The effect of motivational interviewing–based health behavior counseling on lipid control among patients with hyperlipidemia

Abstract

Introduction: Hyperlipidemia is a major modifiable risk factor, and behavioral modification is essential in its management. Motivational interviewing (MI) has been shown in several studies to improve lipid control and reduce cardiovascular disease risk. However, evidence in the context of primary care in Thailand remains limited.

Objective: To evaluate the effect of motivational interviewing–based health behavior counseling, compared with standard care, on changes in blood lipid levels and cardiovascular risk scores among participants.

Methods: A prospective, non-randomize systematic allocation trial was conducted among patients who had abnormal lipid profiles or were at high risk for cardiovascular events attending the Family Medicine Outpatient Department at Nakornping Hospital between 2024 and 2025. The intervention group received motivational interviewing sessions, whereas the control group received standard care. Both groups were followed up at 3 months. Differences in means or proportions between and within groups were analyzed using multiple logistic regression, adjusting for important covariates.

Results: A total of 50 patients were enrolled, with 25 patients allocated to the intervention group (male 36%, mean age 59.44 ± 11.97 years) and 25 patients to the control group (male 36%, mean age 65.40 ± 9.83 years). After 3-month follow-up, both groups showed statistically significant reductions in mean total cholesterol and LDL‑cholesterol levels compared with baseline. The mean changes in total cholesterol were -21.24 mg/dL (95% CI -44.10 to 1.62) in the intervention group and -7.88 mg/dL (95% CI -25.94 to 10.18) in the control group, while the corresponding changes in LDL-cholesterol were -25.12 mg/dL (95% CI -49.54 to -0.70) and -7.56 mg/dL (95% CI -26.05 to 10.93), respectively. However, multivariable logistic regression adjusting for baseline characteristics demonstrated no statistically significant differences between groups. Triglycerides, HDL‑cholesterol, and cardiovascular risk scores tended to improve in both groups, but these changes did not reach statistical significance. In contrast, the intervention group showed a significantly greater increase in knowledge and awareness scores than the control group (mean difference 4.16, 95% CI 3.28–5.04, p < 0.001).

Conclusion: Motivational interviewing helped reduce LDL cholesterol and showed a trend toward improving overall lipid profiles, despite no significant differences in other indicators. Integrating this technique with standard care may support better lipid control and lower long term cardiovascular risk.