Health coaching for glaucoma care: a pilot study using mixed methods

Figures & data

Figure 1 Study overview.

Notes: This pilot study consisted of a mixed methods study design, to collect both qualitative and quantitative data. At the initial visit, informed consent was obtained, demographic and health information was collected, and the visual analog adherence scale was used to assess glaucoma medication adherence. The study subject then began using the MEMS device, which continued for the duration of the study (6 months). The first health coaching session took place after 1 month; subsequent coaching sessions were completed over the following 2–4 months. After completion of the health coaching session, the study subject continued using the MEMS device until the end of the study. During the exit visit, the MEMS device was returned, a short survey was completed, and a 0.5-hour exit interview was conducted.
Abbreviation: MEMS, medication event monitoring system.

Table 1 Characteristics of study subjects

Demographics
Age (mean)	73 years (range 69–83)
Sex	3 male subjects and 1 female subject
Race	2 white subjects and 2 black subjects
Glaucoma history
Type of glaucoma	POAG (2 subjects)
	CACG (1 subject)
	PDG (1 subject)
Severity of glaucomaa	Moderate (2 subjects)
	Severe (2 subjects)
Number of glaucoma medications (mean)	2.8 medications (range 2–3)
History of glaucoma surgery	1 subject (glaucoma tube surgery)
History of glaucoma lasers	3 subjects
Visual impairment
Legal blindness	1 subject (based on visual field criteria)
BCVA in better-seeing eye	20/20 (3 subjects)
	20/70 (1 subject)
Perception of visual impairment	100%
Perceived severity	Almost no effect (2 subjects)
	Mild effect (1 subject)
	Some effect (1 subject)
General medical history
Medical problems	Hypertension (3 subjects)
	None with diabetes
Use of other chronic medications	3 subjects

Note:

a Based on ICD-9 codes for glaucoma severity.

Abbreviations: POAG, primary open-angle glaucoma; CACG, chronic angle closure glaucoma; PDG, pigment dispersion glaucoma; BCVA, best-corrected visual acuity; ICD-9, International Classification of Diseases, ninth revision.

Figure 2 Glaucoma medication adherence.

Notes: (A) Glaucoma medication adherence was assessed using the MEMS device. The percent adherence or percent of prescribed doses taken was calculated each of the following time periods: precoaching (study start to first coaching session), during coaching (first coaching session to last coaching session), and postcoaching (last coaching session to exit visit). The adherence data for each subject are plotted over time to illustrate their measured adherence. Subject 3 is not included in this figure because this study subject began monitoring medication use using a different method (a personal spread sheet) during the coaching portion of the study; hence, MEMS data are not available for this study subject. Study Subjects 1 and 4 show improved adherence postcoaching compared with during coaching. The dip seen with Study Subject 1 is likely due to normalization after a boost at study start. Study Subject 2 has high adherence throughout. (B) Glaucoma medication adherence was assessed using the visual analog adherence scale, with study subjects completing the scale at the study start and at the exit visit. The adherence data for each subject are plotted at study start and end to illustrate their measured adherence. Study Subjects 1, 3, and 4 show improved adherence at the exit visit compared with the study start, although Study Subject 3 has high adherence at the outset. Study Subject 2 has high adherence throughout. Overall, the adherence measured with the visual analog adherence scale is similar to that measured with the MEMS device.
Abbreviation: MEMS, medication event monitoring system.

Table 2 Recommendations for improvement

Improve the description of health coaching

There was a general lack of clarity on the part of the study subjects on what health coaching is, persisting even to the exit visit, suggesting that the introduction of the study by the study-team, the study take-home documents, and the introduction by the health coach were not adequate. A video with an example of a coaching conversation would likely be helpful in the future.

Focus on the eye drops

The health coaching intervention in this pilot study was purposefully left broad, allowing the study subject to guide the coaching conversation onto focus areas of their choice to see what aspects of health coaching would be helpful for glaucoma patients. At least once per session, the health coach touched on glaucoma and ocular health, but otherwise, the focus areas and coaching goals were guided by the study subject entirely. At the close of the study, the subjects noted that more direction and greater focus on eye drops would be helpful in refining the coaching intervention.

Target patients with poor adherence

Health coaching will likely be more helpful with patients who are struggling with medication adherence. However, two of the study subjects had high adherence, but still made significant gains due to the health coaching, even with regard to glaucoma care.

Train an ophthalmic technician or experienced glaucoma patient as a health coach

A health coach with additional glaucoma knowledge may help keep the focus on glaucoma care and may be able to offer additional information and resources, in addition to the coaching support.^Citation16

Offer the coaching to newly diagnosed patients

Patients new to eye drops likely need additional support. Addressing any barriers to medication adherence as early as possible would help to establish lifelong healthy habits and improve visual outcomes.

Figure S1 Intake survey.

Figure S3 Exit survey.

Figure S4 Exit interview guide.

CookPFBremerRWAyalaAJKahookMYFeasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherenceClin Ophthalmol201041091110120957054

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