Background Rehabilitation for patients with a chronic rheumatic disease often addresses relevant health life style changes to prevent a progression of increased symptoms and further functional loss. Health behaviour change may however take a long time to be established. Maintaining an achieved effect and positive self-management strategies after rehabilitation is thus a vulnerable process, often competing with other daily activities and priorities. Research into health related behavior change highlights the importance of motivation, ambivalence and resistance. Motivational interviewing is a client centered counselling method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The method is increasingly used in rehabilitation and health behavior change interventions.
The current study was part of a larger multi-center RCT, where 4 follow-up phone calls after discharge were one of several added-on interventions based on the principles of motivational interviewing. The phone calls were received one week after discharge, as well as after one, three and five months, and were performed by health personnel familiar from the rehabilitation stay. In the phone calls the personal goals that the patients had defined for the period after the rehabilitation were addressed.
Objectives To explore patients experiences of receiving follow-up telephone calls after rehabilitation and its impact on goal attainment and behavioural changes.
Methods Data was obtained from semi-structured interviews with 18 patients who had attended rehabilitation with follow-up telephone calls as an integrated part of the program. Interviews were conducted when the interviewees had received 2 or 3 follow-up calls.The recorded interviews were transcribed verbatim. QSR.NVivo software was used for coding and systemizing. A thematic analysis was applied. Categories and themes were discussed with a team of qualitative researchers.
Results Motivation represents an overarching theme. Three broad subcategories are:
Experience and form: All informants describe receiving the follow up telephone calls as entirely positive. It represented an appreciated more-than-expected intervention that arouse positive feelings. The “spirit of MI” with which the phone calls were conducted was evident in the descriptions; experienced as genuine interest, accept, which resulted in a positive reinterpretation of relapse.
Effect: The patients described the phone calls as motivating by reminding them of their defined individual goals. Knowing that someone would be interested in the efforts to reach goals, seemed to increase determination and efforts to do so, and represented a sense of security; an encouraging feeling of not being on your own. The phone-calls increased self-efficacy and offered concrete advice on further progress.
Relation: The positive motivating effect however seemed to depend upon there being an established relation to the health personnel making the call.
Conclusions Patients who received follow-up telephone calls based on motivational interviewing after rehabilitation experienced that these lead to a maintained focus on individual goals and increased efforts to continue to maintain health behaviour changes. A positive relationship between the patient and the health personnel performing the phone call was described as a prerequisite for the positive effects.
Disclosure of Interest None declared