Effects of Telephone-Based Brief Motivational Interviewing on Self-Management, Medication Adherence, and Glycemic Control in Patients with Uncontrolled Type 2 Diabetes Mellitus in a Rural Community in Thailand

Naruemon Sawaengsri,1 Wantana Maneesriwongul,1 Erica N Schorr,2 Supichaya Wangpitipanit1 1Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2School of Nursing, University of Minnesota, Minneapolis, MN, USACorrespondence: Wantana Maneesriwongul, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, Tel +662 2011600, Fax +662 2012858, Email wantana.lim@mahidol.ac.thIntroduction: Owing to the increased prevalence of type 2 diabetes mellitus (T2DM) and the high proportion of patients with uncontrolled T2DM, effective interventions for disease management are needed.Objective: The study aim was to test the effects of brief motivational interviewing (MI) on patients’ self-management, medication adherence, and glycemic control.Methods: A single-group repeated measures trial was used to examine the effects of usual care only and usual care plus telephone-based brief MI. Participants were 29 patients with uncontrolled T2DM recruited from a rural primary care setting in Nakhon Sawan, Thailand. Participants received usual care during the first 4 weeks, followed by usual care plus brief MI during weeks 4– 8. Outcomes of self-management, medication adherence, fasting blood sugar (FBS) levels, and hemoglobin A1c (HbA1c) levels were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using descriptive statistics, one-way repeated measures analysis of variance, and Friedman test.Results: Significant changes in self-management (p < 0.001), medication adherence (p < 0.001), and FBS (p < 0.05) were observed over the 8-week study. In multiple comparisons, self-management was the only parameter significantly different across baseline, 4, and 8 weeks (p < 0.05, < 0.001, and < 0.001, respectively); medication adherence was significantly different between 4 and 8 weeks (p < 0.05), and between baseline and 8 weeks (p < 0.001); and FBS was significantly different between 4 and 8 weeks (p < 0.05). HbA1c declined over the 8-week study, but not significantly.Conclusion: An intervention combining telephone-based brief MI with usual care significantly increased self-management, medication adherence, and glycemic control (ie, FBS) after 4 weeks, whereas usual care only significantly increased self-management. Phone-based brief MI may be an effective way for healthcare providers to remotely enhance patients’ self-management and glycemic control, thus reducing barriers related to time and geographic location.Keywords: motivational interviewing, tele-intervention, stage of change, medication adherence, glycemic control, diabetes, T2DM