@2024 Afarand., IRAN

---

ISSN: 2252-0805    The Horizon of Medical Sciences 2015;21(3):213-220

Background
… [1-13] Motivational interviewing is a client-centered and direct approach for stimulating intrinsic motivation to change behavior using searching and problem solving [14, 15]. The goal of motivational interviewing techniques is communication between patients and health workers and encouraging people to change their behavior [8]. Motivational interviewing has been widely and effectively used in the field of health [16].
Previous Studies
Motivational interviewing has been used to increase adherence to treatment, improve nutrition and promote physical activities for diabetic people [17], chronic obstructive pulmonary diseases [18], hypertension [19], AIDS [20], and obesity [21]. The effectiveness of motivational interviewing has been noted in patients with hypertension [19]. Some studies indicate higher efficacy of motivational interviewing technique compared to traditional methods [22-24].
Aim(s)
The aim of this study was to investigate the effect of motivational interviewing on adherence to treatment in patients with hypertension and its comparison with standard care.
Research type
The current study is a randomized clinical trial.
Research society, place and time
Patients with hypertension were selected from two health centers located in the city of Gorgan (Iran), and they were studied in 2014.
Sampling method and number
140 patients with hypertension (70 patients in motivational interviewing and 70 in control group were selected using Multistage Cluster Sampling method. Inclusion criteria were receiving at least one medication to control blood pressure, having hypertension diagnosed by a physician, having the age over 18 years old, and having consent to participate in the study. Exclusion criteria were secondary hypertension during the study and being pregnant during the study.
Used devices&materials
Data were collected before and 6 months after intervention. Similar questionnaires were used for evaluating patients in both groups at different times (before the intervention, and 6 months after the intervention). The final evaluation was conducted by a person employed in health center. Blood pressure was measured by the employees in the center using digital pressure gauge (Beurer BM40; Germany) in the sitting position and after 15 minutes. Laboratory parameters of patients were collected from their health records in the center. Motivational interviewing was conducted by a psychologist. According to scientific literature, motivational interviewing has the structure of 5 sessions [25]. Each group consisted of 7 to 10 people who participated in 6 sessions (each session 45 to 60 minutes). The content of these meetings included education about healthy dietary habits, regular physical activity, smoking cessation, on time consumption of medication, and stress reduction. These meetings were held at health centers. The content of standard learning group (control group) consisted of presenting advices and information about changing unhealthy lifestyle and turning it into healthy style and adherence to treatment using lectures and teaching aids such as pamphlets and brochure about blood pressure and held by a person employed in the health center. Data collection tools were the demographic questionnaire, a general questionnaire of self-efficiency and the questionnaire of adherence to the treatment in patients with hypertension. Iranian version of the questionnaire of general self-efficacy was used to measure the self-efficacy of patients. This questionnaire is consisted of 10 questions with 4 choices (from “it is not correct at all” to “it is totally correct”).The amount of Cronbach`s alpha in the pilot study was reported 0.87. The higher score in this questionnaire means the higher self-efficacy [26]. In order to evaluate the adherence to treatment in patients with hypertension, a Persian translation of the Chen et al. questionnaire of adherence to treatment was used [27]. This tool is consisted of 28 multiple choice questions in a Likert scale and 6 domains (diet, exercise, medication, weight control, encouragement, and stress reduction). Cronbach`s Alpha for the total scale of the first 25 patients were 0.83. Collected data were analyzed using SPSS 18 software. Descriptive statistics methods were used to evaluate the data at a basic level. To determine the normal distribution of data in the baseline (before intervention) Kolmogrov-Smirnov test was used. To assess people within the groups, Dependent T-test was used. And finally, to compare between motivational interviewing and control groups, Independent T-test was used. … [28]
Findings by Text
The mean age of participants was 62 ± 12.43years. The mean age of motivational interviewing group was 62.35 ±11.67years, and it was 61.92 ± 13.12years in the control group; and that there was no statistically significant difference between two groups in this respect. Also, there was no significant difference between two groups in terms of other demographic characteristics (Table 1). Laboratory parameters and blood pressure were similar between two groups at baseline. In addition, 6 patients had hypertension problems and complications, and most of the subjects had no symptoms of hypertension. The total score and the mean of dietary habits, physical activity, smoking and drug consumption was higher in motivational interviewing group compared to control group after 6 months. Also, the scores of motivational interviewing group on dietary habits, physical activity, smoking and adherence to treatment were changed before the intervention and 6 months after that, and its value was significantly increased (table 2). Systolic and diastolic blood pressure was less in the motivational interviewing group compared to control group. Also, the blood pressure of patients was reduced significantly in motivational interviewing group after the intervention. Also, the blood pressure of patients in control group was reduced after the intervention. However, after the intervention, laboratory parameters were not significantly different between two groups and within the groups (table 3).
Main comparison to the similar studies
Motivational interviewing had a significant impact on adherence to treatment (such as lifestyle change and medication) in patients with hypertension. The results are similar to the results of other studies in which in addition to the significant decrease in the blood pressure index, the variables of life quality and self-efficacy had significantly improved in the motivational interviewing group [7, 8]. Patients in the motivational interviewing group were more committed to healthy life style (such as physical activity and smoking cessation) compared to control group. The results of current study are in line with previous studies that show the effectiveness of motivational interviewing in the adoption and implementation of healthy behaviors [8, 29]. … [30] People in motivational interviewing group were more committed to the implementation of interventions than control group. And these findings are similar to the findings of other studies [8, 19]. The results of this study are similar to the findings of other studies in which the use of motivational interviewing has improved the adherence to treatment in patients with psychological disorders, AIDS, blood pressure and alcohol addicts [8, 15, 16, 23, 31, 32]. The total scores of life quality, motivation and self-efficacy of patients in motivational interviewing group have been more than control group; and a quite similar technique has been used people in the intervention group having been received 8 sessions of one hour. However, the person involved did not have the necessary expertise, while in the present study, six 1-hour sessions were carried out with a psychologist [33]. People in motivational interviewing group controlled their blood pressure better than people in control group and their systolic and diastolic blood pressure had been decreased. These results are consistent with other studies [8, 19, 34]. There was no significant difference between groups and within the groups in the variables and laboratory parameters such as TC (Total Cholesterol), TG (Triglycerides), LDL (Low Density Lipoprotein), HDL (High Density Lipoprotein) and FBG (Fasting Blood Sugar). The finding is similar to the findings of another study [8]. In a study [19], people in the intervention group have had motivational interviewing similar to the present study in such a way that all participants received the intervention in 30- to 40-minute sessions and during 3, 6, 9 and 12 months. However, the number of sessions was almost the same, while in that study these sessions were ongoing (held by the researcher), but in the present study, it was implemented in a short period (3 weeks). The advantage of the present study was holding the sessions (motivational interviewing) by a psychological specialist. The index of self-efficacy did not have statistically significant difference between two groups, although little changes were seen in the motivational interviewing group after a 6-month intervention, compared to the baseline. This study is consistent with the result of a study [8], but it is not matched with another study [33]. … [35]
Suggestions
Motivational interviewing techniques should be used in the health centers.
Limitations
Single blind study, the use of self-report questionnaire, and the use of general self-efficacy questionnaire for the patients were the limitations of this study.
Conclusions
Motivational interviewing has positive effects on controlling the blood pressure and adherence to therapeutic interventions in patients with hypertension. It seems that using motivational interviewing can be effective on controlling this disease in Golestan Province (Iran), which suffers from a high prevalence of hypertension.
Acknowledgments
All participating patients are appreciated.
Conflict of interest
Non-declared
Ethical Permissions
This study has been approved by Ethics Committee of Golestan University of Medical Sciences.
Funding Sources
This research has been funded by Golestan University of Medical Sciences.

TABLES and CHARTS

Show attach file