Motyvuojančio pokalbio veiksmingumas lėtinėmis ligomis sergančiųjų grupėje

LTLietuvoje nemažai duomenų apie rizikos veiksnių paplitimą bendrojoje populiacijoje ir specifinėse amžiaus grupėse, tačiau stokojama tyrimų, vertinančių sergančiųjų lėtinėmis ligomis sveikatai nepalankaus elgesio paplitimą ir ypatingai trūksta žinių apie šio elgesio psichologinės korekcijos būdų efektyvumą. Monografijoje pristatomi autorių atlikto tyrimo duomenys, kurie atskleidžia, kad motyvuojantis pokalbis gali būti veiksminga psichologinio poveikio priemonė, siekiant širdies ir kraujagyslių bei lėtinėmis sąnarių ligomis sergančių pacientų su sveikata susijusio elgesio pokyčių. Monografijoje akcentuojami du pagrindiniai klausimai: kokį elgesį veikia motyvuojantis pokalbis ir kokiems asmenims jis veikia (įvertinama asmens emocinė būsena ir asmenybės bruožai). Kitaip tariant, joje ieškoma atsakymų, kaip minėti asmens psichologiniai ypatumai veikia šios intervencijos efektyvumą. Tikimasi, kad ši monografija bus vertinga tiek mokslininkams, tiek medicinos praktikams, planuojant įrodymais pagristų psichologinių poveikio metodų taikymą psichosocalinės reabilitacijos programose.

ENStatistics on the incidence of chronic diseases in Europe and Lithuania have not changed for several decades (OECD EU, 2018). Many chronic diseases are characterized by common risk factors and can often be corrected because they are related to human behaviour. In Europe, 9 out of 10 people die from chronic diseases, resulting in 70-80 health care funds spent to treat chronic diseases. As much as 97 percent of health care costs are allocated to their treatment and only 3 percent are invested in prevention (European Commission, 2014). The prevalence of chronic diseases is associated with a high economic burden on society and the quality of life of the individual. According to future forecasts, the Lithuanian population will continue to age, which allows us to assume that the incidence of chronic diseases in the country’s population will increase (Gražulienė, Serapinaitė, Ustinavičienė and Želvienė, 2016). The incidence of cardiovascular diseases, which in Lithuania remains one of the highest in Europe, is of great concern. In both Lithuania and Europe, the incidence of these diseases has increased over the last 25 years. Mortality from cardiovascular disease accounts for 45 percent of all deaths in Europe each year (European Commission, 2018; Wilkins et al., 2017). Another group of diseases with a high prevalence in the elderly is chronic joint diseases. Mortality from these diseases is not as threatening, but it is the primary cause of permanent disability in the world. In Lithuania, this is the third cause of long-term disability (Institute of Hygiene, 2017), in addition, patients with chronic joint diseases have an increased risk of developing cardiovascular disease (Semb, 2017). After assessing the prevalence of these diseases in society, there is a need to address the situation. In response to this problem, a study was conducted, which is presented in this monograph.The study was performed in Abromiškės Rehabilitation Hospital with patients from the Cardiology (N = 362) and Arthrology (N = 134) departments. The aim of the study was to evaluate the effectiveness of Motivational Interviewing (Miller & Rollnick, 1991) in changing the motivation and unhealthy behaviours of people with different chronic diseases. In addition to sociodemographic and physical health indicators, patients’ subjectively assessed behaviour and motivation to change their alcohol consumption, smoking, physical activity, and eating habits were assessed using the Readiness to Change Questionnaire (Rollnick, Heather, Gold & Hall, 1992); emotional state was assessed using the HADS (Hospital Anxiety and Depression Scale) (Zigmond & Snaith, 1983); personality traits – using a short version of the NEO-FFI revised NEO Personality Questionnaire (NEO PI-R) (Costa & McCrae, 1992). The study was conducted in three phases. In the first phase, subjects completed questionnaires and were divided into two groups: the experimental group patients receiving one to four motivational interviewing sessions and standard care at the hospital prescribed by their doctor, and the control group patients receiving routine rehabilitation treatment and information about hospital psychologist services. The second phase took place at the end of rehabilitation, with 1-3 days remaining before discharge from the hospital. By that time, the participants in the experimental group had completed the motivational interviewing sessions. After completing the questionnaires, both groups of respondents were asked to provide personal contacts (telephone number, home address or e-mail address) that could be used to contact and interview them for the third time after three months. The third phase was conducted remotely, three months after discharge from the rehabilitation hospital.In order to investigate whether motivational interviewing was effective in changing motivation and unhealthy behaviours in patients with cardiovascular and chronic joint diseases, changes in motivation and behavioural rates of experimental and control groups during rehabilitation and three months after rehabilitation were compared. The results obtained can be summarized in the main conclusions. First, as expected, the motivational interviewing was effective in strengthening the motivation of patients with cardiovascular and chronic joint diseases to promote changes in physical activity and eating habits during rehabilitation. However, it was unexpected that the motivational interviewing was not effective in changing the subjectively assessed physical activity and eating habits (behaviour) of patients with chronic diseases, neither during the rehabilitation period nor after three months after rehabilitation. This finding, which explains that motivation can be enhanced in a short rehabilitation period, but that behavioural changes require more time, may be important for those working in personal health care settings. The second finding, which summarizes the effect of emotional state on the effectiveness of motivational interviewing, reveals differences between patients with cardiovascular and chronic joint diseases. Lower depression and anxiety levels were associated with the effectiveness of motivational interviewing in patients with cardiovascular disease by enhancing motivation to change physical activity (contemplation stage) and changing eating habits (as subjectively assessed behaviour) during rehabilitation.