Background: Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.
Local Problem: Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.
Methods: This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.
Results: Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.
Conclusion: MI can be an effective part of a strategy to increase vaccination rates.
Purpose: This project examined the effectiveness of an online educational module on basic Motivational Interviewing (MI) techniques for Nurse Practitioners (NPs) providing obesity management to middle-aged women.
Background: Middle-aged women experience distinct physiological and psychosocial factors that contribute to weight gain and make obesity management especially challenging. The evidence supports the use of motivational interviewing (MI) interventions as a highly effective approach to obesity management in combination with standard medical weight loss programs. Educating NPs that provide medical weight loss on basic MI counseling techniques is necessary to facilitate the use of this intervention.
Methods: NP providers at a group of seven medical weight loss clinics in the southwestern United States completed an online MI educational module that was developed for this project. The module content covered basic MI counseling techniques. MI knowledge was assessed using a 6-item pre/post-test. Participants completed an 8-item course evaluation to provide additional feedback.
Results: Ten of the 13 NPs eligible participated in the project. The overall response to the project was positive as demonstrated by high scores on the course evaluation. The average post-test knowledge scores increased after completion of the module, however no statistical significance was noted.
Conclusions: The basic MI education module was beneficial for NPs providing obesity management and future research should focus on developing standardized MI weight loss interventions.
One in every three deaths in the United States results from cardiovascular disease (CDC, 2013). Cardiovascular Rehabilitation (CR) is a medically supervised program designed to help improve cardiovascular health for patients who have experienced heart attack, heart failure, angioplasty, or heart surgery (AHA, 2016). A hospital in the southwestern region of the United States of America reports their 2016 CR attendance rate of 79 %, which is much lower than the national average of 94% (AACVPR, 2016). Motivational interviewing (MI) is a proven method used to promote a positive behavior change for cardiac rehab patients. MI includes quality improvement activities such as peer support and cardiac rehab educational classes that have shown to increase health related quality of life measures and decreased depression symptoms (Pietrabessa et al., 2017; Pack et al., 2013).
Despite all the knowledge about CR and its benefits for health nationally, there are low attendance rates, therefore the purpose of this evidence-based project is to improve CR attendance rates using MI. Patients enrolled into CR participated in the motivational interviewing for eight classes. At the end of the class, they were given notecards to create Specific Measurable Achievable Realistic and Timely (SMART) Goals for themselves for that week. The measurement tools, the PHQ-9 and Dartmouth COOP is a simple, reliable, and valid tool for assessing functional status of cardiac patients and the current CR program utilizes this tool and is familiar with explaining this tool (Eaton, Young, Fergussion, Garrett, & Kolbe, 2005).
A Pearson correlation coefficient was calculated for the relationship between the MI classes and the CR attendance, depression scores, and quality of life. A strong positive correlation was found (r (82)= .456, p< .001) indicating a significant linear relationship between motivational interviewing and cardiac rehab attendance. A weak correlation that was not significant for depression symptoms and quality of life. The impact of this evidence-based project is to give cardiac rehab programs further evidence that the implementation of motivational interviewing can positively influence cardiac rehab attendance rates.
Methods: The quality department at a large children’s hospital in the southwestern United States approved the project as a practice change and parent consent was not required. The project design was a randomized controlled group: pretest-posttest design, quality improvement method. Participants were chosen by convenience sample. Required diagnoses were headache or migraine. Each group had 18 participants, for a total of 36 participants. Ages ranged from four to 18 years of age, with legal guardians present for the intervention group only. New and follow-up patients were included in the project. Demographics for each group were statistically similar. Questionnaires were used to assess knowledge pre and post implementation of teach back tool. Self-management was measured by a follow-up phone call after their appointment to inquire regarding implementation of the headache diary. Charts were reviewed for both groups regarding the number and type of phone calls received by the office.
Outcomes: Paired sample t-test was used to evaluate mean differences in knowledge from pre and post questions of teach back tool. Data analysis concluded a statistical increase in knowledge of triggers and prevention techniques. Cohen’s d for triggers was 2.21 and 1.87 for prevention. Self-management of behavior was measured by use of headache diary and determined by a percentage. Sixty-seven individuals started to use the headache diary. Independent t-test was used to compare number of phone calls from each group. Data concluded a decrease in phone calls. However, due to a small sample size, statistical significance could not be established.
Conclusion: Teach back encourages caregiver/patient and provider interaction, which increases health literacy retention and increases self-management behaviors. Future research should focus on patients with headaches with unknown triggers for their headaches.
The population of older adults in the United States is growing disproportionately, with corresponding medical, social and economic implications. The number of Americans 65 years and older constitutes 13.7% of the U.S. population, and is expected to grow to 21% by 2040. As the adults age, they are at risk for developing chronic illness and disability. According to the Centers for Disease Control and Prevention, 5.7 million Americans have heart failure, and almost 80% of these are 65 years and older. The prevalence of heart failure will increase with the increase in aging population, thus increasing the costs associated with heart failure from 34.7 billion dollars in 2010 to 77.7 billion dollars by 2020. Of all cardiovascular hospitalizations, 28.9% are due to heart failure, and almost 60,000 deaths are accounted for heart failure. Marked disparities in heart failure persist within and between population subgroups. Living with heart failure is challenging for older adults, because being a chronic condition, the responsibility of day to day management of heart failure principally rests with patient. Approaches to improve self-management are targeted at adherence, compliance, and physiologic variables, little attention has been paid to personal and social contextual resources of older adults, crucial for decision making, and purposeful participation in goal attainment, representing a critical area for intervention. Several strategies based on empowerment perspective are focused on outcomes; paying less attention to the process. To address these gaps between research and practice, this feasibility study was guided by a tested theory, the Theory of Health Empowerment, to optimize self-management, functional health and well-being in older adults with heart failure. The study sample included older adults with heart failure attending senior centers. Specific aims of this feasibility study were to: (a) examine the feasibility of the Health Empowerment Intervention in older adults with heart failure, (b) evaluate the effect of the health empowerment intervention on self-management, functional health, and well-being among older adults with heart failure. The Health Empowerment Intervention was delivered focusing on strategies to identify and building upon self-capacity, and supportive social network, informed decision making and goal setting, and purposefully participating in the attainment of personal health goals for well-being. Study was feasible and significantly increased personal growth, and purposeful participation in the attainment of personal health goals.
The study used a multi-phase, multi-method approach. The first phase (alpha) of this study was a qualitative descriptive design to examine the intervention’s fidelity. Evaluation of performance was conducted by experts in the fields of MI, T1D, adolescence and/or online education. The second phase (beta) was a quantitative descriptive design conducted in order to evaluate feasibility by examining the acceptability (recruitment, retention and satisfaction) and implementation (diabetes self-management self-efficacy) to determine whether the intervention was appropriate for further testing.
First phase findings showed that the intervention passed all measures with the content experts (n = 6): it was functional, accurate, usable and secure. Improvements to the intervention were made based on reviewer recommendations. For the second phase 5 adolescents between 14 and 17 were enrolled. Three adolescents completed all 4 weeks of the intervention while 2 completed only 3 weeks. Participants (n = 3) rated satisfaction on a 5-point Likert-type scale ranging from “not at all” satisfied (1) to “very much” satisfied (5). There was a positive response to the intervention (M = 4.28, SD = 0.55). Implementation was measured by a pre- and post-test for diabetes self-management self-efficacy. Participants (n = 3) demonstrated overall improvements in diabetes self-management self-efficacy (Z = -2.952, p = .007).
Implications for further Can-Do-Tude research are planned at a metropolitan diabetes center using updated technology including an application platform. Although the sample was small, findings indicate that the intervention can be conducted using a web-based format and there is initial evidence of improvement in self-efficacy for diabetes self-management.