Discussion: Findings from a Pilot Research comparing

Brief Motivational Interviewing versus Health Education in

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

Introduction Health Education versus

Health Behavior Change Concept
Motivational Interviewing (MI) is is a framework defined as “a directive,
client-centered counseling style for eliciting behavior change by helping Health
clients to resolve and explore ambivalence”.1 The 5 basic principles include Knowledge
Outcomes
expressing empathy, developing discrepancy, avoiding argumentation,
rolling with resistance and supporting self-efficacy. Brief MI, an Health Education concept believes that by giving knowledge to patients will
adaptation of the MI, requires 15 to 20 minutes to execution preserves the result in having better clinical outcomes. Studies2,3,4,5 have shown that knowing
principles of MI.. doesn’t equate to doing thus creating a “knowledge-action” gap.
A pilot research study was done to evaluate the effectiveness of using Brief
MI versus Health Education in lowering LDL in newly diagnosed patients Attitudes Health
with hyperlipidemia in the polyclinic setting. Subjects were randomized to Health
Beliefs Behavior
either the MI or control group and were followed up in 3-month period for Outcomes
Moods Change
post intervention review.
This poster paper presentation will use findings of this pilot research project
to discuss concepts of Health Behavior Change and appropriate outcome Health Behavior Change concept emphasizes better clinical health outcomes
indicators to measure effectiveness of patient education interventions. are results of successful health behavior change.
Patients’ attitudes, beliefs and moods seem to be the cornerstone for initiating/
sustaining of behavior change.
Discussion Objectives In turn, these are influenced by multiple factors including the ability to
1. Findings from the pilot research study “Effectiveness of MI versus initiate/ sustain a particular health behavior and their health outcomes.
Health Education in lowering LDL levels” Brief Motivational Interviewing can be used as one of the strategies in
 Concepts of Health Education versus Health Behavior Change patient education to initiate and sustain new health behaviors in chronic
 Determinants of Patient Education Interventions effectiveness. disease patients in the primary care setting.

Findings from Pilot Study Determinants of Patient Education

Interventions Effectiveness
Mean Northwest Research Lipid Clinic
Fat Intake Score  Health Behavior Change concept emphasizes that successful and
sustainable health behavior change is influenced by patients’ attitudes,
29 beliefs and moods.
26.5 26.8
30 23.3  Recognizing the complexity of social-psychological aspects and
direction association in the equation to attain good clinical parameters is
20
important.
 Patient Education Interventions in primary care setting needs to
10
incorporate strategies like MI to motivate patients to change behaviors.
0
 Clinical parameters might not be the best indicators to measure
Health Education Brief MI effectiveness of these Patient Education Interventions.
Baseline Mean Score Post Intervention Mean Score  Other parameters are needed to analyze this complex equation in parts.
 Parameters like process indicators, satisfaction scores and behavior-
Fat Intake Score change specific indicators should be considered in this complex equation.
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 Conclusion
a diet intake of moderate to low fat and cholesterol.)
Vegetable and Fruits Intake  There is a need for key players: patients, healthcare professionals and
There is an improvement in the frequency and amount of vegetable and administrators, to recognize the complexity of the current patient
fruits intake in the BMI group compared to the Control group. education in chronic disease management to achieve another level of
Exercise care partnership.
Subjects in BMI group exhibit more changes in exercise involvement  Recognizing the “knowledge-action” gap and incorporating strategies
compared to the subjects in Control group. into current patient education model is necessary to ensure successful
Clinical Outcomes health behavior change.
Mean LDL, Triglyceride, High-density lipoprotein levels and Weight  Identifying appropriate determinants in assessing the effectiveness of
reduction remain similar for both groups. these strategies are important for improvement.
Generally all the results of the study were not statistically significant due to
the very small sample size (10). References
However, does this mean that there is really no difference between  Rollnick and Miller, (1995) cited in Miller, 1996, Motivational Interviewing (2nd ed),
p.839
these 2 interventions?  Chan, B. and Molasiottis (1999). The relationship between diabetes knowledge and
compliance among Chinese with non-insulin dependent diabetes mellitus in Hong Kong.
Acknowledgement Journal of Advanced Nursing, 30 (2), 431-438.
The PI sincerely thanks Dr Chan Y.H.(NUS) for his patient guidance and supervision  Sivagnanam, G.et al (2002). A Comparative Study of the Knowledge, Beliefs, and
over this pilot research. Practices of Diabetic Patients Cared for at a Teaching Hospital (Free Service) and Those
Special thanks to Dr Audrey Tan (NHG HQ Projects), CM Ng Soh Mui and CM Alice Cared for by Private Practitioners (Paid Service). Annals of the New York Academic
Goh for their kind assistance in vetting the Brief Motivational Interviewing script. Sciences, 958, 416-419.
The study team like to acknowledge with gratitude the support of Ms Doris Liew,  Kolbe, J. et al (1996). Differential influences on asthma self-management knowledge
Ms Yeo Loo See and and staff of of Yishun Polyclinic, especially NM Tan Wai Lan, and self- management behavior in acute severe asthma. Chest, 110, 1463-1468.
SSN Jamilah and SSN Kasmah.  Worsley, A. (2002). Nutrition knowledge and food consumption: can nutrition
Special thanks to CM Lee Ching Lian, SSN Norshawiyah and SN Sharon Foo for helping knowledge change food behaviour? Asia Pacific Journal of Clinical Nutrition,11(S3),
out in this poster presentation. S579-S585.