Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials.
Cassidi C McDaniel, Jan Kavookjian, Heather P Whitley
PMID 34366228WHAT IT FOUND
Some adults with diabetes had lower A1C, systolic blood pressure, and better confidence in managing diabetes after telehealth motivational interviewing.
Benefits were inconsistent, and many diet, activity, weight, lipid, and self-care outcomes did not change.
Key findings
01In trials testing motivational interviewing delivered by telehealth, A1C improved significantly in 60% of studies targeting it, including studies reaching goals below 7% or reporting reductions of less than 1.0%, 1.0 to 2.9%, and more than 3.0%.
02In trials testing motivational interviewing delivered by telehealth, systolic blood pressure improved significantly in 56% of studies, with reductions from 1.6 to 7.0 mmHg, but diastolic blood pressure and the proportion reaching the <130/80 mmHg goal did not improve significantly.
03In trials testing motivational interviewing delivered by telehealth, BMI improved significantly in only 9% of studies investigating it, weight alone did not change significantly, and glucose monitoring and foot care did not improve significantly.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Search procedures may not have captured all relevant studies, although CENTRAL and Clinicaltrials.gov were used to reduce publication bias. The first author alone screened titles and abstracts, so relevant studies could have been missed before full-text review. The review did not perform a meta-analysis, and the percentages of positive effects are not a pooled estimate. Trials differed widely in interventionists, motivational interviewing training, delivery mode, contact frequency, and duration, so it is hard to identify which component worked. Motivational interviewing fidelity was assessed in only three studies, and only one reported fidelity results, so delivered quality is uncertain. Performance and detection bias risk was mostly high or unclear, partly because participants, personnel, and outcome assessors were often not blinded. Prediabetes was studied in only one trial. The economic result came from a safety-net setting with mostly indigent and Latino patients, so it may not generalize.
Declared interests
McDaniel was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award TL1TR003106 and by the American Foundation for Pharmaceutical Education Pre-Doctoral Fellowship. Kavookjian is on the Merck Speakers Bureau for non-product medical education on motivational interviewing, shared decision-making, and health literacy communication. She also served as a Merck consultant for motivational interviewing content in person-centered communication education materials. She consults for MediMergent, LLC, for an FDA-funded project training pharmacists in motivational interviewing for medication taking in diabetes.
The easy way to misread this
Do not read the A1C and systolic blood pressure improvements as proof that telehealth motivational interviewing works for every diabetes outcome. Many diet, activity, weight, lipid, and self-care outcomes did not improve significantly, and motivational interviewing fidelity was rarely assessed.