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Chronic kidney disease (CKD) is a global health threat to patients' physical and mental health. Effective self-management can slow disease progression in early stages. However, prolonged treatment often leads to ego depletion and subsequently impacts self-management. Interventions to address this issue remain underdeveloped. To evaluate the effects of psychological empowerment-based motivational interviewing program on early-stage CKD patients' self-management, perceived empowerment, and ego depletion and to explore their engagement experiences and the underlying reasons for the intervention's effectiveness. The study employed the explanatory sequential mixed methods design comprised of a randomized controlled trial and a qualitative study, which were conducted in a tertiary hospital from July 2022 to November 2023. About 70 patients with early CKD were randomly assigned to a control group (  = 35) receiving standard clinical nursing, or an intervention group receiving a 12-week nurse-led psychological empowerment-based motivational interviewing program consisting of four interview sessions and four consolidation sessions. CKD Self-Management Behavior Scale, Patient Perception of Empowerment Scale, Self-Regulation Fatigue Scale, and biochemical indicators were collected at baseline (T1), after 4 weeks of intervention (T2), immediately postintervention completion (T3), and 4 weeks after intervention completion (T4). Data were analyzed by generalized estimating equation model. Semistructured interviews were conducted with the participants in the intervention group. The participants' mean age was 42.76 years (SD = 10.59). Compared with the control group, the intervention group had a statistically significant improvement in self-management behavior (T2:  = 18.26, T3:  = 23.73, T4:  = 23.78; < 0.001), ego depletion (T2:  = -8.46, T3:  = -11.35, T4:  = -13.35; < 0.001), and perceived empowerment (T2:  = 5.77, =0.002; T3:  = 9.41, T4:  = 8.99; < 0.001). Qualitative interviews of 14 participants indicated that the intervention could affect self-perception, improve emotion, and establish healthy behaviors, which may explain such encouraging effects. The psychological empowerment-based motivational interviewing program produced immediate and delayed benefits on self-management, perceived empowerment, and ego depletion in patients with early CKD. These findings provide new strategies for chronic disease management and psychological nursing. Chinese Registry of Clinical Trials: ChiCTR2200064257.

Lower rates of smoking cessation are a major reason for the higher prevalence of smoking among socioeconomically disadvantaged adults. Because barriers to quitting are both more numerous and severe, socioeconomically disadvantaged smokers may benefit from more intensive intervention. We sought to determine whether a smoking cessation intervention delivered by public housing residents trained as Tobacco Treatment Advocates (TTAs) could increase utilization of cessation resources and increase abstinence. We conducted a group-randomized trial among Boston public housing residents who were interested in quitting smoking. Participants at control sites received standard cessation materials and a one-time visit from a TTA who provided basic counseling and information about cessation resources. Participants at intervention sites were eligible for multiple visits by a TTA who employed motivational interviewing, cessation counseling, and navigation to encourage smokers to utilize cessation treatment (Smokers' Quitline and clinic-based programs). Utilization and 7-day and 30-day point prevalence abstinence were assessed at 12 months. Self-reported abstinence was biochemically verified. Intervention participants (n = 121) were more likely than control participants (n = 129) to both utilize treatment programs (adjusted odds ratio [aOR]: 2.15; 95% confidence interval [CI]: 0.93-4.91) and 7-day and 30-day point prevalence abstinence (aOR: 2.60 (1.72-3.94); 2.98 (1.56-5.68), respectively). Mediation analysis indicated that the higher level of utilization did not explain the intervention effect. An intervention delivered by peer health advocates was able to increase utilization of treatment programs and smoking abstinence among public housing residents. Future studies of similar types of interventions should identify the key mechanisms responsible for success. In order to narrow the large and growing socioeconomic disparity in smoking rates, more effective cessation interventions are needed for low-income smokers. Individual culturally-relevant coaching provided in smokers' residences may help overcome the heightened barriers to cessation experienced by this group of smokers. In this study among smokers residing in public housing, an intervention delivered by peer health advocates trained in motivational interviewing, basic smoking cessation skills, and client navigation significantly increased abstinence at 12 months. Future research should address whether these findings are replicable in other settings both within and outside of public housing.

Background Many patients have mixed feelings about end-of-life care, even when facing life-limiting conditions. Motivational interviewing might be useful for supporting patients in evoking reasons for advance care planning. This study aimed to examine the effects of an advance care planning program adopting motivational interviewing among palliative care patients. Methods A two-arm parallel randomized controlled trial was conducted between January 2018 and December 2019 in the palliative care clinics of two hospitals. Adult patients who were newly referred to palliative care services, with a score of 60 or higher in the Palliative Performance Scale and mentally competent, were eligible for the study. While all participants received palliative care as usual care, those in the intervention group also received the advance care planning program through three home visits. The primary outcome was the readiness to discuss and document end-of-life care decisions, and the secondary outcomes included decisional conflict, perceived stress, and quality of life. Results A total of 204 participants (mean [SD] age, 74.9 [10.8]; 64.7% male; 80.4% cancer) were recruited. Generalized estimating equation analyses showed a significant improvement in readiness for advance care planning behaviors in the intervention group compared with the control group at 3 months post-allocation (group-by-time interaction, appointing proxy: β  = 0.80; 95% CI, 0.25–1.35; p  = .005; discussing with family: β  = 0.76; 95% CI, 0.22–1.31; p  = .006; discussing with medical doctors: β  = 0.86; 95% CI, 0.30–1.42; p  = .003; documenting: β  = 0.89; 95% CI, 0.36–1.41; p  < .001). The proportions of signing advance directives and placing a do-not-attempt cardiopulmonary resuscitation order were significantly higher in the intervention group, with a relative risk of 3.43 (95% CI, 1.55–7.60) and 1.16 (95% CI, 1.04–1.28), respectively. The intervention group reported greater improvements in social support and value of life than the control group immediately after the intervention. Significant improvements in decisional conflicts and perceived stress were noted in both groups. Conclusions Motivational interviewing was effective in supporting patients to resolve ambivalence regarding end-of-life care, thereby increasing their readiness for discussing and documenting their care choices. Trial registration ClinicalTrials.gov Identifier: NCT04162912 (Registered on 14/11//2019).

\"The first teacher's guide to the proven counseling approach known as motivational interviewing (MI), this pragmatic book shows how to use everyday interactions with students as powerful opportunities for change. MI comprises skills and strategies that can make brief conversations about any kind of behavioral, academic, or peer-related challenge more effective. Extensive sample dialogues bring to life the \"dos and don'ts\" of talking to K-12 students (and their parents) in ways that promote self-directed problem solving and personal growth. The authors include the distinguished codeveloper of MI plus two former classroom teachers. User-friendly features include learning exercises and reflection questions; additional helpful resources are available at the companion website. Written for teachers, the book will be recommended and/or used in teacher workshops by school psychologists, counselors, and social workers\"-- Provided by publisher.

Abstract Rationale Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. Objectives To determine the effect of comprehensive health coaching on the rate of COPD readmissions. Methods A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing–based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. Measurements and Main Results We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01–0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15–0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20–0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30–1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point. Conclusions Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

Background Cigarette smoking poses a major threat to public health. While cessation support provided by healthcare professionals is effective, its use remains low. Chatbots have the potential to serve as a useful addition. The objective of this study is to explore the possibility of using a motivational interviewing style chatbot to enhance engagement, therapeutic alliance, and perceived empathy in the context of smoking cessation. Methods A preregistered web-based experiment was conducted in which smokers ( n  = 153) were randomly assigned to either the motivational interviewing (MI)-style chatbot condition ( n  = 78) or the neutral chatbot condition ( n  = 75) and interacted with the chatbot in two sessions. In the assessment session, typical intake questions in smoking cessation interventions were administered by the chatbot, such as smoking history, nicotine dependence level, and intention to quit. In the feedback session, the chatbot provided personalized normative feedback and discussed with participants potential reasons to quit. Engagement with the chatbot, therapeutic alliance, and perceived empathy were the primary outcomes and were assessed after both sessions. Secondary outcomes were motivation to quit and perceived communication competence and were assessed after the two sessions. Results No significant effects of the experimental manipulation (MI-style or neutral chatbot) were found on engagement, therapeutic alliance, or perceived empathy. A significant increase in therapeutic alliance over two sessions emerged in both conditions, with participants reporting significantly increased motivation to quit. The chatbot was perceived as highly competent, and communication competence was positively associated with engagement, therapeutic alliance, and perceived empathy. Conclusion The results of this preregistered study suggest that talking with a chatbot about smoking cessation can help to motivate smokers to quit and that the effect of conversation has the potential to build up over time. We did not find support for an extra motivating effect of the MI-style chatbot, for which we discuss possible reasons. These findings highlight the promise of using chatbots to motivate smoking cessation. Implications for future research are discussed.

We studied pregnant women in a large European multicenter randomized controlled trial of physical activity and/or healthy eating and found no effect on gestational diabetes mellitus risk, despite the significant gestational weight gain limitation.AbstractContext:Lifestyle approaches for preventing gestational diabetes mellitus (GDM) have produced mixed results.Objective:The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [healthy eating (HE), physical activity (PA), and both HE and PA (HE+PA)] with usual care (UC) in reducing GDM risk.Design:The present study was a multicenter randomized controlled trial conducted from 2012 to 2014 [the DALI (vitamin D and lifestyle intervention for GDM prevention) lifestyle study].Setting:The study occurred at antenatal clinics across 11 centers in 9 European countries.Patients:Consecutive pregnant women at <20 weeks of gestation with a body mass index (BMI) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria (n = 436). For the intervention, women were randomized, stratified by site, to UC, HE, PA, or HE+PA. The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing. A gestational weight gain (GWG) <5 kg was targeted. The coaches received standardized training and an intervention toolkit tailored to their culture and language.Main Outcome Measures:The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [homeostasis model assessment insulin resistance (HOMA-IR)] at 24 to 28 weeks.Results:We randomized 108 women to HE+PA, 113 to HE, 110 to PA, and 105 to UC. In the HE+PA group, but not HE or PA alone, women achieved substantially less GWG than did the controls (UC) by 35 to 37 weeks (−2.02; 95% confidence interval, −3.58 to −0.46 kg). Despite this reduction, no improvements were seen in fasting or postload glucose levels, insulin concentrations, or HOMA-IR. The birthweights and large and small for gestational age rates were similar.Conclusions:The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia. Thus, lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2.