An Assessment of the Fidelity of Two Different Interventions to Improve Adherence to Glaucoma Treatment in Patients of African Descent

Abstract

Glaucoma is a chronic eye disease, which is asymptomatic and can slowly lead to blindness if left untreated. Glaucoma is caused by damage to the optic nerve and can lead to irreversible loss of sight. The overall objective of this MURI study was to determine the impact of two different interventions on compliance to glaucoma medication in patients of African descent with open-angle glaucoma. Two types of intervention were used – Education and Motivational Interviewing (MI). The educational intervention involved sharing knowledge with patients about glaucoma, its causes, and its treatments, to help patients better understand glaucoma and the importance of adhering to the daily medication regimen. The MI intervention involved communicating with the patients and encouraging them to identify strategies that would help them better adhere to their medications. These sessions were video-recorded and the content of each video was transcribed verbatim. The transcripts were then scored to assess the fidelity of each session with the intervention type that was given; this was done to ensure that each patient in the MI group received intervention consistent with MI, and that each patient in the Education group received an intervention free of MI. The standard Motivational Interviewing Treatment Integrity 3.0 coding sheet was used to code the MI and Education sessions. Global ratings were given for empathy, direction, collaboration, evocation and autonomy/support on a scale ranging from 1 (Low) to 5 (High). The following behaviors were counted within each transcript: giving information, MI adherent (asking permission, affirm, emphasize control, support), MI Non-adherent (advise, confront, direct), questions (closed questions, open questions), and reflections (simple, complex). We expect that the MI interventions would have significantly higher scores on MI adherent behaviors and significantly lower on MI-non-adherent behaviors compared to the Education session.