Motivational Interviewing: 6 Reasons It’s Key to Adherence

By | March 5, 2014

Patient motivation is a critical to the success of any adherence intervention. Without it, patients lack the energy or desire to follow through on recommended solutions. Here are 6 reasons to make Motivational Interviewing a cornerstone of adherence improvement.

Patient Motivation Is Pivotal

My last post described patient motivation as the ‘fuel’ needed to drive an ‘adherence improvement engine’ (see here for the full story). Without this ‘fuel’, adherence improvement plans may never really have a chance.

Lack of motivation has always been recognized as a factor in non-adherence. However, the ‘fuel’ analogy throws into sharper focus just how important a factor motivation can be. It’s like a veto, with the power to negate any plan a HCP puts together to improve adherence.

So patient motivation should always be a front-of-mind for concern in non-adherent patients. And if motivation is poor, it needs to be addressed before tackling any other factors contributing to non-adherence.

And one way to build motivation is through the use of the Motivational Interviewing.

Building patient motivation is vital to improving adherence. Here are 6 reasons why Motivational Interviewing should be the first step.Motivational Interviewing: The Headlines

As a quick introduction, Motivational Interviewing is a collaborative counseling style that uses special techniques to strengthen a person’s own motivation and commitment for changing their behavior. It’s an established approach for addressing substance use disorders and has successfully been used to address motivation-related adherence issues.

Further information about Motivational Interviewing can be found here.

Motivational Interviewing: Reasons to Make It an Adherence Cornerstone

Here are 6 reasons for HCPs to use Motivational Interviewing (MI) as an early and fundamental part of plans to address non-adherence.

1. MI Works!

Motivational Interviewing has been the subject of two meta-analysis/review publications (see here and here). The first reviewed and analyzed results from 72 randomized, controlled trials and found MI had a significant and clinically relevant effect in 74% of these studies. The second publication focused just on the impact of MI on medication adherence. It reviewed and analyzed results from 26 studies (5216 patients) and found an effect size of 0.34 (p<0.001).

2. MI Is Widely Applicable

The techniques of Motivational Interviewing are broadly applicable across different patient types and different conditions. Unlike other narrower, more focused adherence solutions, its effectiveness is not tied to specific patient reasons for non-adherence.

3. MI Helps Assess Patient Motivation

Motivational Interviewing techniques allow HCPs to quickly assess a patient’s motivation level. If poor, MI-based conversation helps the patient discover internal motivations to adopt adherent behaviors. These internal motivations may then make the patient more willing to follow the HCP’s recommendations for other adherence support solutions.

4. MI Has Sustainable Effects

Motivational Interviewing elicits a patient’s own motivation to adhere. Because motivation comes from within, it has a higher prospect of being sustained by the patient. Especially if MI techniques continue to be the centerpiece of regular doctor-patient conversations.

5. MI Can Be Delivered in Small Bites

Motivational Interviewing techniques can be easily included into routine patient conversations. Indeed, several studies have shown adherence benefits based on individual MI-based discussions lasting between 5 to 15 minutes (see here, here, and here).

6. Bonus Reason: MI Provides a Long-Term Skill Enhancements

Motivational Interviewing has wider applications than just adherence improvement. Clinical interviewing competency has for the longest time been a key HCP skill. With the increasing move to patient-centered care and shared decision-making, the need to improve and expand these skills has grown ever more important. Training in MI provides HCPs with significant additional skills that will help them better navigate the new requirements of patient conversations. Skills that will remain of value over the longer-term. Indeed, MI is increasingly recognized as a valuable skills asset (see here for an article on Aetna’s investment in MI).

Disclaimer: Just in case you’re wondering; no, I don’t have any vested interest in MI. All of the above is simply based on my extensive reading of adherence-related subject matter.