomes.

PRACTICE IMPLICATIONS

Future research should focus on analyzing which intervention components are effective and who profits most from TBHC interventions.

REGISTRATION

German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS): DRKS00000584.

Motivational support programme to enhance health and well-being and promote weight loss in overweight and obese adolescents: A randomized controlled trial in Turkey

AIM

The aim of this study is to investigate the effect on health, well-being and weight loss of a motivational support programme provided for adolescents who were overweight and obese.

METHODS

This was a randomized controlled trial. Sixty-four adolescents (39 girls and 25 boys) who were overweight and obese and consulted at our polyclinic from January 2015 to February 2016 comprised the study population. The sociodemographic characteristics, well-being levels and physical parameters of the adolescents were evaluated. Routine follow-ups were practiced for both groups. The adolescents in the experimental group had motivational interviews and were sent reminder messages over a 6-month period, and education programmes were conducted with the parents.

RESULTS

After 6 months, the body mass index values had decreased in the experimental group compared with baseline, with no decrease in the controls. Scores for the Paediatric Quality of Life total scale and physical health and psychosocial health subscale points were increased in experimental and control groups, but the quality of life scale points of the experimental group were higher than the control group. In the experimental group, aspartate aminotransferase, alanine aminotransferase, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and total cholesterol were decreased.

CONCLUSION

The motivational support programme affected the adolescents' health positively and can be recommended as a routine nursing intervention.

Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity: A Randomized Controlled Trial

BACKGROUND

Exercise training has positive effects on the management of cardiometabolic conditions. Little is known about the effectiveness of home-based telehealth exercise training programs among patients with cardiometabolic multimorbidity, which is associated with functional decline and decreased health-related quality of life.

OBJECTIVE

The aim of this study was to determine the effectiveness of a 12-week home-based telehealth exercise training program designed to increase physical activity and exercise capacity and improve health-related quality of life in patients with cardiometabolic multimorbidity.

METHODS

A randomized controlled trial was conducted. Fifty eligible patients with 2 or more cardiometabolic conditions from outpatient clinics of a medical center in Northern Taiwan were randomized to either an experimental group (EG; received a 12-week home-based telehealth exercise training program) or a control group (CG; maintained usual lifestyles). The home-based telehealth exercise training program consisted of 36 individualized home-based exercise training sessions and a weekly reminder for maintenance of exercise and providing patient support. Amounts of physical activity, exercise capacity, and health-related quality of life were assessed at baseline and 12 weeks. Generalized estimating equations were used to examine the intervention effects via the interaction of time and group.

RESULTS

The EG had higher amounts of physical activity (β = 1333, P = .004) and moderate-intensity physical activity (β = 330, P = .04) than the CG after the intervention. The EG had increased exercise capacity (VO2peak, β = 4.43, P = .04), as well as improved health-related quality of life (physical function, β = 7.55, P = .03; and physical component summary, β = 4.42, P = .03) compared with those in the CG.

CONCLUSIONS

A 12-week home-based telehealth exercise training program is feasible and effective in increasing amounts of physical activity, elevating exercise capacity, and improving health-related quality of life in patients with cardiometabolic multimorbidity.

The effects of a nurse-led lifestyle intervention program on cardiovascular risk, self-efficacy and health promoting behaviours among patients with metabolic syndrome: Randomized controlled trial

BACKGROUND

Metabolic syndrome is a cluster of cardio-metabolic risk factors and a major burden for public health due to its increasing prevalence and adverse effects on cardiovascular health. Lifestyle modification is the first-line intervention for metabolic syndrome management. However, adopting healthy behaviours is challenging among patients with metabolic syndrome.

OBJECTIVE

To examine the effects of a nurse-led lifestyle intervention program on cardiovascular risks, self-efficacy and the implementation of health promoting behaviours.

DESIGN

A two-armed randomized controlled trial.

SETTINGS AND PARTICIPANTS

A total of 173 patients that satisfied the metabolic syndrome definition of International Diabetes Federation was recruited from a hospital in North China.

METHODS

The participants were randomly assigned to either attend the lifestyle interventions (n = 86) or receive usual care from the study hospital (n = 87). The lifestyle intervention followed the framework of Health Promotion Model and consisted of one face-to-face education session (30-40 min), one educational booklet and six telephone follow-ups (bi-weekly, 20-30 min per call) in three months. The Framingham 10-year risk score was calculated to measure the participants' cardiovascular risks at baseline and 3-month. The Self-rated Abilities for Health Practices and Health Promoting Lifestyle Profile II was employed to measure the self-efficacy and health promoting behaviours at baseline, 1-month, and 3-month. The generalized estimating equation model was employed to examine the effects of the lifestyle intervention program.

RESULTS

No difference was detected in the baseline characteristics between the two groups. Decreased cardiovascular risk was found in the lifestyle intervention group, but no significant group-by-time effect was detected. The self-efficacy for nutrition, stress dimension and sum score of health promoting behaviours revealed significant improvements at 1-month (all p < 0.05). Significant improvements were also detected in all subscales, total scale of self-efficacy, all dimensions and the sum score of health promoting behaviours at 3-month (all p < 0.05).

CONCLUSIONS

The nurse-led Health Promotion Model guided lifestyle intervention program effectively improved the self-efficacy and implementation of health promoting behaviours in patients with metabolic syndrome. We recommend that nurses apply lifestyle interventions in routine care for patients with metabolic syndrome. Tweetable abstract: The RCT revealed that nurse-led lifestyle intervention was effective to improve self-efficacy and healthy behaviours among 173 MetS patients.

Impact of motivational interviewing on engagement in a parent-exclusive paediatric obesity intervention: randomized controlled trial of NOURISH+MI

BACKGROUND

Attrition and treatment adherence are notorious challenges in paediatric obesity interventions.

OBJECTIVE

To evaluate if brief, pretreatment motivational interviewing (MI) can improve retention (at baseline, post-assessment and follow-up assessment) and adherence (i.e. attendance) in a parent-exclusive paediatric obesity intervention.

METHODS

MI was implemented with parents as an adjunct to a larger randomized controlled trial of Nourishing Our Understanding of Role-modeling to Improve Support and Health (NOURISH⁺ ), a parent intervention for children with overweight ages 5-11 years. Parents (N = 112) were randomized to receive two MI sessions (one telephone and one in person) or reminder calls.

RESULTS

Parents (91% women; 52% African American) who completed one telephone MI session were more likely to attend baseline (74%) compared with parents who received reminder calls only (53%, p < .001). After a second MI session, there were no group differences in treatment initiation (p > .05). Treatment attendance, post or 4-month follow-up assessment completion did not differ between conditions (p > .05).

CONCLUSION

One MI session implemented prior to treatment can improve baseline attendance; a second MI session did not enhance these effects. A single-session telephone-based MI pretreatment might be a cost and time-effective strategy to enhance recruitment efforts. Further strategies to address retention and treatment attendance are needed.

Comparing the effects of face-to-face and telenursing education on the quality of family caregivers caring in patients with cancer

BACKGROUND

Taking care of patients with cancer is often done at home and by family caregivers. However, these groups do not receive the necessary education regarding care at home.

OBJECTIVES

The present study aimed to compare the effects of face-to-face and telenursing training methods on the quality of services provided by the family caregiver for patients with cancer.

MATERIALS AND METHODS

A total of 103 family caregivers of patients with cancer were randomly divided into 3 groups: control (N = 35), face to face (N = 34), and telenursing (N = 34). The control group only received the routine training, and the face-to-face and telenursing groups were trained for 12 weeks. Quality of care was measured using a questionnaire before and after intervention. Chi-square, Fisher's exact, and analysis of variance tests were used for data analysis.

RESULTS

After intervention, the average total quality score for the care of patients in face-to-face (166.13 ± 13.91) and telenursing (157.76 ± 17.24) groups was significantly higher than the control group (82.51 ± 16.84) (P < 0.001). In addition, the average psychosocial care score for face-to-face group (49.06 ± 6.05) was significantly higher than telenursing group (43.83 ± 6.15) (P < 0.001).

CONCLUSION

The results of the study showed that the two methods of training were effective on the quality of care among family caregivers of patients with cancer to a similar extent.

Telephone Support and Telemonitoring for Low-Income Older Adults

The objective of the current pilot study was to determine whether nurse-led telephone counseling improves health behavior, self-care, and physiological indices for low-income older adults using a telemonitoring system. The control group (n = 15) was provided with weekly health education only, and the intervention group (n = 20) was given additional telephone support by nurses. At baseline and 8 weeks, data on health and self-care behaviors were collected using a self-reported questionnaire, and blood pressure and fasting blood glucose levels were assessed. Nurse-led telephone support had a medium effect on improving health behavior (Cohen's d = 0.58, 95% confidence interval [CI] [-0.10, 1.27]), reducing systolic blood pressure (Cohen's d = -0.61, 95% CI [-1.29, 0.08]), and improving self-care behavior for hypertension (Cohen's d = 1.16, 95% CI [0.05, 2.27]). Findings support that nurse-led telephone support may be effective for improvements in health behavior, systolic blood pressure, and hypertension self-care in disadvantaged older adults under remote monitoring. Further studies are needed to obtain a powered sample size and investigate the long-term effects of personalized elements surrounding telehealth in community-based settings. [Res Gerontol Nurs. 2018; 11(4):198-206.].

Effectiveness of the I2AO2 interdisciplinary programme led by nurses on metabolic syndrome and cardiovascular risk: a randomized, controlled trial

Objective To evaluate the effectiveness of an interdisciplinary programme led by nurses in relation to metabolic syndrome (MS) and cardiovascular risk (CVR). Methods This randomized, controlled, clinical trial included 74 patients diagnosed with MS (experimental group [EG], n = 37; control group [CG], n = 37). The intervention consisted of a 12-month interdisciplinary programme (pre-test, 6 months of intervention, 12 months of intervention, and 1-year follow-up post-intervention) coordinated by nursing. Results We found a progressive and significant reduction for all clinical, biochemical, and anthropometric parameters analysed at different time points. In the EG, remission of MS by 48.1% in the short term was observed (83.8% in the medium term) and maintained at 1 year post-intervention. In the CG, the prevalence of MS increased by 2.7% from the initial evaluation to study completion. A similar trend was observed for CVR. In the EG, 100% of subjects had a moderate-low risk of CVR at 1 year post-intervention, whereas the CG had CVR in all categories. Conclusion An interdisciplinary, nurse-led programme improves participants' metabolic and cardiovascular health, while maintaining long-term effects. Our findings suggest an important role of the professional nurse as a nexus between the patient, different professionals, and the community.

Counselor competence for telephone Motivation Interviewing addressing lifestyle change among Dutch older adults

Counselor competence in telephone Motivation Interviewing (MI) to change lifestyle behaviors in a primary care population was assessed using the Motivational Interviewing Treatment Integrity (MITI) rating system. Counselor behavior was evaluated by trained raters. Twenty minutes of a random sample of 336 MI sessions were coded representing 232 counselees. Ninety-four sessions (28%) were double coded to assess inter-rater agreement. The MI fidelity was examined by comparing the MI fidelity scores direction, empathy, spirit, % open questions, % complex reflections, reflections-to-questions ratio, % MI-adherent responses with the matching beginner proficiency MITI threshold. The inter-rater agreements for the MI fidelity summary scores were good (spirit, reflections-to-questions ratio), fair (empathy, % open questions, % MI-adherent responses) or poor (direction, % complex reflection). The MI fidelity scores for direction, empathy, spirit and the percentage of complex reflections exceeded the MITI threshold, but lower scores were found for the percentage of open questions, the reflections-to-questions ratio and the percentage of MI-adherent responses. In conclusion, evidence that MI was implemented was revealed. However, the inter-rater agreements scores and some fidelity scores leave room for improvement indicating that raters and counselors may need more ongoing training and feedback to achieve and maintain adequate competence. These findings apply to more complex skills (as rating complex reflections) in particular.