A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease

Li-Li Zhuo; Daguan Zhang; Wei-Xiao Xiang; Tian-Na Liu; Yin-Rong Ding

doi:doi:10.11648/j.cmr.20261501.12

Research Article |

| Peer-Reviewed

A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease

Li-Li Zhuo, Daguan Zhang, Wei-Xiao Xiang, Tian-Na Liu, Yin-Rong Ding^*

Published in Clinical Medicine Research (Volume 15, Issue 1)

Received: 24 March 2026 Accepted: 7 April 2026 Published: 23 April 2026

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Abstract

Objectives: To evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD. Methods: 60 GERD patients were enrolled based on inclusion and exclusion criteria and randomly assigned to the observation (30 cases) or control groups (30 cases). The observation group underwent MI combined with PNI, while control group received conventional nursing interventions. The changes in inflammatory response-related indicators were compared between two groups. The reflux disease questionnaire (RDQ), symptom self-rating scale (SCL-90), self-efficacy scale (GSES), simple SF-36 scale and Pittsburgh sleep quality index scale (PSQI) were employed to assess the patient's conditions before, three months following and after nursing. Results: Baseline inflammatory markers and scale scores showed no significant between-group differences. After 3 months, the observation group demonstrated significant reductions in these inflammatory markers compared with baseline and the control group. At the same time point, SCL-90 scores decreased across multiple domains, GSES scores improved, and SF-36 scores increased in several dimensions. PSQI scores were also significantly lower in the observation group, indicating better sleep quality. Conclusion: MI combined with PNI may reduce inflammation, relieve negative emotions, and enhance self-efficacy, quality of life, and sleep in GERD patients.

Published in	Clinical Medicine Research (Volume 15, Issue 1)
DOI	10.11648/j.cmr.20261501.12
Page(s)	6-18
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Gastroesophageal Reflux Disease, Emotions, Motivational Interviewing, Nursing Care

1. Introduction

Gastroesophageal reflux disease (GERD) is caused by the reflux of gastric and duodenal contents into the esophagus, which causes esophageal discomfort symptoms or complications. It is reported that the incidence of GERD has increased by 77.53% in the past 30 years

[1, 2]

. The disease is attributed to the malfunction of the anti-reflux defense mechanism, which results in the esophagus being invaded by the reflux of gastric and duodenal contents. The action of gastric juice damages the gastric tube and gastric mucosa, which in turn causes inflammation, heartburn, chest pain and other symptoms

[3]

. GERD patients with recurrent disease, a long course of disease, and those who have not responded to treatment experience significant distress, both mentally and physically.

Furthermore, they are at an increased risk of developing cancer, which further impairs their quality of life

[4]

. Long-term negative emotions, such as feelings of anxiety confusion, and low self-efficacy, are often seen in people with GERD. Such conditions not only exacerbate the condition itself, but also increase the difficulty of treatment

[5]

Motivational interviewing (MI) is a patient-centered counseling technique that helps patients overcome lifestyle barriers by enhancing their intrinsic motivation and readiness for change

[6]

. The fundamental principle of MI is to respect patients' autonomy and facilitate self-exploration instead of merely guiding or persuading them

[7]

. Currently, in managing digestive diseases and chronic diseases, MI can assist patients in identifying and resolving behavioral issues related to their condition, such as dietary habits, lifestyle and medication adherence

[8, 9]

. Phased nursing interventions (PNI) involve providing personalized care in stages, tailored to changes in the patient’s condition and treatment needs. This approach emphasizes continuous support in areas such as patient education, psychological care, lifestyle guidance, and symptom management

[10]

. For GERD patients, PNI offers comprehensive support throughout the disease trajectory, from diagnosis to long-term management. It helps patients better understand their condition and enhances their ability to manage it, leading to improved treatment adherence and quality of life

[11]

. While previous studies have shown that both MI and PNI can independently improve patients’ mental health and quality of life

[12]

, the effectiveness of their combined application remains unclear. This study aimed to evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD.

2. Methods

2.1. Patients

A prospective study was conducted on 60 patients with GERD who were recruited between June 2022 and June 2023 at our medical center based on predefined inclusion and exclusion criteria. This was a prospective, observational study approved by the institutional review board of the affiliated 1st Affiliated Hospital of Wenzhou Medical University. The approval number is “KY-2024-142”.

Inclusion criteria: (1) Patients met the diagnostic criteria for gastroesophageal reflux disease following clinical examination; (2) Age between 18 and 65 years; (3) Gastro-oesophageal reflux disease questionnaire (GerdQ) score ≥ 8

[13, 14]

. Exclusion criteria: (1) Presence of heart, liver, kidney, or other organ dysfunction; (2) Language, communication, or mental disorders; (3) Inability to cooperate with nursing interventions; (4) Presence of malignant tumors, pregnancy, or lactation.

The participants were divided into a control group (n = 30) and an observation group (n = 30). The observation group received MI combined with PNI, while the control group underwent conventional nursing interventions (CNI, Figure 1).

Download: Download full-size image

Figure 1. Flow chart of the study.

2.2. Nursing Intervention Methods

2.2.1. Control Group

The control group received CNI, which included the following components: (1) Health education delivered through oral explanations and informational leaflets; (2) Psychological support; (3) Guidance on daily activities, dietary precautions, and medication use; (4) Maintenance of a quiet, comfortable, and clean ward environment.

2.2.2. Observation Group

The observation group received MI combined with PNI. Upon hospital admission, the responsible nurse warmly receives the patient, engages in timely one-on-one communication, and collects comprehensive personal information. A thorough assessment of the patient’s condition is conducted, followed by the development of a personalized motivational interview plan based on the evaluation results. During the first interview, the nurse introduces themselves and explains the purpose, structure, and significance of the motivational interview to ensure patient cooperation. Patients undergo at least three phased interviews during treatment, each lasting 20–30 minutes: (1) First Interview (Day 1–2 of Hospitalization): The primary goal is to establish a trusting relationship with the patient, identify difficulties in coping with the disease, and assess psychological stress and negative emotions. Patients complete a self-administered questionnaire covering personal medical history, demographics (gender, age), smoking and alcohol use, lifestyle habits, dietary patterns, and sleep quality; (2) Second Interview (Day 3–5 of Hospitalization): The nurse educates the patient and their family on the pathogenesis, risk factors, and treatment strategies for GERD. This stage aims to enhance the patient’s understanding of GERD while fostering family support and involvement in the patient’s care; (3) Third Interview (Around Day 7 of Hospitalization): The nurse discusses treatment progress, symptom improvement, and evidence-based strategies for preventing disease recurrence. A follow-up plan is developed, and a consensus is reached on post-discharge telephone follow-ups.

2.3. Observing Indicators

2.3.1. Measurement of Inflammatory Response Indicators

Venous blood samples (3 mL) were collected from patients at three time points: before nursing, three months after nursing, and 24 hours after completing the nursing cycle. Serum was obtained by centrifugation at 4000 rpm for 5 minutes. The supernatant was then extracted and stored for subsequent analysis. The concentrations of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), calcitonin gene-related peptide (CGRP), and 5-hydroxytryptamine (5-HT) were measured using enzyme-linked immunosorbent assay (ELISA).

2.3.2. Reflux Disease Questionnaire Scale Scoring

The Reflux Disease Questionnaire (RDQ) assesses the severity and frequency of GERD symptoms, including heartburn, anorexia, non-cardiac chest pain, and acid reflux. Symptom frequency is categorized into six levels: “never,” “less than one day per week,” “one day per week,” “two to three days per week,” “four to five days per week,” and “almost every day,” assigned scores of 0, 1, 2, 3, 4, and 5, respectively. The severity of symptoms is classified into four levels: “never had symptoms,” “mild symptoms, only noticeable when pointed out by a doctor,” “moderate symptoms affecting daily life and requiring occasional medication,” and “severe symptoms significantly impacting daily life, requiring long-term medication.” These severity scores are then multiplied by a factor of 3. The final RDQ score is calculated as the sum of the symptom frequency score and the adjusted severity score.

2.3.3. Symptom Checklist-90 Assessment

The Symptom Checklist-90 (SCL-90) was used to evaluate negative emotions in both groups. The assessment included ten factors: somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and other psychological symptoms. The scale consists of 90 items, each rated on a five-point scale from 1 to 5, with higher scores indicating greater psychological distress

[15]

2.3.4. General Self-efficacy Scale Assessment

The General Self-Efficacy Scale (GSES) consists of ten items designed to assess an individual’s confidence in overcoming setbacks and difficulties. Each item is rated on a four-point scale: “incorrect completion,” “somewhat correct,” “mostly correct,” and “completely correct.” The total score ranges from 10 to 40 points. A score of 31 or above indicates a high sense of self-efficacy, 21–30 represents moderate self-efficacy, and 11–20 signifies low self-efficacy. The scale demonstrates high reliability (Cronbach’s α = 0.901) and validity (0.853)

[16]

2.3.5. Short Form-36 Rating Scale

The Short Form-36 (SF-36) Rating Scale provides a direct and comprehensive assessment of patients’ quality of life through quantitative scoring. The scale consists of eight dimensions, each with a maximum score of 100 points. The total score is calculated as the average of the converted scores across these dimensions, with higher scores indicating better quality of life. In 1992, British scholar J. E. Brazier and colleagues conducted a reliability and validity test of the SF-36

[17]

. The Cronbach’s α coefficient for each dimension exceeded 0.85, and the test-retest reliability after two weeks was 0.75, demonstrating strong convergent validity and discriminant validity.

2.3.6. Pittsburgh Sleep Quality Index

The Pittsburgh Sleep Quality Index (PSQI) assesses sleep quality across seven dimensions, each scored on a four-point scale (0–3 points). These dimensions include sleep quality, sleep latency, and other relevant factors. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality. The scale has demonstrated high reliability (Cronbach’s α = 0.896) and validity (0.847)

[18]

2.3.7. Assessment of Unhealthy Dietary Habits

To evaluate the impact of nursing interventions on patients’ dietary habits, specific risk factors associated with poor eating behaviors were assessed. These behaviors included rapid eating, overeating, and the consumption of excessively hot, spicy, or greasy foods. A questionnaire and interviews were conducted before and after nursing to determine the prevalence and changes in these habits, thereby assessing the effectiveness of the intervention in promoting healthier lifestyle choices.

2.4. Statistical Analysis

Data were presented as mean ± standard deviation. An independent sample t-test was used to compare continuous variables between the two groups. Categorical data were expressed as frequencies (n) and percentages (%), and comparisons were performed using the chi-square (χ²) test. A p-value < 0.05 was considered statistically significant. All statistical analyses were conducted using SPSS 27.0, and data visualization was performed with Prism 8.0.

3. Results

3.1. Comparison of Baseline Patient Data

There were no significant differences between the two groups in terms of age, sex ratio, disease history, body mass index (BMI), or GERD-Q scores (p > 0.05 for all variables, Table 1).

Table 1. The comparison of baseline data in the two groups.

Baseline information	Control group (n=30)	Observer group (n=30)	Statistic	p
Age (year)	43.20±6.52	43.70±6.48	-0.298	0.767
Gender
Males	13(43.33)	15(50.00)	<i></i>²=0.268	0.605
Female	17(56.67)	15(50.00)
Course of disease (year)	6.70±1.09	6.33±0.92	1.408	0.164
BMI (kg/m²)	21.88±1.59	21.91±1.40	-0.095	0.925
GerdQ score	13.70±1.54	13.27±1.48	1.112	0.271

3.2. Comparison of Changes in Inflammatory Response

At baseline, there were no significant differences in serum levels of inflammatory markers IL-6, IL-1β, and TNF-α between the control and observation groups (p > 0.05). After three months of nursing intervention, inflammatory marker levels decreased in both groups; however, the reduction was significantly greater in the observation group (p < 0.05). Following the intervention, IL-6, IL-1β, and TNF-α levels in the observation group continued to decline, showing a statistically significant reduction compared to the control group (p < 0.05, Figure 2A-C). Besides, there were no statistically significant differences in CGRP and 5-HT levels between the control and observation groups (p > 0.05). After three months of nursing intervention, both groups experienced a decline in CGRP and 5-HT levels; however, the reduction was significantly greater in the observation group (p < 0.05). By the end of the nursing period, CGRP and 5-HT levels in the observation group continued to decrease, demonstrating a statistically significant difference compared to the control group (p < 0.05, Figure 2D, E).

A-E Comparison of IL-6 (A), IL-1β (B), TNF-α (C), CGRP (D) and 5-HT (E) levels between the control and observation groups (*p < 0.05).

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Figure 2. Comparison of Changes in Inflammatory Response.

3.3. Comparison of RDQ Changes

At baseline, there were no significant differences in RDQ scores for heartburn, dysphagia, non-cardiac chest pain, and acid reflux between the control and observation groups (p > 0.05). However, after three months of nursing intervention and after the study, RDQ scores for these symptoms were significantly lower in the observation group compared to the control group (p < 0.05, Figure 3A-D).

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Figure 3. Comparison of different clinical observation indicators A-D Comparison of RDQ scores for heartburn (A), dysphagia (B), non-cardiac chest pain (C), and acid reflux (D) between the control and observation groups; E-H Comparison of RDQ scores for SCL-90 (E), GSES (F), SF-36 (G), and PSQI (H) between the control and observation groups (*p < 0.05; **p < 0.01; ***p < 0.001).

3.4. Comparison of SCL-90 Scale Scores

The SCL-90 consists of nine dimensions. At baseline, there were no significant differences in the scores or total scores of the SCL-90 between the control and observation groups (p > 0.05). However, after three months of nursing intervention and at the end of the study, scores for somatization, interpersonal sensitivity, depression, and other dimensions significantly decreased in the observation group (p < 0.05, Table 2 and Figure 3E).

Table 2. Changes in dimensional scores of the SCL-90 scale in the two groups.

SCL-90 scale		Control group (n=30)	Observer group (n=30)	Statistic	p
Somatization	Before nursing	30.80±5.02	30.07±7.20	t=0.458	0.649
	Care for 3 months	24.33±4.21	21.27±5.30	t=2.484	0.016
	End of care	22.40±3.74	19.83±3.28	t=2.827	0.006
Obsessive-compulsive symptoms	Before nursing	34.47±6.91	33.50±7.08	t=0.353	0.595
	Care for 3 month	28.20±5.53	26.53±5.63	t=1.157	0.252
	End of care	25.30±4.24	24.00±4.68	t=1.128	0.264
Interpersonal sensitivity	Before nursing	27.53±6.22	27.10±6.41	t=0.266	0.791
	Care for 3 month	26.40±4.67	24.00±4.63	t=2.000	0.050
	End of care	21.50±3.53	18.83±3.68	t=2.865	0.006
Depression	Before nursing	40.23±7.31	40.63±7.32	t=-0.212	0.833
	Care for 3 month	36.20±5.30	34.57±5.18	t=1.207	0.232
	End of care	30.40±6.26	26.43±4.70	t=2.774	0.007
Anxiety	Before nursing	34.20±6.08	34.00±6.20	t=0.126	0.900
	Care for 3 month	30.27±4.65	28.53±4.13	t=1.527	0.132
	End of care	29.03±4.12	23.47±4.32	t=5.110	<0.001
Hostility	Before nursing	20.27±4.14	19.80±4.04	t=0.442	0.660
	Care for 3 month	17.27±3.50	15.47±3.19	t=2.080	0.042
	End of care	14.30±4.26	12.40±2.65	t=2.075	0.042
Terror	Before nursing	24.33±4.63	24.50±4.50	t=-0.141	0.880
	Care for 3 month	21.53±4.13	20.40±4.38	t=1.031	0.307
	End of care	17.53±5.32	14.57±4.13	t=2.413	0.019
Paranoia	Before nursing	18.30±5.62	18.47±5.42	t=-0.117	0.907
	Care for 3 month	15.30±3.67	13.83±3.52	t=1.579	0.120
	End of care	13.80±3.86	11.33±3.27	t=2.668	0.010
Psychosis	Before nursing	26.97±3.50	27.20±3.42	t=-0.261	0.795
	Care for 3 month	23.53±3.69	22.70±3.68	t=0.876	0.385
	End of care	20.10±3.25	16.23±3.66	t=4.329	<0.001
Other	Before nursing	22.53±4.67	22.57±4.55	t=-0.028	0.978
	Care for 3 month	18.50±3.30	16.30±3.54	t=2.489	0.016
	End of care	15.57±3.18	12.93±2.66	t=3.476	0.001

3.5. Comparison of Changes in GSES Scale Scores

The GSES scores were assessed at three-time points: before nursing, three months after nursing, and at the end of the intervention. At baseline, no significant differences were observed between the two groups (p > 0.05). However, after three months of nursing and at the study’s conclusion, the GSES scores in the observation group significantly increased (p < 0.05, Figure 3F).

3.6. Comparison of Changes in SF-36 Scale Scores

The SF-36 scale consists of eight dimensions. At baseline, no significant differences were observed in the scores or overall SF-36 scores between the two groups (p > 0.05). However, after three months of nursing and at the end of the study, the scores for physiological function, physiological role, physical pain, and other dimensions significantly improved in the observation group (p < 0.05, Table 3 and Figure 3G).

Table 3. Comparison of SF-36 scale scores in the two groups.

SF-36 scale		Control group (n=30)	Observer group (n=30)	Statistic	p
Physiological function	Before nursing	53.50±12.01	54.03±11.36	T=-0.177	0.860
	Care for 3 month	61.17±6.22	70.03±6.38	T=-5.452	<0.001
	End of care	72.50±8.23	83.37±8.72	T=-4.963	<0.001
Physiological role	Before nursing	58.83±9.71	59.13±9.43	T=-0.121	0.904
	Care for 3 month	68.27±6.80	76.37±7.15	T=-4.497	<0.001
	End of care	72.60±8.20	84.20±7.85	T=-5.596	<0.001
Physical pain	Before nursing	54.53±9.10	53.27±9.33	T=0.532	0.596
	Care for 3 month	65.47±9.60	71.20±10.13	T=-2.251	0.028
	End of care	73.93±10.33	84.00±8.45	T=-4.133	<0.001
General health status	Before nursing	55.13±10.89	55.83±10.37	T=-0.255	0.800
	Care for 3 month	63.50±7.25	70.07±8.15	T=-3.297	0.002
	End of care	73.90±6.13	82.90±7.18	T=-5.223	<0.001
Energy	Before nursing	50.13±8.10	51.57±8.68	T=-0.661	0.511
	Care for 3 month	64.57±7.30	72.73±7.54	T=-4.263	<0.001
	End of care	75.40±6.77	82.63±6.37	T=-4.262	<0.001
Social function	Before nursing	54.77±8.64	53.50±8.44	T=0.574	0.568
	Care for 3 month	61.97±6.89	73.30±6.38	T=-6.613	<0.001
	End of care	74.70±6.35	80.70±6.42	T=-3.639	0.001
Emotional function	Before nursing	52.20±9.30	50.90±9.56	T=0.534	0.595
	Care for 3 month	64.23±8.72	74.77±7.26	T=-5.084	<0.001
	End of care	71.87±5.16	81.07±6.46	T=-6.096	<0.001
Mental health	Before nursing	51.47±8.68	51.90±9.13	T=-0.188	0.851
	Care for 3 month	63.17±6.15	73.47±7.18	T=-5.965	<0.001
	End of care	73.97±7.89	83.80±6.22	T=-5.364	<0.001

3.7. Comparison of PSQI Scale Scores

Table 4 and Figure 3H illustrate significant improvements in the PSQI scores in the observation group by the end of the nursing intervention (p < 0.05). At baseline, there were no significant differences in sleep parameters between the two groups (p > 0.05).

Table 4. Comparison of change in PSQI scale scores in the two groups.

PSQI scale		Control group (n=30)	Observer group (n=30)	Statistic	p
Sleep quality	Before nursing	2.07±1.02	2.10±0.96	t=-0.131	0.896
	Care for 3 month	1.60±1.07	1.63±1.03	t=-0.123	0.903
	End of care	1.37±1.10	1.43±0.97	t=-0.249	0.804
Time before falling asleep	Before nursing	2.07±0.91	1.80±0.10	t=1.084	0.283
	Care for 3 month	1.70±1.09	1.50±0.97	t=0.750	0.456
	End of care	1.63±1.10	1.37±1.07	t=0.954	0.344
Sleep time	Before nursing	2.03±1.00	1.93±1.02	t=0.385	0.702
	Care for 3 month	1.73±1.17	1.53±1.07	t=0.689	0.494
	End of care	1.77±1.14	0.90±0.85	t=3.355	0.001
Sleep efficiency	Before nursing	2.00±1.05	2.47±0.82	t=-1.919	0.060
	Care for 3 month	1.63±1.13	1.47±1.07	t=0.568	0.560
	End of care	1.30±1.18	1.17 ±1.18	t=0.450	0.655
Sleep disorders	Before nursing	2.23±0.86	2.47±0.68	t=-1.166	0.248
	Care for 3 month	2.07±0.87	1.70±0.99	t=1.527	0.132
	End of care	1.57±1.01	1.00±0.98	t=2.207	0.031
Hypnotic drugs	Before nursing	1.70±1.09	2.10±1.03	t=-1.463	0.149
	Care for 3 month	1.63±0.96	1.50±1.04	t=0.514	0.609
	End of care	1.50±0.97	0.97±0.89	t=2.214	0.031
Daytime dysfunction	Before nursing	2.07±1.05	2.33±0.84	t=-1.085	0.282
	Care for 3 month	2.00±0.95	1.50±1.23	t=1.769	0.082
	End of care	1.87±1.01	1.60±1.10	t=0.978	0.332

3.8. Comparison of Unhealthy Dietary Habits

Before the nursing intervention, there were no significant differences in the prevalence of unhealthy living habits between the two groups (p > 0.05). However, following the completion of the intervention, the observation group demonstrated a significant reduction in unhealthy behaviors compared to the control group (p < 0.05), as shown in Table 5.

Table 5. Comparison of bad living habits after nursing care between the two groups.

Group		Eat too fast	Eat too much	Eating overheating	Spicy greasy
Control group (n=30)	Before nursing	6	4	4	4
Observer group (n=30)	Before nursing	5	3	6	2
<i></i>²		0.271
p		0.602
Control group (n=30)	End of care	5	2	3	4
Observer group (n=30)	End of care	1	1	1	2
<i></i>²		6.239
p		0.012

4. Discussion

GERD is a prevalent chronic digestive disorder that significantly affects patients beyond the physiological level. Its chronic nature leads to persistent physical discomfort, reduced anti-reflux function, impaired esophageal clearance, and a weakened esophageal mucosal barrier. These factors contribute to the reflux of gastric contents into the esophagus, potentially causing esophageal mucosal inflammation

[19]

. Notably, when the mucosal barrier is compromised, even normal reflux can lead to reflux esophagitis, which is characterized by esophageal mucosal inflammation due to reflux-induced irritation

[20]

. Persistent inflammation may also result in more severe lesions. Therefore, identifying effective nursing interventions to mitigate the inflammatory response in GERD patients and enhance therapeutic efficacy is of critical importance.

Previous research has already shown that IL-6

[21]

, IL-1β

[22]

, TNF-α

[23]

, CGRP and 5-HT

[24]

play important roles in the pathogenesis of inflammatory bowel disease (IBD). The study conducted by Deshpande et al. demonstrated that MI effectively reduces the body’s inflammatory response and improves therapeutic outcomes

[25]

. Our study results indicated that MI-based nursing interventions significantly lower the levels of IL-6, IL-1β, TNF-α, CGRP and 5-HT, which is in line with previous literature results.

MI is rooted in social psychology and is based on the principles of developmental conflict, empathy, and self-efficacy to help patients modify maladaptive behavioral patterns. The core of MI lies in stimulating patients’ intrinsic motivation and enabling them to overcome barriers to lifestyle changes through active listening, empathy, and guidance

[26]

The findings of this study suggest that integrating MI with PNI improves patients’ physical symptoms, reduces negative emotions, enhances self-efficacy, improves quality of life and sleep quality, and has a positive nursing effect both at three months and at the end of the nursing process. This outcome may be attributed to the consistent application of MI throughout the nursing intervention. From initial admission and preliminary assessment to post-discharge maintenance, MI strategies were applied flexibly.

During the preliminary assessment, nurses collected patients’ data through one-on-one communication, evaluated their condition, and developed personalized MI plans. In the first interview, nurses established a trusting relationship with patients to understand their perception of the disease, encouraged them to express their thoughts and concerns, and helped them recognize the benefits of behavioral modification. This patient-centered communication approach enhanced patients’ self-awareness regarding their disease and treatment

[27]

In subsequent interviews, nurses explained the pathogenesis, risk factors, and treatment options, further increasing patients’ understanding and reinforcing health awareness. In the preparation stage, nurses and patients collaborated to identify the causes of problematic behaviors and develop individualized goals and action plans. During the action stage, nurses adjusted these plans based on the patient’s behavioral changes and disease progression while providing necessary education and motivation.

The application of MI not only enhances patients’ awareness of healthy behaviors but also improves their adherence to treatment

[28]

. MI encourages patients to take an active role in managing their conditions, which is essential for improving treatment efficacy, modifying harmful habits, and enhancing overall quality of life

[29]

. Furthermore, the personalized and flexible nature of MI enables the implementation of nursing interventions tailored to patients’ specific needs, thereby enhancing their effectiveness.

PNI represents an innovative approach to nursing interventions. This model asserts that behavioral modification is a dynamic process rather than an instantaneous change. Rooted in a patient-centered nursing philosophy, PNI divides the nursing process into distinct stages, addressing both the physiological and psychological needs of patients at each phase while formulating targeted intervention plans to facilitate behavioral change

[30]

In this study, PNI was implemented, beginning with a personalized patient assessment upon admission. Through one-on-one communication, nurses gathered comprehensive patient information and developed individualized care plans. During the initial interview, MI techniques were used to establish trust and assess the patient’s perception and attitude toward GERD.

Subsequently, during the intention stage, nursing staff provided patients with detailed information about the disease and emphasized the importance of a healthy lifestyle. In the preparation stage, nurses collaborated with patients to set behavioral change goals and develop action plans. In the action stage, patients began implementing these plans, while nurses offered continuous support and education. Finally, in the maintenance phase, telephone follow-ups were conducted to provide ongoing psychological support and health guidance, reinforcing sustained behavioral changes.

This structured and continuous nursing approach not only enhances patients’ self-efficacy but also fosters active engagement in disease management

[31]

5. Conclusions

The results demonstrated that PNI significantly reduced the inflammatory response in patients, enhanced self-efficacy, improved the quality of life for individuals with GERD, and alleviated negative emotions and sleep disturbances. This patient-centered approach effectively promotes behavioral change by addressing patients’ needs at different stages of the disease, offering a novel strategy for chronic disease management

[32]

. A growing body of evidence suggests that PNI serves as a comprehensive framework for facilitating behavioral change in patients

[33]

6. Limitations

This study assessed the effectiveness of MI combined with PNI in patients with GERD. While the results were positive, several limitations should be acknowledged. The small sample size and recruitment from a single hospital may limit the generalizability of the findings. Additionally, the six-month follow-up period was insufficient to assess long-term effects, and the influence of patients’ family environments was not considered. Future research should aim to expand the sample size, extend the follow-up duration, and include participants from diverse medical and cultural backgrounds to enhance the study’s representativeness and the reliability of its conclusions. These improvements will also contribute to the further optimization of nursing strategies for GERD patients.

Abbreviations

GERD	Gastroesophageal Reflux Disease
MI	Motivational Interviewing
PNI	Phased Nursing Interventions
GerdQ	Gastro-oesophageal Reflux Disease Questionnaire
CNI	Conventional Nursing Interventions
IL-6	Interleukin-6
TNF-α	Tumor Necrosis Factor-α
IL-1β	Interleukin-1β
CGRP	Calcitonin Gene-related Peptide
5-HT	5-hydroxytryptamine
ELISA	Enzyme-linked Immunosorbent Assay
RDQ	Reflux Disease Questionnaire
SCL-90	Symptom Checklist-90
GSES	General Self-Efficacy Scale
SF-36	Short Form-36
PSQI	Pittsburgh Sleep Quality Index
BMI	Body Mass Index

Acknowledgments

The authors would like to express their gratitude to all participating nurses.

Author Contributions

Li-Li Zhuo: Conceptualization, Funding acquisition, Methodology, Writing – original draft

Daguan Zhang: Project administration, Software

Wei-Xiao Xiang: Formal analysis, Investigation, Validation

Tian-Na Liu: Resources, Validation

Yin-Rong Ding: Data curation, Supervision, Visualization, Writing – review & editing

Funding

This work was founded by the Science and Technology Project of Wenzhou (Y20220625).

Conflicts of Interest

The authors declare no conflicts of interest.

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APA Style

Zhuo, L., Zhang, D., Xiang, W., Liu, T., Ding, Y. (2026). A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clinical Medicine Research, 15(1), 6-18. https://doi.org/10.11648/j.cmr.20261501.12

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ACS Style

Zhuo, L.; Zhang, D.; Xiang, W.; Liu, T.; Ding, Y. A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clin. Med. Res. 2026, 15(1), 6-18. doi: 10.11648/j.cmr.20261501.12

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AMA Style

Zhuo L, Zhang D, Xiang W, Liu T, Ding Y. A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clin Med Res. 2026;15(1):6-18. doi: 10.11648/j.cmr.20261501.12

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@article{10.11648/j.cmr.20261501.12,
  author = {Li-Li Zhuo and Daguan Zhang and Wei-Xiao Xiang and Tian-Na Liu and Yin-Rong Ding},
  title = {A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease},
  journal = {Clinical Medicine Research},
  volume = {15},
  number = {1},
  pages = {6-18},
  doi = {10.11648/j.cmr.20261501.12},
  url = {https://doi.org/10.11648/j.cmr.20261501.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20261501.12},
  abstract = {Objectives: To evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD. Methods: 60 GERD patients were enrolled based on inclusion and exclusion criteria and randomly assigned to the observation (30 cases) or control groups (30 cases). The observation group underwent MI combined with PNI, while control group received conventional nursing interventions. The changes in inflammatory response-related indicators were compared between two groups. The reflux disease questionnaire (RDQ), symptom self-rating scale (SCL-90), self-efficacy scale (GSES), simple SF-36 scale and Pittsburgh sleep quality index scale (PSQI) were employed to assess the patient's conditions before, three months following and after nursing. Results: Baseline inflammatory markers and scale scores showed no significant between-group differences. After 3 months, the observation group demonstrated significant reductions in these inflammatory markers compared with baseline and the control group. At the same time point, SCL-90 scores decreased across multiple domains, GSES scores improved, and SF-36 scores increased in several dimensions. PSQI scores were also significantly lower in the observation group, indicating better sleep quality. Conclusion: MI combined with PNI may reduce inflammation, relieve negative emotions, and enhance self-efficacy, quality of life, and sleep in GERD patients.},
 year = {2026}
}

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TY  - JOUR
T1  - A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease
AU  - Li-Li Zhuo
AU  - Daguan Zhang
AU  - Wei-Xiao Xiang
AU  - Tian-Na Liu
AU  - Yin-Rong Ding
Y1  - 2026/04/23
PY  - 2026
N1  - https://doi.org/10.11648/j.cmr.20261501.12
DO  - 10.11648/j.cmr.20261501.12
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 6
EP  - 18
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20261501.12
AB  - Objectives: To evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD. Methods: 60 GERD patients were enrolled based on inclusion and exclusion criteria and randomly assigned to the observation (30 cases) or control groups (30 cases). The observation group underwent MI combined with PNI, while control group received conventional nursing interventions. The changes in inflammatory response-related indicators were compared between two groups. The reflux disease questionnaire (RDQ), symptom self-rating scale (SCL-90), self-efficacy scale (GSES), simple SF-36 scale and Pittsburgh sleep quality index scale (PSQI) were employed to assess the patient's conditions before, three months following and after nursing. Results: Baseline inflammatory markers and scale scores showed no significant between-group differences. After 3 months, the observation group demonstrated significant reductions in these inflammatory markers compared with baseline and the control group. At the same time point, SCL-90 scores decreased across multiple domains, GSES scores improved, and SF-36 scores increased in several dimensions. PSQI scores were also significantly lower in the observation group, indicating better sleep quality. Conclusion: MI combined with PNI may reduce inflammation, relieve negative emotions, and enhance self-efficacy, quality of life, and sleep in GERD patients.
VL  - 15
IS  - 1
ER  -

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Author Information

Li-Li Zhuo

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Daguan Zhang

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Wei-Xiao Xiang

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Tian-Na Liu

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Yin-Rong Ding

Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

Contact Email

http://orcid.org/0009-0008-2363-5486

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Zhuo, L., Zhang, D., Xiang, W., Liu, T., Ding, Y. (2026). A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clinical Medicine Research, 15(1), 6-18. https://doi.org/10.11648/j.cmr.20261501.12

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ACS Style

Zhuo, L.; Zhang, D.; Xiang, W.; Liu, T.; Ding, Y. A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clin. Med. Res. 2026, 15(1), 6-18. doi: 10.11648/j.cmr.20261501.12

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AMA Style

Zhuo L, Zhang D, Xiang W, Liu T, Ding Y. A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease. Clin Med Res. 2026;15(1):6-18. doi: 10.11648/j.cmr.20261501.12

Copy | Download

@article{10.11648/j.cmr.20261501.12,
  author = {Li-Li Zhuo and Daguan Zhang and Wei-Xiao Xiang and Tian-Na Liu and Yin-Rong Ding},
  title = {A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease},
  journal = {Clinical Medicine Research},
  volume = {15},
  number = {1},
  pages = {6-18},
  doi = {10.11648/j.cmr.20261501.12},
  url = {https://doi.org/10.11648/j.cmr.20261501.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20261501.12},
  abstract = {Objectives: To evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD. Methods: 60 GERD patients were enrolled based on inclusion and exclusion criteria and randomly assigned to the observation (30 cases) or control groups (30 cases). The observation group underwent MI combined with PNI, while control group received conventional nursing interventions. The changes in inflammatory response-related indicators were compared between two groups. The reflux disease questionnaire (RDQ), symptom self-rating scale (SCL-90), self-efficacy scale (GSES), simple SF-36 scale and Pittsburgh sleep quality index scale (PSQI) were employed to assess the patient's conditions before, three months following and after nursing. Results: Baseline inflammatory markers and scale scores showed no significant between-group differences. After 3 months, the observation group demonstrated significant reductions in these inflammatory markers compared with baseline and the control group. At the same time point, SCL-90 scores decreased across multiple domains, GSES scores improved, and SF-36 scores increased in several dimensions. PSQI scores were also significantly lower in the observation group, indicating better sleep quality. Conclusion: MI combined with PNI may reduce inflammation, relieve negative emotions, and enhance self-efficacy, quality of life, and sleep in GERD patients.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - A Prospective Analysis of the Effects of Motivational Interviewing Combined with Phased Nursing Interventions on Patients with Gastroesophageal Reflux Disease
AU  - Li-Li Zhuo
AU  - Daguan Zhang
AU  - Wei-Xiao Xiang
AU  - Tian-Na Liu
AU  - Yin-Rong Ding
Y1  - 2026/04/23
PY  - 2026
N1  - https://doi.org/10.11648/j.cmr.20261501.12
DO  - 10.11648/j.cmr.20261501.12
T2  - Clinical Medicine Research
JF  - Clinical Medicine Research
JO  - Clinical Medicine Research
SP  - 6
EP  - 18
PB  - Science Publishing Group
SN  - 2326-9057
UR  - https://doi.org/10.11648/j.cmr.20261501.12
AB  - Objectives: To evaluate the effects of MI combined with PNI on the quality of life, self-efficacy, psychological state, and sleep quality of patients with GERD. Methods: 60 GERD patients were enrolled based on inclusion and exclusion criteria and randomly assigned to the observation (30 cases) or control groups (30 cases). The observation group underwent MI combined with PNI, while control group received conventional nursing interventions. The changes in inflammatory response-related indicators were compared between two groups. The reflux disease questionnaire (RDQ), symptom self-rating scale (SCL-90), self-efficacy scale (GSES), simple SF-36 scale and Pittsburgh sleep quality index scale (PSQI) were employed to assess the patient's conditions before, three months following and after nursing. Results: Baseline inflammatory markers and scale scores showed no significant between-group differences. After 3 months, the observation group demonstrated significant reductions in these inflammatory markers compared with baseline and the control group. At the same time point, SCL-90 scores decreased across multiple domains, GSES scores improved, and SF-36 scores increased in several dimensions. PSQI scores were also significantly lower in the observation group, indicating better sleep quality. Conclusion: MI combined with PNI may reduce inflammation, relieve negative emotions, and enhance self-efficacy, quality of life, and sleep in GERD patients.
VL  - 15
IS  - 1
ER  -

Copy | Download