The art of motivating behavior change: the use of motivational interviewing to promote health

Health promotion and disease prevention have always been essential to public health nursing. With the changing health care system and an increased emphasis on cost-containment, the role of the nurse is expanding even more into this arena. A challenge for public health nurses, then, is to motivate and facilitate health behavior change in working with individuals, families, and communities and designing programs based on theory. Leading causes of death continue to relate to health behaviors that require change. The purpose of this article is to integrate theory with practice by describing the Transtheoretical Model of Change as well as the principles of motivational interviewing that can be used in motivating behavioral change. A case scenario is presented to illustrate the use of the models with effective interviewing skills that can be used to enhance health. Implications for practice with an emphasis on providing an individually tailored matched intervention is stressed.     

Promoting nurse interventionist fidelity to motivational interviewing in a diabetes self-care intervention

We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.     

Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review

Aim. This paper is a report of a literature review to identify research involving interventions to improve medication adherence in people with multiple co-existing chronic conditions. Title. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. Background. The importance of managing co-existing, chronic conditions in people of all ages is critical to prevent adverse health outcomes. Data sources. Databases, including Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed and Web of Science were searched for the period January 1997–2007 using the combined keywords adherence, compliance, drug therapy, medication, clinical trial, randomized controlled trial, intervention, chronic condition, chronic disease, multiple morbidity and comorbidity. References of retrieved papers were also considered. Methods. The inclusion criteria were: English language, oral medication adherence, self-administered medications, multiple prescribed medications for three or more chronic conditions and randomized controlled trials lasting at least 3 months. Results. Studies examining medication adherence in people with multiple chronic conditions targeted people over 70 years of age, and were primarily focused on the management of polypharmacy and reducing healthcare costs. Adherence was measured using different tools and estimates of adherence, and interventions were predominantly delivered by pharmacists. The evidence for effective interventions to enhance medication adherence in multiple chronic conditions was weak, and psychosocial interventions were absent. Conclusion. Interventions that improve medication adherence for people with multiple chronic conditions are essential, given the increased prevalence of these conditions in people of all ages. Outcomes of improved adherence, such as disease control and quality of life, require investigation. Psychosocial interventions engaging people in medication self-management offer potential for improved patient outcomes in complex diseases.     

肾移植受者免疫抑制药物依从性现况分析

目的:调查肾移植受者免疫抑制药物依从性的现况并分析其影响因素。方法:采用一般情况调查表和免疫抑制药物依从性Basel评估量表对肾移植受者进行多中心横断面调查。结果:共纳入819例肾移植受者,免疫抑制药物依从性差的发生率为43.8%,其中不按时服药最常发生,其次是漏服药。免疫抑制药物依从性的独立影响因素包括移植时间、器官来源、术后是否存在并发症和透析时间。结论:目前肾移植受者的免疫抑制药物依从率较低,尤其是移植时间长、活体供肾、有并发症以及透析时间短的受者,医务人员在随访过程中应重视该人群依从性的筛查,帮助肾移植受者进行疾病和药物的管理。