Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence

Figures & data

Figure 1 Study recruitment and participant flow.

Table 1 Motivational interviewing (MI) counseling style

MI principle	Sample communication techniques
Express empathy	— Use open-ended rather than yes/no questions (“how are you doing with this medication?”) — Reflect back the patient’s statements (“I hear you saying …”) — Validate the patient’s concerns (“a lot of people have trouble taking their medication exactly as it’s prescribed …”)
Roll with resistance	— Don’t argue (“I apologize; I wasn’t trying to lecture you”) — Reflect back emotions (“it sounds like you feel stuck”) — Ask about the patient’s experience (“what have you heard about this medication?” “are there people in your family who had similar experiences?” “what have you tried so far?”)
Develop discrepancy	— Empathize with ambivalence (“you want to, and it’s also hard”) — Highlight areas of contradiction (“there are things you don’t like about treatment, but you also see some benefits”) — Summarize problems and strengths together (“you’ve had trouble remembering medication, but you are able to juggle many other things in your life successfully”)
Support self-efficacy	— Emphasize autonomy (“this is really your decision”) — Educate using “ask-tell-ask” rather than “tell-ask-tell” (“how do you usually take your medication? Can I tell you a little more about the way it works? The medication only stays active for a certain length of time, so it’s very important to use the drops exactly 12 hours apart to get the desired benefits. What do you think of what I just told you?”) — Ask the patient to make choices (“what would you like to do now? Where do we go from here?”)

Table 2 Treatment fidelity of motivational interviewing (MI) in outpatient glaucoma care

Criteria	Fidelity measures	Results
Theory fidelity	1. Expert review by co-authors and three colleagues with MI expertise 2. Feedback from glaucoma educator	1 & 2. Suggestions led to new material on logistical barriers to adherence, cultural competence, and mental health issues, plus some changes in the exact wording of interventions
Educator training	1. Amount of training provided 2. Trainer rating of educator’s MI skill on a 1–10 scale (1 = no experience; 4 = novice; 7 = skilled; and 10 = expert) 3. Educator’s ratings on Likert-type scales (1 = low to 5 = high): knowledge, MI skills, and willingness to use MI	1. Training included 5.5 hours self-study + 6 hours in-person with role-plays 2. Trainer’s ratings: educator’s MI skill at start of training = 3, MI skill after training = 7 3. Educator’s ratings: increase in knowledge (pre = 1.5, post = 4.5), MI skills (pre = 1.3, post = 2.5), and willingness (pre = 1.3, post = 4.0)
Implementation	1. Counselor’s use of MI-consistent interventions, as documented on session record form. Interventions were considered MI-consistent if they matched the patient’s counselor-rated stage of readiness for change	1. For patients with low readiness: 13/13 sessions used active listening alone (MI-consistent), 10/13 also used problem-solving (MI-inconsistent). For patients with high readiness: 11/16 sessions used active listening, 2/16 education plus listening, and 3/16 problem-solving plus listening (all MI-consistent)
Receipt	1. Enrollment 2. Attrition 3. Representativeness of participating patients	1. 12/14 eligible patients consented 2. 8/8 patients completed 2+ sessions; 4/8 patients completed all 6 sessions 3. 4 participants (50%) were male, and 4 (50%) were white non-Hispanic; clinic patients overall were 38% male and 78% white non-Hispanic
Enactment	1. Change in motivation, based on a 1–4 stage-of-change scale 2. Change in % adherence, based on MEMS and clinical interview measures	1. Motivation increased with more sessions, T = 1.98, P = 0.058, β = 0.15 2. Adherence increased based on MEMS, T = 2.25, P = 0.032, β = 2.68, but not based on clinical interview, T = 1.07, P = 0.30, β = 1.03.