Unlocking adherence: The power of motivational interviewing in medication management

Medication non-adherence is a pervasive challenge in healthcare, leading to significant morbidity, mortality, and healthcare costs¹. Motivational interviewing (MI) has emerged as a promising approach to enhance adherence by addressing the psychological barriers to medication compliance.

Understanding Motivational Interviewing

Motivational interviewing is a patient-centered counseling technique that enhances motivation to change by exploring and resolving ambivalence. It is grounded in the concept of autonomy and supports self-efficacy. Motivational interviewing has been successfully applied in various settings, including substance abuse and chronic disease management^2-4.

Motivational Interviewing in Practice: A Case Study

Consider a patient with type 2 diabetes, Mr. Lee, who has recently been diagnosed with type 2 diabetes and is feeling overwhelmed by his treatment and the lifestyle changes required. A motivational interviewing approach would involve:

• Engaging: Building rapport and establishing a trusting relationship
  
  During the “Engaging” phase, healthcare professionals (HCPs) should prioritize active listening and empathy to build rapport⁵. They must create a non-judgmental space where patients feel valued and understood⁵. HCPs should ask open-ended questions to encourage dialogue and use reflective listening to validate the patient’s feelings⁵. Establishing trust involves demonstrating genuine interest in the patient’s concerns and collaborating to address them. This foundation of trust is essential for patients to feel comfortable sharing their challenges with medication adherence, ultimately leading to more effective motivational interviewing and improved health outcomes⁵.
  
  Engaging effectively with patients like Mr. Lee, who has recently been diagnosed with type 2 diabetes, is essential for successful treatment adherence. Here’s a practical example:
  
  During his first appointment after diagnosis, Mr. Lee appears anxious about his new oral antidiabetic medication and the lifestyle adjustments ahead. His healthcare provider begins by creating a welcoming atmosphere, saying, “Mr. Lee, I understand that this is a lot to take in. Let’s take it one step at a time.”
  
  The provider asks Mr. Lee about his daily routine, diet, and any concerns he has about taking medication regularly. As Mr. Lee shares his apprehension about side effects and changing his eating habits, the provider listens attentively, offering affirmations like, “You’re taking a big step towards managing your health.”
  
  By acknowledging Mr. Lee’s efforts and providing clear, manageable steps for his lifestyle changes, the healthcare provider builds a rapport based on trust and understanding, crucial for Mr. Lee’s journey in managing type 2 diabetes.

• Focusing: Narrowing down the conversation to medication adherence
  
  In the focusing phase, healthcare professionals should concentrate on identifying and clarifying the patient’s priorities related to medication adherence. They should guide the conversation to explore specific areas where the patient is ready to change while respecting the patient’s autonomy and choices⁵.
  
  Focusing the conversation on medication adherence is a critical step in motivational interviewing. Here’s how it might look in practice:
  After establishing rapport with Mr. Lee, his healthcare provider shifts the discussion to the importance of taking oral antidiabetics consistently. The provider might say, “Mr. Lee, managing your blood sugar levels is key, and your medications are a big part of that. Can we explore what might make it easier for you to remember to take them every day?”
  
  Together, they brainstorm strategies, such as setting alarms or linking pill-taking to daily routines like meals. The provider listens to Mr. Lee’s input and concerns, ensuring the conversation remains focused on practical solutions that align with Mr. Lee’s lifestyle and preferences. This targeted dialogue helps Mr. Lee feel involved and committed to his medication regimen, a crucial factor in successful diabetes management.

• Evoking: Exploring Mr. Lee’s reasons for non-adherence and drawing out his own motivations for change
  
  Evoking is the process of uncovering a patient’s personal motivations for change. Healthcare professionals should encourage the patient to voice any concerns and aspirations related to his/her health and treatment⁵. It’s crucial to listen for and reinforce the patient’s own arguments for change, known as “change talk,” which can be a powerful motivator for adopting healthier behaviors⁵. Reflective listening and strategic questioning help in guiding the patients to recognize the discrepancies between their current behaviors and their broader life goals, thereby enhancing their motivation for change⁵.
  
  In Mr. Lee’s case, his healthcare provider might explore his reasons for non-adherence to his oral antidiabetics and lifestyle changes. The conversation could go as follows:
  
  “Mr. Lee, it’s important for us to understand what might be making it hard for you to take your medication. Is it the timing, the cost, or something else?” As Mr. Lee mentions his busy schedule and forgetfulness, the provider encourages him to express his health goals, “What are your hopes for managing your diabetes?”
  
  By identifying that Mr. Lee wants to stay healthy to attend his daughter’s future wedding, the provider taps into his intrinsic motivation. They discuss how adherence to medication can help him achieve this personal goal. This empathetic approach helps Mr. Lee realize the value of his treatment plan, fostering a stronger commitment to his health.

• Planning: Collaboratively setting achievable goals for adherence
  
  In the planning phase, healthcare professionals should collaborate with patients to develop a realistic and actionable plan for change⁵. This involves setting specific, measurable, achievable, relevant, and time-bound (SMART) goals⁵. HCPs should ensure the plan is patient-centered, taking into account the patient’s preferences, resources, and barriers. It’s important to break down larger goals into smaller, manageable steps and to arrange for follow-up support⁵. The plan should be flexible, allowing for adjustments based on the patient’s progress and feedback. Encouraging self-monitoring and problem-solving strategies is also key for sustaining change⁵.
  
  In the planning phase of motivational interviewing, setting achievable goals is vital for ensuring Mr. Lee’s adherence to his diabetes management plan. Here’s a practical example:
  
  Mr. Lee and his healthcare provider collaborate to create a personalized adherence plan. They start by setting small, attainable goals, such as Mr. Lee taking his oral antidiabetic medication at breakfast for a week. They discuss using a pillbox and the provider suggests, “How about we try placing your medication next to your coffee machine as a reminder?”
  
  They also plan lifestyle modifications in increments. For instance, Mr. Lee agrees to replace one sugary drink with water each day and take a 10-minute walk after dinner. The provider offers encouragement, “These are great first steps, Mr. Lee, and we’ll review your progress together.”
  
  By involving Mr. Lee in the goal-setting process and tailoring the plan to his daily routine, the provider ensures that the goals are realistic and manageable, increasing the likelihood of adherence.

Challenges and solutions

Motivational interviewing appear to be effective at improving medication adherence². By fostering a collaborative and empathetic environment, healthcare professionals can empower patients to take an active role in their treatment, leading to better health outcomes.

References

1. Walsh CA, Cahir C, Tecklenborg S, Byrne C, Culbertson MA, Bennett KE. The association between medication non-adherence and adverse health outcomes in ageing populations: A systematic review and meta-analysis. Br J Clin Pharmacol. 2019 Nov;85(11):2464-2478.
2. Zomahoun HTV, Guénette L, Grégoire JP, Lauzier S, Lawani AM, Ferdynus C, Huiart L, Moisan J. Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. Int J Epidemiol. 2017 Apr 1;46(2):589-602.
3. Bischof G, Bischof A, Rumpf HJ. Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice. Deutsches Arzteblatt International. 2021 Feb;118(7):109-115.
4. Motivational Interviewing: Inspiring Patients to Change, Knowledge Plus, NEJM, Site last accessed 21/05/2024 https://knowledgeplus.nejm.org/wp-content/uploads/2023/10/motivational-interviewing.pdf
5. Levounis P, Arnaout B, Marienfeld C. Motivational Interviewing for Clinical Practice. 1st ed. American Psychiatric Association Publishing; 2017. ISBN: 978-1615370467
6. Motivational Interviewing: The Four Key Stages, BMJ, Last accessed 21/05/2024 https://www.bmj.com/careers/article/motivational-interviewing-the-four-key-stages

This article was written with the assistance of generative AI technology and reviewed for accuracy.