Effects of Psychological Empowerment-Based Motivational Interviewing Program on Self-Management Behavior in Patients With Early Chronic Kidney Disease: A Mixed Methods Study.

BACKGROUND

Chronic kidney disease (CKD) is a global health threat to patients' physical and mental health. Effective self-management can slow disease progression in early stages. However, prolonged treatment often leads to ego depletion and subsequently impacts self-management. Interventions to address this issue remain underdeveloped.

AIM: To evaluate the effects of psychological empowerment-based motivational interviewing program on early-stage CKD patients' self-management, perceived empowerment, and ego depletion and to explore their engagement experiences and the underlying reasons for the intervention's effectiveness.

METHODS

The study employed the explanatory sequential mixed methods design comprised of a randomized controlled trial and a qualitative study, which were conducted in a tertiary hospital from July 2022 to November 2023. About 70 patients with early CKD were randomly assigned to a control group (n = 35) receiving standard clinical nursing, or an intervention group receiving a 12-week nurse-led psychological empowerment-based motivational interviewing program consisting of four interview sessions and four consolidation sessions. CKD Self-Management Behavior Scale, Patient Perception of Empowerment Scale, Self-Regulation Fatigue Scale, and biochemical indicators were collected at baseline (T1), after 4 weeks of intervention (T2), immediately postintervention completion (T3), and 4 weeks after intervention completion (T4). Data were analyzed by generalized estimating equation model. Semistructured interviews were conducted with the participants in the intervention group.

RESULTS

The participants' mean age was 42.76 years (SD = 10.59). Compared with the control group, the intervention group had a statistically significant improvement in self-management behavior (T2: β = 18.26, T3: β = 23.73, T4: β = 23.78; p < 0.001), ego depletion (T2: β = -8.46, T3: β = -11.35, T4: β = -13.35; p < 0.001), and perceived empowerment (T2: β = 5.77, p=0.002; T3: β = 9.41, T4: β = 8.99; p < 0.001). Qualitative interviews of 14 participants indicated that the intervention could affect self-perception, improve emotion, and establish healthy behaviors, which may explain such encouraging effects.

CONCLUSIONS

The psychological empowerment-based motivational interviewing program produced immediate and delayed benefits on self-management, perceived empowerment, and ego depletion in patients with early CKD. These findings provide new strategies for chronic disease management and psychological nursing. Trial Registration: Chinese Registry of Clinical Trials: ChiCTR2200064257.