The Effectiveness of an Intervention Based on the Information, Motivation, and Behavioral Skills Model on Treatment Adherence and Self-Efficacy in Patients with Coronary Artery Diseases: An Explanatory Mixed Method Study

Zahra Khademian; Nasrin Zahmatkeshan; Mahnaz  Rakhshan; Ladan Zarshenas

doi:10.18502/jimc.v7i4.16633

Zahra Khademian Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Nasrin Zahmatkeshan Department of Operating Room, School of Para Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
Mahnaz Rakhshan Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Ladan Zarshenas Department of Nursing, School of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

DOI: https://doi.org/10.18502/jimc.v7i4.16633

Keywords: Coronary artery disease, Follow-up studies, Iran, Medication adherence, Motivation, Psychological distress, Self efficacy, Self-management

Abstract

Background: Promoting adherence to treatment and self-efficacy in patients with coronary artery diseases helps to improve patient outcomes. The present study was conducted to explain the effectiveness of interventions based on information, motivation, and behavioral skills model on treatment adherence and self-efficacy in patients with coronary artery diseases.

Methods: This explanatory-sequential study was conducted on patients with coronary artery diseases in Shiraz, Iran. First, a quasi-experimental study was conducted on 112 patients who were randomly assigned to two intervention and control groups. The intervention consisted of ten motivational training sessions that were designed based on Information, Motivation, and Behavioral Skills (IMBS) model and continued with six months of telephone follow-up and counseling. Data were collected before, three months, and six months after the end of the intervention. Then, in the second phase, a qualitative study including 20 in-depth interviews with 18 participants from the intervention group was conducted. The data were analyzed by deductive and inductive qualitative content analysis. Finally, quantitative findings were explained with the help of qualitative findings.

Results: The findings showed that the mean score of treatment adherence, medication adherence, and self-efficacy in the intervention group was significantly higher than the control group 3 and 6 months after the intervention (p<0.001). The results of the qualitative phase of the study also showed that the four main categories include receiving targeted information, encouragement to care, gained self-efficacy/doubt in care, and improvement/non-improvement of treatment adherence behaviors can explain quantitative phase results.

Conclusion: The results showed that receiving training with effective methods, strengthening the support system, self-confidence and positive attitudes about care, and promoting self-management and proper management of emotional distress contributed to the effectiveness of the interventions. However, receiving conflicting information, limited financial resources, and the inability to face challenges were among the obstacles to strengthening self-efficacy and adherence to treatment.