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This study aimed to examine the effect of motivational interviewing on healthy lifestyle behaviors and biochemical parameters in patients who underwent stent implantation after coronary angiography. Specifically, it investigated whether a structured motivational interviewing program could improve patients' health-promoting behaviors and positively influence biochemical outcomes such as blood lipid levels and body mass index (BMI). The research was designed as a randomized controlled study and was conducted in the cardiology outpatient clinic of a training and research hospital in Istanbul. The study included patients diagnosed with coronary artery disease who had undergone coronary angiography followed by stent implantation and were being followed in the outpatient clinic. Participants were randomly assigned to either the intervention group or the control group. In the intervention group, patients received a motivational interviewing-based program over a three-month period. This program included face-to-face educational sessions lasting approximately 30-45 minutes, focusing on coronary artery disease, risk factors, healthy nutrition, physical activity, stress management, sleep regulation, and smoking cessation. In addition, participants received reminder messages twice a week to support behavioral change and encourage adherence to healthy lifestyle practices. The control group continued their routine medical follow-up and standard care without additional intervention. Data were collected at baseline and at the end of the third month. In the intervention group, data were additionally collected at the end of the first month. Both groups were evaluated using the Health-Promoting Lifestyle Profile II scale, and biochemical parameters including HDL, LDL, total cholesterol, triglycerides, and BMI were measured and recorded. The study aimed to determine whether motivational interviewing could serve as an effective nursing intervention to promote sustainable lifestyle changes and improve clinical outcomes in patients with coronary artery disease following stent implantation.
Coronary artery disease is characterized by the development of atherosclerotic plaques in the epicardial coronary arteries, leading to progressive narrowing of the vessel lumen and reduced myocardial perfusion. Atherosclerosis is a chronic inflammatory process influenced by modifiable and non-modifiable risk factors. Modifiable risk factors include hypertension, diabetes mellitus, dyslipidemia, smoking, physical inactivity, and unhealthy dietary habits, while non-modifiable factors include age, sex, and genetic predisposition. Coronary artery disease is one of the leading causes of morbidity and mortality worldwide and is associated with major cardiovascular events such as myocardial infarction and stroke.
Lifestyle modification is a fundamental component of both primary and secondary prevention of coronary artery disease. However, a considerable proportion of patients continue unhealthy behaviors following coronary interventions, increasing the risk of recurrent cardiovascular events. For this reason, interventions aimed at promoting sustainable behavioral change are essential in this population. Health-promoting behaviors, including regular physical activity, balanced nutrition, stress management, medication adherence, and smoking cessation, are critical in reducing cardiovascular risk and improving clinical outcomes. Motivational interviewing is a patient-centered counseling approach designed to enhance intrinsic motivation for behavioral change. It is particularly effective in individuals who are ambivalent or resistant to change and is based on principles such as expressing empathy, developing discrepancy between current behaviors and health goals, rolling with resistance, and supporting self-efficacy. This approach is widely used in chronic disease management and nursing practice to support behavioral change.
In this study, a structured motivational interviewing-based intervention supported by educational sessions and reminder messages was developed to improve healthy lifestyle behaviors in patients with coronary artery disease who underwent coronary angiography and stent implantation and were followed in a cardiology outpatient clinic. The intervention was also designed to improve biochemical parameters, including lipid profile indicators and body mass index. This randomized controlled trial was conducted in the cardiology outpatient clinic of a tertiary training and research hospital in Istanbul, Türkiye. The study population consisted of adult patients with coronary artery disease who underwent stent implantation following coronary angiography and were under outpatient follow-up. The sample size was determined using a power analysis. Participants were allocated to the intervention and control groups using simple randomization. Inclusion criteria included age 18 years or older, ability to read and understand Turkish, at least one month post-stent implantation or balloon angioplasty, clinical stability, and access to a mobile phone. Patients with psychiatric disorders affecting participation, communication difficulties, or severe clinical instability were excluded.
The intervention group received a structured face-to-face educational session covering coronary artery disease, risk factors, nutrition, physical activity, stress management, sleep hygiene, and smoking cessation, followed by motivational interviewing sessions and twice-weekly reminder messages for three months. The control group received routine clinical follow-up without additional intervention. Health-promoting lifestyle behaviors were assessed using the Health-Promoting Lifestyle Profile II scale. Biochemical outcomes, including lipid profile parameters (HDL, LDL, total cholesterol, triglycerides) and body mass index, were used to evaluate clinical outcomes. Assessments were performed at baseline, at one month, and at three months. Body mass index was calculated as weight in kilograms divided by height in meters squared. Data were collected using standardized instruments and analyzed using appropriate statistical methods. Statistical significance was set at p < 0.05. Ethical approval was obtained from the relevant institutional ethics committee, and written informed consent was obtained from all participants before enrollment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Motivational Interviewing Program Group | Experimental | Participants received a motivational interviewing program supported by education and twice-weekly reminder messages for three months in addition to routine outpatient follow-up. |
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| Routine Care Control Group | No Intervention | Participants received routine cardiology outpatient follow-up and standard care without motivational interviewing or reminder messages. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Motivational Interviewing | Behavioral | A structured motivational interviewing program delivered by a trained researcher, supported by patient education and reminder messages aimed at improving healthy lifestyle behaviors and cardiovascular risk factor management. |
| Measure | Description | Time Frame |
|---|---|---|
| Health-Promoting Lifestyle Behaviors | Health-promoting lifestyle behaviors were assessed using the Health-Promoting Lifestyle Profile II (HPLP-II) scale. The scale consisted of six sub-dimensions: spiritual growth, interpersonal relationships, nutrition, physical activity, health responsibility, and stress management. | Baseline, 1 month (intervention group), and 3 months after intervention. |
| Blood Lipid Profile | Blood lipid parameters including HDL cholesterol, LDL cholesterol, total cholesterol, and triglycerides were measured using a biochemical monitoring form. | Baseline and 3 months after intervention. |
| Body Mass Index (BMI) | Body mass index was calculated as weight in kilograms divided by height in meters squared (kg/m²). | Baseline and 3 months after intervention. |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Biruni University | Istanbul | Zeytinburnu | 34010 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| Result | Uysal, H., & Enç, N. (2012). Motivational interview for compliance in patients with chronic heart failure. Turkish Journal of Cardiovascular Nursing, 3(3), 33-38. https://doi.org/10.5543/khd.2012.004 | ||
| Result | Savucu, Y. (2020). Healthy life style behaviors. Journal of Sport and Recreation Researches, 2(1), 34-43. | ||
| Result | Özdemir, H., & Taşcı, S. (2013). Motivational interviewing technique and use of nursing. Journal of the Faculty of Health Sciences of Erciyes University, 1(1), 41-47. | ||
| Result | Ögel, K. (2009). Motivational interviewing. Türkiye Klinikleri Journal of Psychiatry-Special Topics, 2(2), 41-44. | ||
| Result | Koplay, M., & Erol, C. (2013). Coronary artery disease. Turkish Journal of Radiology Seminars, 1(1), 57-69. https://doi.org/10.5152/trs.2013.007 | ||
| Result | Kızılırmak, M., & Demir, S. (2018). The motivational interview and using in nursing. Gümüşhane University Journal of Health Sciences, 7(4), 103-109. | ||
| Result | Gür, G., & Sunal, N. (2019). Determination of health perception and healthy lifestyle behaviors in patients with coronary artery disease. Journal of Health Sciences and Professions, 6(2), 210-219. https://doi.org/10.17681/hsp.420313 |
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| ID | Term |
|---|---|
| D003324 | Coronary Artery Disease |
| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
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| ID | Term |
|---|---|
| D062405 | Motivational Interviewing |
| ID | Term |
|---|---|
| D037001 | Directive Counseling |
| D003376 | Counseling |
| D008605 | Mental Health Services |
| D004191 | Behavioral Disciplines and Activities |
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Participants were randomly assigned to either an intervention group or a control group in a parallel-group design. The intervention group received a motivational interviewing program supported by education and twice-weekly reminder messages for three months, while the control group received routine outpatient care. Outcomes were assessed at baseline and at the end of the third month in both groups, with an additional assessment at the first month in the intervention group.
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| Result | Bilgin, S., & Evcimen, H. (2020). The use of motivational interview technique in overweight and obese adolescents. Journal of Duzce University Health Sciences Institute, 10(2), 258-262. https://dx.doi.org/10.33631/duzcesbed.553805 |
| Result | Bahar, Z., Beşer, A., Gördes, N., Ersin, F., & Kıssal, A. (2008). Healthy Life Style Behavior Scale II: A reliability and validity study. Journal of Cumhuriyet University School of Nursing, 12(1), 1-13. |
| Result | Alpay, S. & Şahin, E. (2024). Use of motivational interviewing technique in obstetrics and gynecology nursing and midwifery postgraduate theses in Turkey. Journal of Women's Health Nursing, 10(2), 104-118. |
| Result | Akdemir, N., & Özer, Z. C. (2021). Coronary artery diseases and nursing care. In: Internal Medicine and Nursing Care. Akdemir N (ed.). Akademisyen Publishing, pp. 553-568. |
| Result | Açıkgöz, D., & Taşkın Yılmaz, F. (2025). The relationship of cardiovascular disease risk factors knowledge level and health perception with adherence to medication in coronary artery. University of Health Sciences Journal of Nursing, 7(2), 105112. https://doi.org/10.48071/sbuhemsirelik.1636048 |
| 3644262 | Result | Walker SN, Sechrist KR, Pender NJ. The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nurs Res. 1987 Mar-Apr;36(2):76-81. |
| Result | Savaşan, A., Ayten, M., & Ergene, O. (2013). Hopelessness and healthy life style behaviors in patients with coronary artery disorder. Journal of Psychiatric Nursing, 4(1). https://doi.org/10.5505/phd.2013.07279 |
| 15826439 | Result | Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005 Apr;55(513):305-12. |
| 21682813 | Result | Methapatara W, Srisurapanont M. Pedometer walking plus motivational interviewing program for Thai schizophrenic patients with obesity or overweight: a 12-week, randomized, controlled trial. Psychiatry Clin Neurosci. 2011 Jun;65(4):374-80. doi: 10.1111/j.1440-1819.2011.02225.x. |
| 38056987 | Result | Kwiecinski J, Tzolos E, Williams MC, Dey D, Berman D, Slomka P, Newby DE, Dweck MR. Noninvasive Coronary Atherosclerotic Plaque Imaging. JACC Cardiovasc Imaging. 2023 Dec;16(12):1608-1622. doi: 10.1016/j.jcmg.2023.08.021. |
| 35328769 | Result | Jebari-Benslaiman S, Galicia-Garcia U, Larrea-Sebal A, Olaetxea JR, Alloza I, Vandenbroeck K, Benito-Vicente A, Martin C. Pathophysiology of Atherosclerosis. Int J Mol Sci. 2022 Mar 20;23(6):3346. doi: 10.3390/ijms23063346. |
| 29905499 | Result | Dobber J, Latour C, Snaterse M, van Meijel B, Ter Riet G, Scholte Op Reimer W, Peters R. Developing nurses' skills in motivational interviewing to promote a healthy lifestyle in patients with coronary artery disease. Eur J Cardiovasc Nurs. 2019 Jan;18(1):28-37. doi: 10.1177/1474515118784102. Epub 2018 Jun 15. |
| 35504280 | Result | Bjorkegren JLM, Lusis AJ. Atherosclerosis: Recent developments. Cell. 2022 May 12;185(10):1630-1645. doi: 10.1016/j.cell.2022.04.004. Epub 2022 May 2. |
| Related Info | View source |
| Related Info | View source |
| D001161 |
| Arteriosclerosis |
| D001157 | Arterial Occlusive Diseases |
| D014652 | Vascular Diseases |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |