heart failure, motivational nursing intervention, self-care, stages of change



  1. Paradis, Veronique RN, MSc
  2. Cossette, Sylvie RN, PhD
  3. Frasure-Smith, Nancy PhD
  4. Heppell, Sonia RN, MSc, NP
  5. Guertin, Marie-Claude PhD


Background and Research Objective: Heart failure (HF) patients experience frequent episodes of decompensation. While medication and behavior change play a major role in maintaining physiological stability, patient adherence to self-care recommendations is not optimal. The Theory of Heart Failure Self-care helped to understand the concepts of self-care and chose a model of intervention. Conviction and confidence are central factors in facilitating self-care. Motivational interviewing (MI), which aims to strengthen conviction and confidence, has been shown to improve self-care. In addition, the Transtheoretical Model, based on patients' readiness to change, also has proven efficacy. The MI based on the stages of change (MISC), a combination of MI and Transtheoretical Model, offers promise for improving self-care. The goal of this pilot study was to evaluate the preliminary effect of an MISC intervention on HF patients' self-care behaviors.


Subjects and Method: Thirty patients were recruited from an HF clinic and randomly assigned to an experimental (EG) or control group (n = 15/group). Patients from the EG received 3 interventions (1 in person, 2 on the phone). Data were collected at baseline and at 1 month after randomization. The effect of the intervention was assessed on 5 self-care outcomes using analysis-of-covariance models.


Results and Conclusion: Significant results were obtained regarding the confidence in performing self-care behaviors specific to HF (P =.005). Although the results of the other hypotheses were not statistically significant, for the majority, trends were in the expected direction in favor of the EG. The study suggests that an MISC intervention is useful to increase patients' confidence in HF self-care and has potential to improve self-care. Further research is needed.