Reviews and feature articlesBrief motivational interviewing as a clinical strategy to promote asthma medication adherence
Section snippets
MI: basic principles
MI involves 2 key aims: (1) building patients' intrinsic motivation to adopt health recommendations and (2) resolving patients' ambivalence about behavior change (eg, adherence).21 In MI intrinsic motivation is strengthened by discussing how change is consistent with the patient's own values and goals.26 For example, if a patient loves to play basketball, the HCP asks how taking his or her asthma medication can help him or her play better. Intrinsic motivation is also increased by having the
Patient-practitioner communication strategies: foundation of MI
An important goal of MI is to establish a comfortable and noncoercive atmosphere so that patients feel free to discuss their feelings about the recommended treatment. This is particularly relevant for asthma medication, about which patients might falsely self-report adherence.3 Creating a nonjudgmental atmosphere enhances the likelihood of accurate self-report.30 Four communication components engender MI spirit: open-ended questions, affirmations, reflective listening, and summary statements
Setting an agenda
Koning et al47 found that one third of patients with asthma or chronic obstructive pulmonary disease desired greater participation in decision making about their treatment. Patients with asthma who report active participation in treatment decisions are more adherent.48 However, patients might be hesitant to voice their agendas without being prompted.49 MI provides a framework to actively solicit patients' agendas. The HCP provides a menu of options for discussion and lets the patient decide
The effectiveness of MI as a patient-centered method
MI overlaps with patient-centered medicine in that both approaches involve patient acceptance, collaboration, open-ended questions, and listening skills. MI uses patient-centered communication but also includes a set of strategies to help move patients toward change. Patient-centered approaches improve health outcomes for a variety of conditions, such as asthma,62 diabetes,28, 63 obesity,64 and blood pressure.65, 66 In asthma management physicians trained in patient-centered communication have
Building MI into clinical practice
Although HCPs might be concerned about the time it takes to integrate MI into a busy clinical practice, studies have shown minimal time differences (typically no more than 2 minutes) between delivery of patient-centered counseling and delivery of standard approaches.89 One study of primary care physicians found that MI took an average of 9.69 minutes.90 The small amount of extra counseling time might be well spent, given that patient-centered approaches are associated with better adherence,
Conclusion
Patient-centered approaches improve the HCP's performance, patient satisfaction, and health outcomes without an increased burden of time and cost. MI is a patient-centered approach that is effective for promotion of health behavior across a wide variety of areas. MI involves fostering practitioner-patient communication and using brief strategies to help patients resolve their ambivalence about change and build intrinsic motivation for change. MI strategies have been modified such that HCPs can
References (95)
- et al.
Measurement of children's asthma medication adherence by self report, mother report, canister weight, and Doser CT
Ann Allergy Asthma Immunol
(2000) - et al.
Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white
J Allergy Clin Immunol
(2003) - et al.
Adherence and persistence with fluticasone propionate/salmeterol combination therapy
J Allergy Clin Immunol
(2006) - et al.
Persistence, adherence, and effectiveness of combination therapy among adult patients with asthma
J Allergy Clin Immunol
(2006) - et al.
Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma
J Allergy Clin Immunol
(2004) - et al.
Relations among asthma knowledge, treatment adherence, and outcome
J Allergy Clin Immunol
(2003) - et al.
An interdisciplinary intervention for undertreated pediatric asthma
Chest
(2006) - et al.
Breaking the access barrier: evaluating an asthma centers' efforts to provide education to children with asthma in schools
Chest
(2005) - et al.
Assessment of a therapeutic education programme for asthma patients: “un souffle nouveau”
Patient Educ Counseling
(2005) - et al.
Challenges in asthma patient education
J Allergy Clin Immunol
(2005)
Patient-focused care: using the right tools
Chest
Using motivational interviewing with smokers: do therapist behaviors relate to engagement and therapeutic alliance?
J Subst Abuse Treat
The physician-patient working alliance
Patient Educ Counseling
Therapist influence on client language during motivational interviewing sessions
J Subst Abuse Treat
Self-perception theory
Two-year follow-up of bibliotherapy and therapist-directed controlled drinking training for problem drinkers
Behav Psychother
Health beliefs and compliance with inhaled corticosteroids by asthmatic patients in primary care practices
Respir Med
Professional responses to innovation in clinical method: diabetes care and negotiating skills
Patient Educ Counseling
Home health care nurses as a new channel for smoking cessation treatment: outcomes from project CARES (Community-nurse Assisted Research and Education on Smoking)
Prev Med
Helping smokers make decisions: the enhancement of brief intervention for general medical practice
Patient Educ Counseling
Do patient intervention ratings predict alcohol related consequences?
Addict Behav
Factors influencing patient decisions about the use of asthma controller medication
Ann Allergy Asthma Immunol
An evidence-based review of patient-centered behavioral interventions for hypertension
Am J Prev Med
Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study
J Assoc Nurses AIDS Care
Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy
Behav Res Ther
Incorporating motivational interviewing into behavioral obesity treatment
Cogn Behav Pract
Should patients with persistent severe asthma be monitored for medication adherence?
Ann Allergy Asthma Immunol
National Asthma Education and Prevention Program. Expert panel report 2: guidelines for the diagnosis and management of asthma
Adherence to oral montelukast and inhaled fluticasone in children with persistent asthma
Pharmacotherapy
Corticosteroid use after hospital discharge among high-risk adults with asthma
Am J Respir Crit Care Med
Medication adherence in pediatric asthma: reasoning, responsibility, and behavior
J Pediatr Psychol
Adherence with twice-daily dosing of inhaled steroids. Socioeconomic and health-belief differences
Am J Respir Crit Care Med
Relationship of adherence to pediatric asthma morbidity among inner-city children
Pediatrics
National ambulatory medical care survey: 2004 summary
Adv Data
Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis
BMJ
The Coping with Asthma Study: a randomised controlled trial of a home based, nurse led psychoeducational intervention for adults at risk of adverse asthma outcomes
Thorax
Evaluation of an individualised asthma programme directed at behavioural change
Eur Respir J
Motivational interviewing: preparing people for change
Stages and processes of self-change of smoking: toward an integrative model of change
J Consult Clin Psychol
A randomized controlled pilot study of motivational interviewing to change attitudes about adherence to medications for asthma
J Clin Psych Med Settings
Health behavior change: a guide for practitioners
Motivational interviewing in service to health promotion
Am J Health Promot
Expanding patient involvement in care. Effects on patient outcomes
Ann Intern Med
Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes
J Gen Intern Med
The impact of patient-centered care on outcomes
J Fam Pract
Relationships between physician practice style, patient satisfaction, and attributes of primary care
J Fam Pract
Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles
J Consult Clin Psychol
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2022, Patient Education and CounselingCitation Excerpt :It involves leveraging a patient’s intrinsic motivation to adopt recommended treatment and medication regimens as well as helping the patient to resolve ambivalence about behavior change. The overall idea is to relate the change to the patient’s values and goals [13,14]. A pilot study of black inner-city adolescents showed that motivational interviewing is feasible and acceptable in this patient population.
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Supported in part by grants R01 HL062165-06 (BB) and HL079301 and HL075344 (KAR).
Disclosure of potential conflict of interest: B. Borrelli has consulting arrangements with and has received grant support from the National Institutes of Health. A. Weinstein has patent licensing arrangements with Asthma Management Systems and is employed by Asthma and Allergy Care. The rest of the authors have declared that they have no conflict of interest.