A randomized trail using motivational interviewing for maintenance of blood pressure improvements in a community-engaged lifestyle intervention: HUB City Steps

Authors: LANDRY, ALICIA - University Of Southern Mississippi; MADSON, MICHAEL - University Of Southern Mississippi; Thomson, Jessica; ZOELLNER, JAMIE - University Of Virginia; CONNELL, CAROL - University Of Southern Mississippi; YADRICK, KATHY - University Of Southern Mississippi

Submitted to: Health Education Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/17/2015
Publication Date: 11/23/2015
Publication URL: http://handle.nal.usda.gov/10113/61982
Citation: Landry, A.S., Madson, M.B., Thomson, J.L., Zoellner, J.M., Connell, C., Yadrick, K. 2015. A randomized trail using motivational interviewing for maintenance of blood pressure improvements in a community-engaged lifestyle intervention: HUB City Steps. Health Education Research. 30(6):910-922. doi: 10.1093/her/cyv058.

Interpretive Summary: Hypertension disproportionately affects more African Americans than whites (41% vs. 29%, respectively), with increased rates of mortality from stroke and heart disease also seen in African Americans. Much of these increased rates are attributable to uncontrolled hypertension, making blood pressure control essential for improving health. While community based, lifestyle interventions have proven effective at improving health behavior, these changes often are not maintained after intervention completion. Motivational interviewing is one approach that holds promise for maintaining health behavior changes post intervention. This counseling approach focuses on eliciting and strengthening an individual’s motivation to change through guided discussions concerning action plans for change. However, the optimal number of motivational interviewing sessions needed to maintain change is not known. In this study, participants received either a low or high dose of motivational interviewing delivered via telephone calls (4 vs. 10) during a 12-month maintenance phase following a 6-month intervention phase. The intervention, HUB City Steps, was designed to improve hypertension risk factors through physical activity and dietary changes; it was proven effective. Results from the current study indicated that blood pressure significantly increased during the maintenance phase, regardless of motivational interviewing dose. These findings suggest that as many as 10 motivational interviewing telephone calls over a 12-month period are not sufficient to maintain decreases in blood pressure resulting from active intervention. Future research is needed to determine best practices for maintaining health behavior changes, such as blood pressure reduction.

Technical Abstract: Background: Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. Purpose: To compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with African Americans. Methods: Participants were tracked through a 12-month maintenance phase following a 6-month intervention targeting physical activity and diet. For the maintenance phase, participants were randomized to receive a low (4) or high (10) dose of motivational interviewing delivered via telephone by trained research staff. Generalized linear models were used to test for group differences in blood pressure. Results: Blood pressure significantly increased during the maintenance phase. No differences were apparent between randomized groups. Conclusions: Results suggest that 10 or fewer motivational interviewing calls over a 12-month period may be insufficient to maintain post-intervention improvements in blood pressure. Further research is needed to determine optimal strategies for maintaining changes.