Does Motivational Interviewing Improve Medication Adherence?

Abstract

We agree, but with 1 critical caveat. Unlike pharmacological interventions, which undergo extensive development to determine drug safety and tolerability (phase 1 trials) and effects on the treatment target (phase 2 trials), behavioral interventions have consistently failed to conduct similar phase studies. These are needed to ensure that the treatment (eg, MI) is effective in altering the behavioral processes of interest (eg, medication regimen adherence) prior to proceeding with large-scale randomized controlled trials (phase 3 trials), which can then assess the effects of the intervention on disease morbidity and mortality. 4 For example, phase 1 research in behavioral medicine should first aim to clearly define the intervention (from a theoretical basis) and assess acceptability. Phase 2 would determine the "dose" required to effect change in the target behavior and identify how a treatment works and its feasibility in the target population. Thus, until a behavioral intervention has met the requirements of phase 1 and 2, it would be premature to launch into a full-scale phase 3 randomized controlled trial to test the efficacy of the intervention in a sample large enough to determine its effects on relevant "hard" health outcomes. This model is now being recommended by the National Institutes of Health's Office of Behavioral and Social Sciences Research (OBSSR), 4 and we would like to encourage behavioral scientists to adopt this strategy for future development and testing of behavioral medicine interventions, such as MI.

Motivational interviewing to improve self-care for patients with chronic heart failure: MITI-HF randomized controlled trial

“…In addition to different patient populations, there are a few other critical differences between MITI-HF and OPTIMA that may explain the differences in results. As suggested by Lavoie in a letter to the editor regarding OPTIMA, one key tenet of behavioral trial design is targeting participants with evidence of poor behavior at the beginning of the trial [60]. As a pragmatic trial, OPTIMA enrolled any patient who received a new prescription regardless of baseline adherence.…”

Efficacy of brief motivational interviewing to improve adherence to inhaled corticosteroids among adult asthmatics: results from a randomized controlled pilot feasibility trial

“…Even though one might expect this to be evenly distributed between the groups (due to randomization), it may have ultimately diluted any treatment effect (ie, reduced power) and contributed to the nonsignificant findings observed. 72 Fourth, we employed a manualized intervention (with some degree of flexibility to be consistent with the spirit of MI), which increases the reproducibility of the findings. Fifth, we used an experienced (>10 years) clinical psychologist who received extensive MI training with regular supervision and feedback to administer the intervention.…”