8/14/2019 CDMPosteroriginal

1/1

Discussion: Findings from a Pilot Research comparing

Brief Motivational Interviewing versus Health Education in

lowering Low-density Lipoprotein levelsML. Ho, PS. Goh and YP. Seah. Nursing, National Healthcare Group Polyclinics

Motivational Interviewing (MI) is is a framework defined as a directive,

ient-centered counseling style for eliciting behavior change by helping

ients to resolve and explore ambivalence.1 The 5 basic principles includexpressing empathy, developing discrepancy, avoiding argumentation,

olling with resistance and supporting self-efficacy. Brief MI, an

daptation of the MI, requires 15 to 20 minutes to execution preserves the

rinciples of MI..

pilot research study was done to evaluate the effectiveness of usingBrief

MIversusHealth Education in lowering LDL in newly diagnosed patients

ith hyperlipidemia in the polyclinic setting. Subjects were randomized to

ther the MI or control group and were followed up in 3-month period for

ost intervention review.

his poster paper presentation will use findings of this pilot research project

o discuss concepts of Health Behavior Change and appropriate outcome

ndicators to measure effectiveness of patient education interventions.

Health Education concept believes that by giving knowledge to patients will

result in having better clinical outcomes. Studies2,3,4,5 have shown that knowing

doesnt equate to doing thus creating a knowledge-action gap.

Introduction

Discussion Objectives

Findings from Pilot Study

Health Education versus

Health Behavior Change Concept

Determinants of Patient Education

Interventions Effectiveness

Conclusion

References

1. Findings from the pilot research study Effectiveness of MI versusHealth Education in lowering LDL levels

Concepts ofHealth Education versus Health Behavior Change

Determinants ofPatient Education Interventionseffectiveness.

Knowledge

Health

Outcomes

Acknowledgement

The PI sincerely thanks Dr Chan Y.H.(NUS) for his patient guidance and supervision

over this pilot research.

Special thanks to Dr Audrey Tan (NHG HQ Projects), CM Ng Soh Mui and CM Alice

Goh for their kind assistance in vetting the Brief Motivational Interviewing script.

The study team like to acknowledge with gratitude the support of Ms Doris Liew,

Ms Yeo Loo See and and staff of of Yishun Polyclinic, especially NM Tan Wai Lan,

SSN Jamilah and SSN Kasmah.

Special thanks to CM Lee Ching Lian, SSN Norshawiyah and SN Sharon Foo for helping

out in this poster presentation.

Health Behavior Change concept emphasizes better clinical health outcomes

are results of successful health behavior change.

Patients attitudes, beliefs and moods seem to be the cornerstone for initiating/sustaining of behavior change.

In turn, these are influenced by multiple factors including the ability to

initiate/ sustain a particular health behavior and their health outcomes.

Brief Motivational Interviewing can be used as one of the strategies in

patient education to initiate and sustain new health behaviors in chronic

disease patients in the primary care setting.

Health Behavior Change concept emphasizes that successful and

sustainable health behavior change is influenced by patients attitudes,

beliefs and moods.

Recognizing the complexity of social-psychological aspects and

direction association in the equation to attain good clinical parameters is

important.

Patient Education Interventions in primary care setting needs to

incorporate strategies like MI to motivate patients to change behaviors.

Clinical parameters might not be the best indicators to measure

effectiveness of these Patient Education Interventions.

Other parameters are needed to analyze this complex equation in parts.

Parameters likeprocess indicators,satisfaction scores and behavior-

change specific indicators should be considered in this complex equation.

Attitudes

Beliefs

Moods

Health

Outcomes

Health

Behavior

Change

There is a need for key players: patients, healthcare professionals and

administrators, to recognize the complexity of the current patient

education in chronic disease management to achieve another level of

care partnership.

Recognizing the knowledge-action gap and incorporating strategies

into current patient education model is necessary to ensure successful

health behavior change.

Identifying appropriate determinants in assessing the effectiveness of

these strategies are important for improvement.

Rollnick and Miller, (1995) cited in Miller, 1996, Motivational Interviewing(2nd ed),

p.839 Chan, B. and Molasiottis (1999). The relationship between diabetes knowledge and

compliance among Chinese with non-insulin dependent diabetes mellitus in Hong Kong.Journal of Advanced Nursing, 30 (2), 431-438.

Sivagnanam, G.et al (2002). A Comparative Study of the Knowledge, Beliefs, and

Practices of Diabetic Patients Cared for at a Teaching Hospital (Free Service) and Those

Cared for by Private Practitioners (Paid Service).Annals of the New York Academic

Sciences, 958, 416-419. Kolbe, J. et al (1996). Differential influences on asthma self-management knowledge

and self- management behavior in acute severe asthma. Chest, 110, 1463-1468. Worsley, A. (2002). Nutrition knowledge and food consumption: can nutrition

knowledge change food behaviour?Asia Pacific Journal of Clinical Nutrition,11(S3),

S579-S585.

2926.5 26.8

23.3

0

10

20

30

Health Education Brief MI

Mean Northwest Research Lipid Clinic

Fat Intake Score

Baseline Mean Score Post Intervention Mean Score

Fat Intake Score

The subjects in BMI group shows a reduction in the mean Fat Intake Score

of 3.5 compared to the Control group of 2.5. (A score of 24 of less indicates

a diet intake of moderate to low fat and cholesterol.)

Vegetable and Fruits Intake

There is an improvement in the frequency and amount of vegetable and

fruits intake in the BMI group compared to the Control group.

Exercise

Subjects in BMI group exhibit more changes in exercise involvement

compared to the subjects in Control group.

Clinical Outcomes

Mean LDL, Triglyceride, High-density lipoprotein levels and Weight

reduction remain similar for both groups.

Generally all the results of the study were not statistically significant due to

the very small sample size (10).

However, does this mean that there is really no difference between

these 2 interventions?