Improving Adherence in African American Patients through Motivational Interviewing

Abstract

Glaucoma is a chronic disease of the eye and African Americans are more susceptible to the disease compared to other races. The medical treatment of glaucoma requires that patients instill eye drops each day for the rest of their lives. Adherence to this regimen be challenging and has been reported to be worse in patients of African American descent (AD), a segment of the population that is disproportionately affected by the disease. Motivational Interviewing (MI) is a goal-oriented, patient-centered counseling style for eliciting behavior change by helping patients to explore and resolve ambivalence. MI can improve adherence and has been shown to be more effective in minority populations. The purpose of the pilot study was to determine whether MI might improve adherence in glaucoma patients of AD. Thirteen patients of African American descent (AD) who received a clinical diagnosis of open-angle glaucoma were included in the study. Patients were included in the study if they used once-a-day prostaglandin analog eye drops and administered their own medication. Adherence was measured using Medical Event Monitoring System (MEMS) bottles. The cap of these bottles electronically records the date and time at which the bottle is opened. At the initial visit patients were instructed to place the eye medication bottle in the MEMS bottle and to continue to use their medication as they normally would. At the second visit (week 3), baseline adherence was assessed. Patients with adherence levels below 75% (n=9) received MI and those with adherence levels over 75% served as controls (n=4). At the last visit (week 9), patients returned and the final adherence was assessed. Baseline and final adherence were compared in each group using a t-test. In the group who received MI, final adherence (67.9% ± 7.68) was significantly higher than baseline adherence (55.95% ± 22.16) (p=0.03). In the control group, no significant difference between baseline adherence (81.38% ± 5.52) and final adherence (82% ± 17.33) (p=0.46) was observed. These preliminary results suggest that motivational interviewing may be effective in improving adherence in patients of AD with glaucoma.