Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials

“The PRISMA flow diagram was used to document the number of studies retained at each tier of the review process [30].”

“Studies included in the full-text review were also assessed for methodological quality during review using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials [32].”

“2 million people [1], and prediabetes affects an expanding population of approximately 88 million adults [1], where an estimated 70% will progress to diabetes [2].”

“In addition, the ADA endorses deliberately attending to various areas of psychosocial care [57], and many established measures used in these respective areas were applied in the measurement of outcomes across the reviewed studies, such as the Diabetes Distress Scale (DDS) [36] and the Patient Health Questionnaire (PHQ…”

“Diabetes requires consistent attention to an array of self-management behaviors; these can be affected by various personal factors including motivators and barriers for using treatment(s) as recommended, attitudes, beliefs, and knowledge level, among others [10].”

“In other literature, patterns of heterogeneity among MI interventions have been reported [14, 28, 54], and different training settings and methods may impact both the quality and delivery of MI [15, 55, 56].”

“To improve diabetes self-management, behavioral interventions have demonstrated improvements in diabetes control by targeting eating habits [11], physical activity [11], and medication taking [12], among others.”

“To improve diabetes self-management, behavioral interventions have demonstrated improvements in diabetes control by targeting eating habits [11], physical activity [11], and medication taking [12], among others.”

“In other literature, patterns of heterogeneity among MI interventions have been reported [14, 28, 54], and different training settings and methods may impact both the quality and delivery of MI [15, 55, 56].”

“In other literature, patterns of heterogeneity among MI interventions have been reported [14, 28, 54], and different training settings and methods may impact both the quality and delivery of MI [15, 55, 56].”

“Telehealth has been shown to demonstrate equally efficacious impacts on outcomes compared to face-to-face interventions [20], and promising outcomes have been documented for the effects of telehealth on facilitating and supporting self-management [21].”

“MI has been feasibly implemented through various technology-based modes, including computer, video, phone, and animation [24].”

“In some studies, eating habits were significantly affected regarding improved overall diet [33, 36, 43, 49], reduced fat intake and fat-related eating habits [35, 41], and increased vegetable and fruit intake [35], but eating habit goals were not significantly different between groups [36].”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“Telehealth has been shown to demonstrate equally efficacious impacts on outcomes compared to face-to-face interventions [20], and promising outcomes have been documented for the effects of telehealth on facilitating and supporting self-management [21].”

“When delivering behavioral interventions for PWD, telehealth is a mode of delivery that has historically improved access to care [16], and telehealth utilization has rapidly increased due to the COVID-19 pandemic [17, 18] and expansions in reimbursements from the Centers for Medicare and Medicaid Services (CMS) for te…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“Others found no effects between groups [33–35, 39, 41, 47, 49, 50], but 3 of these studies found SS improvements within groups [33, 34, 47].”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“, MI) delivered through telehealth [25].”

“When delivering behavioral interventions for PWD, telehealth is a mode of delivery that has historically improved access to care [16], and telehealth utilization has rapidly increased due to the COVID-19 pandemic [17, 18] and expansions in reimbursements from the Centers for Medicare and Medicaid Services (CMS) for te…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“Although not a strict fidelity assessment, another study evaluated the interventionists’ skills after MI training through practice calls prior to intervention implementation, with scores ranging from 3–4 on a 7-point Likert-type scale [40].”

“− Döbler, 2018 [43] + + − − ?”

“57), respectively [40]; while 2 studies demonstrated no effects [43, 52].”

“Exploration and synthesis of the literature is needed since MI has shown outcomesimpacting potential, even when this counseling method and approach has been delivered through means other than face-to-face encounters [27]; rigorous evaluation and report of design, intervention methods, and results from randomized contr…”

“Lastly, MI-based telehealth provides a person-centered approach with nonjudgmental accountability that is better received by individuals compared to traditional healthcare practitioners’ communication styles [58].”

“In other literature, patterns of heterogeneity among MI interventions have been reported [14, 28, 54], and different training settings and methods may impact both the quality and delivery of MI [15, 55, 56].”

“When delivering behavioral interventions for PWD, telehealth is a mode of delivery that has historically improved access to care [16], and telehealth utilization has rapidly increased due to the COVID-19 pandemic [17, 18] and expansions in reimbursements from the Centers for Medicare and Medicaid Services (CMS) for te…”

“Significant improvements were demonstrated for physical activities/behaviors [35, 37, 41, 43, 49], steps walked [37, 42, 53], and exercise action planning [43]; however, exercise coping planning [43], physical activity goals [36], and moderate to vigorous physical activity [42, 44] were not affected.”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“Swoboda, USA, 2017 [36] Pragmatic pilot RCT, single site Adults (40–75 years old) with T2D and risk for CVD, not loss to follow-up in Swoboda, 2016 [35] I (I1+I2): 37 (A1C=NR) C: 17 (A1C=NR) No training details 4-month intervention I1: Multiple goal/behavior change (face-toface meeting + 7 biweekly phone calls with di…”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“− + + + + Ingersoll, 2015 [48] ?”

“− Young, 2019 [44] + ?”

“As a result of MI-based telehealth interventions in retained studies, statistically significant improvements were documented between intervention and control groups for quality of life [33, 34, 37, 38, 44, 49, 50], psychological distress [33, 34, 38, 53], perceived stress [53], diabetes self-efficacy/ empowerment [33,…”

“In other literature, patterns of heterogeneity among MI interventions have been reported [14, 28, 54], and different training settings and methods may impact both the quality and delivery of MI [15, 55, 56].”

“Previous systematic reviews have reported that motivational interviewing-based interventions are beneficial to medication adherence among patients with chronic diseases, including asthma, cardiovascular disease, and diabetes [7,8,42,43].”

“A systematic review of RCTs (n 1⁄4 21 studies) has found that MI-based telehealth intervention is effective in improving glycated hemoglobin, systolic blood pressure, T2DM self-efficacy, and PA behaviors.(16) In another recent systematic review of adolescents (n 1⁄4 19 studies), the MI intervention group showed a redu…”

“Six reviews reported the effect on self-management or care [22, 23, 26, 27, 35, 48], and 6 reported on self-efficacy [22, 27, 35, 36, 43, 46].”

“15,16 It has been stated that MI techniques can be used to reveal behavioural changes that help patients become aware of their own ambivalent emotions (con fl icting emotions) and resolve them.”

“…T2DM (Lee et al. 2017; Hangaard et al. 2021), others on various types of diabetes (Jaana and Paré 2007; Pimouguet et al. 2011; Polisena et al. 2009; McDaniel et al. 2022), while most of the included studies focused on various chronic conditions, including diabetes (Paré et al. 2010; Beratarrechea…”

“Studies of telehealth diabetes management programs conducted prior to the pandemic have shown improvements in HbA1c levels and other behavioral and health outcomes [14,15,36].”

“Motivational interviewing is an evidence-based skill set designed to aid individuals in identifying motivation for change and to facilitate personalized changes in lifestyle and behavior [21].”

“However, these reviews were constrained by a small number of studies (McDaniel et al. 2022), solely HbA1c as a glycemic control measurement (Berhe et al. 2020), and significant heterogeneity without further meta-regression analysis (Bilgin et al. 2022).”

“MI originated as a treatment for addiction but subsequently became widely employed to address a variety of other lifestyle and health issues, such as inactivity (Galbraith et al., 2022) and maladaptive diabetes management (McDaniel et al., 2021).”

“Based on the emerging evidence about the impact of SDM and motivational interviewing for adults with diabetes and/or CVD, 23,38–40 we hypothesized that patients attributed to primary care practices with high adoption of patient-engagement strategies will have a lower odds of potentially preventable…”

“All providers receive extensive evidence-based training on diabetes self-management and operate under a motivational interviewing framework to promote self-efficacy and autonomy for behavior change [30,31].”

“…a systematic review examining MI-based tele-health interventions in individuals diagnosed with DM and prediabetes evaluated the results of 21 randomized controlled trials and concluded that MI-based telehealth applications were among the most effective methods for improving self-efficacy [48].”

“All these factors are responsible for the heterogeneity of the outcomes of MI techniques in the literature and highlight the need for standardization of the MI technique to provide more reliable evidence on the true impact of MI and its long-term impact on persons with T2DM [10, 13, 21, 27].”

“Meta-analysis and systematic review studies conducted on motivational interviewing have demonstrated a significant decrease in HbA1c and FBG levels among participants accessing this intervention (McDaniel et al., 2022; Ramadan et al., 2019).”

“In practice, this can be implemented through motivational interviewing, individualized counseling, goal setting, self-monitoring, and family involvement in meal planning , including technology-supported approaches when feasible (Hinkle et al., 2022; McDaniel et al., 2022; Steffen et al., 2021) .”

“Other research, focusing on nurse-led telehealth and motivational interviewing, has demonstrated some positive success in improving medication adherence and activity behaviors as well, 35,36 thus lending support to our findings.”

“…un cambio conductual benéfico para su salud a través de la motivación intrínseca 6 y ha sido ampliamente utilizada para ayudar en tratamientos a pacientes usuarios de drogas ilícitas 7 , de alcohol y tabaco 8 , obesos 9 , con enfermedades sistémicas crónicas 10 y también con enfermedad periodontal.”