The results of this study indicated no significant differences in demographic characteristics between the two groups. In other words, the study groups were homogenous in terms of demographic characteristics, and any significant difference in the dependent variable was attributed to the MI sessions at the end of the study.
Our findings also demonstrated that the MI approach positively influenced the nutritional self-efficacy in patients with diabetes. In addition, the MI method could effectively enhance the sense of self-efficacy in the face of negative emotions, social pressure, and physical discomfort situations, leading the patients toward performing positive and enjoyable activities. In fact, the MI approach could create sustainable and relatively long-lasting changes in all of the previously mentioned parameters. These findings confirmed the hypothesis that MI is a more effective method than routine education approach in increasing the sense of self-efficacy of eating behavior as a predictor of success in weight loss programs. Baer believes that low self-confidence in the control of eating behavior, especially when experiencing negative emotions, is associated with symptoms of eating disorders . Our results showed that physical exercise self-efficacy could improve in patients with diabetes after MI sessions. It might be due to enhancing optimism and positive emotions and reinforcing the self-care and self-management motivation of these patients after MI sessions. Nowadays, experts consider physical exercise along with diet and medication as the third major pillar of diabetes treatment .
Our results showed the MI approach positively influenced the self-monitoring of blood glucose (SMBG) in the patients with diabetes. The basic principles of MI are to reinforce the sense of self-efficacy to the clients regarding all behavioral changes. Most of the MI techniques used in this research were exclusively related to this matter, such as the evaluation of commitment-confidence, controlling temper in stimulating situations, participation in decision-making, supporting the autonomy of the clients, elimination of bias, and drawing attention to discuss change. In this respect, Simpson et al argued that the MI approach mostly emphasizes on the support of self-efficacy, participation, and inquiries for the viewpoints of the clients . Thus, creating a strong sense of self-efficacy against temptations can lead to SMBG.
Our results indicated that the MI method positively influenced foot care in the patients with diabetes. By compensating for disabilities and regulating individual performance, the MI approach could improve practical care in patients. Nevertheless, the MI method had no effects on the smoking habits of the patients in the current research. Most diabetic patients have a dual sense of decision-making when it comes to change rather than resistance/poor will power. Diabetes control requires the understanding of the information and required treatment procedures, and inadequate knowledge regarding the disease control process may decrease the patients’ self-confidence in this process.
After MI sessions in our study, the mean score of diabetes management self-efficacy increased in the intervention groups. Thus, it confirmed that the implementation of the MI approach could positively influence the management self-efficacy of these patients. MI has a positive impact on the self-efficacy of individuals by affecting the perceptions and increasing the mental involvement of patients to realize their conditions and learn to manage their problems independently. In this regard, our findings are in congruence with the study by Walpole et al which was conducted to evaluate the effects of MI on increased self-efficacy in adolescents . Our finding is confirmed by following studies. Song et al showed that MI had a positive impact on the self-management of patients with diabetes . Bóveda-Fontán et al confirmed the effectiveness of MI in the management of patients with dyslipidemia . In addition, Mojahed et al indicated that MI enhanced the self-efficacy of pregnant women and helped them to quit hookah smoking . In another study focusing on self-efficacy and chronic diseases, Ebrahimi Belil et al observed that increasing self-efficacy in patients resulted in creating a sense of empowerment to perform personal tasks, reducing fear, enhancing stress management, improving social relationships and promoting self-management . According to Sheeran et al self-efficacy could directly affect health-related behaviors, as well as other cognitive determinants. Furthermore, it could be argued that individuals with higher self-efficacy have more prominent personal goals, expect better outcomes, and consider the obstacles against self-management as challenges to be overcome, all of which ultimately increase their self-management .
Similar to our findings, Chen et al reported an improvement in the self-efficacy of more than half of the participants in the intervention group after implementing the MI approach . In other research, MI was provided in the form of video calls as diabetes self-management education, and the results showed a significant improvement in the patients' self-efficacy . Inconsistent with our results, the findings of similar research showed that educational interventions for diabetes self-management improved the glycated hemoglobin levels more significantly compared to the diabetes self-management education based on the MI approach . In addition, another study demonstrated that MI had no considerable impact on the routine care of patients with types I and II diabetes . The resaon could be due to high attrision rates in their studies.
One of the limitations of our study was the small sample size, which might have an impact on the effect size of the study. Conducting the study in a small region, which had a specific cultural background was another limitation of the study. The cultural tendencies of individuals affect their learning abilities and implementation of the teachings. Therefore, it is suggested that further investigations be conducted in this regard with larger sample sizes and in larger areas with various cultures, so that the effects of MI on diabetes management self-efficacy could be confirmed, and the results could be generalized with greater confidence.