Development of a motivational interviewing genetic counseling intervention to increase cascade cholesterol screening in families of children with familial hypercholesterolemia

2019 ◽  
Vol 28 (5) ◽  
pp. 1059-1064 ◽  
Author(s):  
Valerie Kruger ◽  
Krista Redlinger‐Grosse ◽  
Scott T. Walters ◽  
Erin Ash ◽  
Deborah Cragun ◽  
...  
2016 ◽  
Vol 12 (15) ◽  
pp. 95
Author(s):  
Raimonda Petroliene ◽  
Liuda Sinkariova ◽  
Dalia Karpovaite ◽  
Loreta Zajanckauskaite-Staskeviciene ◽  
Jurga Misiuniene ◽  
...  

It is well known that in order to control the morbidity and mortality of cardiovascular disease patients, their lifestyle should be taken into account (American Heart Association, 2012; Klumbiene et al., 2002). Studies of various disease patients’ manners (Knight et al., 2006; Thompson et al., 2011) confirm that motivational interviewing (Miller & Rollnick, 2013) is an effective method for changing unhealthy behavior. Nevertheless, our practical experience of motivational interviewing based psychological counseling with rehabilitation hospitals’ cardiac patients’ (Sinkariova et al., 2015) revealed noteworthy observations about some participants lack of motivation to change unhealthy behavior. This observation encouraged us to start a study with the aim to find out if cardiac rehabilitation participants’ personality traits and emotional state are related to the effectiveness of motivational interviewing based psychological counseling. The study used a quasi-experiment where cardiac rehabilitation patients were assigned to control (regular rehabilitation, n=55) or experimental (rehabilitation plus motivational interviewing based psychological counseling intervention, n=64) groups. A total of 119 participants (male=83, female=36, M age=60.47, SD=8.762) attended a survey, which included NEO-FFI, HADs, and “Readiness to change questionnaire” at the beginning and end of cardiac rehabilitation. Nonparametric data analysis showed that patients’ personality traits are not related to the effectiveness of motivational interviewing based counseling, whereas depression is positively related to the effectiveness of intervention to change alcohol consumption. Conclusions/Implications: Depression as an expression of emotional state is an important feature for the effectiveness of motivational interviewing based counseling to change cardiac patients’ alcohol consumption. Further understanding of relationships between psychological characteristics and the effectiveness of intervention could help to improve cardiac diseases prevention, treatment, and rehabilitation.


Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Margaret M McCarthy ◽  
Victoria V Dickson ◽  
Stuart D Katz ◽  
Deborah A Chyun

Background: Exercise continues to be promoted for the primary and secondary prevention of heart disease, yet many adults remain inactive and ethnic minority adults are less active than Whites. One of the goals of Healthy People 2020 is to increase the proportion of office visits that include counseling about exercise with patients diagnosed with heart disease; one approach may be the use of motivational interviewing (MI). However, adherence to the essential principles of MI is critical in achieving desired outcomes. Purpose: The purpose of this study was to evaluate the use of MI in an exercise counseling intervention in a sample of minority adults with heart failure (HF). Methods: Twenty ethnic minority adults with stable HF were recruited from an urban HF clinic. Measures of physical activity (International Physical Activity Questionnaire (IPAQ); weekly step-counts via accelerometer) and functional status (Duke Activity Status Index (DASI); 6-minute walk test [6MWT]) were taken at baseline and 12-weeks. The initial exercise counseling session (15 minutes) using MI discussed previous exercise experience, future goals, and practical exercise guidelines, including symptom management. The interview guide, written using principles of MI, was reviewed with an expert in MI and revised prior to the first interview. During subject recruitment, four subjects’ interviews were reviewed (#3, #4, #16, #20) by another independent expert and scored for use of MI. After each scoring and discussion of results, the interview guide was again revised to further facilitate the use of MI. The initial session was followed by 12 weekly 5-minute phone calls. Results: Interview #3 scored 50% overall adherence to MI with more closed than open questions (6 vs.4) and 44% of reflections were complex (vs. simple). Interview #4 ranked 40% MI adherent with more closed vs. open questions (9 vs. 3) and only 30% complex reflections. Interview #16 ranked 100% adherent with more closed than open questions (6 vs. 3) but more complex reflections (54%). Interview #20 ranked 80% adherent with more open vs. closed questions (8 vs. 1) and 42% complex reflections. At 12 weeks, there were concurrent significant improvements in the IPAQ walking score (p=.04), weekly step-counts (p=.03), and 6MWT (p=.0006) with a trend toward significant improvement in the DASI (p=.08). Conclusion: The use of MI in brief exercise counseling and phone follow-up may lead to increases in physical activity and functional status. Independent scoring and repeated review of the practice of MI over time may improve its continued use. Further testing of the intervention in a randomized trial is warranted.


2017 ◽  
Vol 14 (1) ◽  
pp. 54-68 ◽  
Author(s):  
Patricia Davern Soderlund

Objectives This review examines the effectiveness of motivational interviewing for physical activity self-management for adults diagnosed with diabetes mellitus type 2. Motivational interviewing is a patient centered individually tailored counseling intervention that aims to elicit a patient’s own motivation for health behavior change. Review questions include (a) How have motivational interviewing methods been applied to physical activity interventions for adults with diabetes mellitus type 2? (b) What motivational interviewing approaches are associated with successful physical activity outcomes with diabetes mellitus 2? Methods Database searches used PubMed, CINAHL, and PsycINFO for the years 2000 to 2016. Criteria for inclusion was motivational interviewing used as the principal intervention in the tradition of Miller and Rollnick, measurement of physical activity, statistical significance reported for physical activity outcomes, quantitative research, and articles written in English. Results A total of nine studies met review criteria and four included motivational interviewing interventions associated with significant physical activity outcomes. Discussion Findings suggest motivational interviewing sessions should target a minimal number of self-management behaviors, be delivered by counselors proficient in motivational interviewing, and use motivational interviewing protocols with an emphasis placed either on duration or frequency of sessions.


2015 ◽  
Vol 28 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Margaret M. McCarthy ◽  
Victoria Vaughan Dickson ◽  
Stuart D. Katz ◽  
Kathleen Sciacca ◽  
Deborah A. Chyun

Author(s):  
Martina Michaelis ◽  
Carmen Witte (née Farian) ◽  
Barbara Schüle ◽  
Katrin Frick ◽  
Monika A. Rieger

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses (‘health coach’) has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the ‘health coach’ in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.


Contraception ◽  
2015 ◽  
Vol 92 (4) ◽  
pp. 323-329 ◽  
Author(s):  
A.K. Whitaker ◽  
M.T. Quinn ◽  
S.L. Martins ◽  
A.N. Tomlinson ◽  
E.J. Woodhams ◽  
...  

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Emily M Bucholz ◽  
Angie M Rodday ◽  
Katherine Kolor ◽  
Muin Khoury ◽  
Sarah D deFerranti

Background: Familial hypercholesterolemia (FH) significantly increases the risk of atherosclerotic cardiovascular disease (ASCVD); however, recent data from ambulatory care centers suggests that prescription rates for statins remain low in patients with severe dyslipidemia or diagnosed FH. National rates of screening, awareness, and treatment with statins among individuals with FH or severe dyslipidemia are unknown. Methods: Data from the 1999 to 2014 National Health and Nutrition Examination Survey (NHANES) were used to estimate prevalence rates of self-reported screening, awareness, and statin therapy among U.S. adults ≥20 years of age (n=42,471 weighted to represent 212 million U.S. adults) with FH (defined using the Dutch Lipid Clinic criteria) and with severe dyslipidemia (defined as low-density lipoprotein cholesterol (LDL-C) levels ≥190mg/dL). Logistic regression was used to identify sociodemographic and clinical correlates of hypercholesterolemia awareness and statin therapy. Results were extrapolated to the U.S. adult population. Results: The US prevalence of definite/probable FH was 0.47% (standard error 0.03%) and of severe dyslipidemia was 6.59% (SE 0.17%). Rates of cholesterol screening and awareness were high (>80%) among adults with definite/probable FH or severe dyslipidemia; however, statin use was uniformly low (52.3% (SE 8.2%) of adults with definite/probable FH and 37.6% (SE 1.2%) of adults with severe dyslipidemia). Less than half of those on statins were prescribed a high-intensity statin. The prevalence of statin use in adults with definite/probable FH and severe dyslipidemia increased slightly over time but not faster than trends in the general population. Older age, insurance, having a usual source of care, diabetes, hypertension, and having a personal history of early ASCVD were associated with statin use. The discrepancy between cholesterol screening and treatment rates was most pronounced in younger patients, uninsured patients, and patients without a usual source of care. Conclusions: Despite high rates of cholesterol screening and awareness, only about half of U.S adults with FH are on statin therapy and even fewer are prescribed a high-intensity statin; young and uninsured patients are at the highest risk for under treatment. A low rate of statin use in young adults is of particular relevance given the early onset of ASCVD in adults with FH. This study highlights an opportunity and an imperative to improve statin treatment rates in this high-risk population. Additional studies are needed to better understand how to close the gap between screening and treatment among adults with FH and improve treatment rates among those with limited access to care.


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