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Characteristics of patients who do not respond to motivational interviewing for heart failure self-care
Stawnychy, Michael A. Zeffiro, Valentina Iovino, Paolo Vellone, Ercole Riegel, Barbara
Stawnychy, Michael A.
Zeffiro, Valentina
Iovino, Paolo
Vellone, Ercole
Riegel, Barbara
Abstract
Background
Motivational interviewing (MI) improves heart failure (HF) self-care for most yet fails to work for some patients. Identifying patients less likely to benefit from MI would save time in identifying a more suitable treatment for these patients.
Objective
The aim of this study was to identify the characteristics of adults with HF less likely to clinically improve self-care after MI.
Methods
This was a secondary intervention group analysis (n = 230) of MOTIVATional intErviewing to improve self-care in Heart Failure patients (MOTIVATE-HF), a trial evaluating MI in improving HF self-care maintenance and management. Self-care was measured with the Self-care of Heart Failure Index v. 6.2 at baseline and 3 months from enrollment. Participants were dichotomized into MI nonresponder (standardized score change <8 points) or MI responder (score change ≥8 points). Logistic regression, adjusted for group differences, identified determinants of nonresponse (odds ratio [95% confidence interval]).
Results
Significant risk factors for self-care maintenance nonresponse 3 months after the intervention were nonischemic HF (2.58 [1.33–5.00], P = .005) and taking fewer medications (0.83 [0.74–0.93], P = .001). These variables explained 29.6% of the variance in HF self-care maintenance. Risk factors for self-care management nonresponse were living alone (4.33 [1.25–14.95], P = .021) and higher baseline self-care management (1.06 [1.02–1.09], P < .001), explaining 35% of the variance in HF self-care management.
Conclusions
Motivational interviewing may be less beneficial in patients with nonischemic HF and taking fewer medications. Patients with HF living alone with relatively better self-care management may be at risk for MI treatment failure. Identifying characteristics of nonresponders to MI in HF contributes to clinical decision making and personalized interventions.
Keywords
adults, heart failure, motivational interviewing, secondary analysis, self-care
Date
2022
Type
Journal article
Journal
Journal of Cardiovascular Nursing
Book
Volume
37
Issue
5
Page Range
E139-E148
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled