It’s widely accepted that patient motivation is a factor in non-adherence. But just how much of a factor is it? And how does it rank vs other factors? Here are some thoughts on why patient motivation is of primary importance to improving adherence.
Improving Adherence Behaviors Isn’t Easy
I’d guess we’re all familiar with the old joke about psychiatrists and light bulbs. It goes something like this:
Q. How many psychiatrists does it take to change a light bulb?
A. Only one, but the light bulb really has to WANT to change.
The point at issue here is that getting people to change behaviors is not easy. Behavioral change only works if people really want to do it. And patients need to be strongly motivated to make a change happen.
Many articles on adherence focus on practical measures, such as:
- Patient education
- Cost reduction
- Patient reminders
These measures may work fine … if patient motivation is strong. But what about the large numbers of patients who intentionally don’t adhere? If anything, such patients are motivated NOT to adhere. And these may account for over 40% of the non-adherence population (see here).
Even among more positive patients, it’s generally accepted that just telling people what to do isn’t always enough. Simply loading patients up with education, copay cards, and reminders doesn’t predict adherence (see here). These measures only work well when patients are motivated.
Whichever way you look at it, patient motivation looks like a critical factor.
Reasons to Think About Patient Motivation First
1. Patient motivation is essential to behavior change
Improving patient adherence means changing patient behaviors, which can be tough. Improvements in adherence behaviors are unlikely to occur unless patients are highly motivated and have a strong intent to make the necessary changes. Motivation is cited as a pivotal element for changing adherence behavior (see here).
2. Patients need help to find their motivation(s)
To acquire and sustain new adherence behaviors, patients must find their motivation(s) from within themselves. And often this is not be easy for them to do. By having motivation front-of-mind and by using available motivational techniques (more about these in a later post), HCPs can play a key role in unlocking an individual patient’s commitment to change.
3. Motivational techniques are effective in improving adherence!
Here are a few publications that underline this point.
- See here for a 26 study meta-analysis that found a statistically significant (p<0.001) benefit, with an effect size of up to 0.34
- See here for benefit in patient weight reduction
- See here for benefit in patients with high cholesterol
- See here for benefits in patients with asthma
4. Patient motivation is widely applicable
Indeed an argument could be made that motivational improvement is universally applicable, based on a report that suggested:
“For many people there is a negative psychological overlay to taking medication.”
Certainly, motivation can be an important factor for improving adherence across wide ranges of both patient types and conditions, irrespective of non-adherence reasons. This contrasts strongly with many other intervention types that are narrowly focused and associated with specific reasons.
5. Motivation enhances effectiveness of other adherence interventions
Lastly – though by no means least – improving patient motivation can improve the effectiveness of other adherence solutions (see here).
Patient Motivation – The Bottom Line
So in summary, motivation looks like a BIG factor in adherence. And there are compelling reasons why improving patient motivation should be front-and-center for managing adherence across a wide variety of patient types and conditions.
Any other reasons you’d like to add?