Adherence: Key Words for Motivational Interviewing

For People Living with HIV (PLWH), medication adherence is essential to prevent viral resistance, and disease progression. Most experts in HIV recommend adherences levels of 90% or better for antiretroviral (ARVs), an adherence level that challenges many patients.

Motivational interviewing—a patient-centered method to enhance intrinsic motivation by exploring, and resolving ambivalence—has gained a good reputation for increasing adherence. Researchers from the University of Lausanne, Geneva, Switzerland found that no published literature has analyzed the actual content of motivational interviews associated ARV adherence, and set out to fill that knowledge gap.

They employed computational text analysis to identify factors associated with low or high ARV adherence. The text they analyzed was gathered from 8,428 interviews with 522 patients. Pharmacists had conducted these interviews. The researchers set the bar high, looking for words that occurred at least 10 times among the various interviews, and also occurred in at least 6 interviews with 6 different patients. Their analysis program found 7,608 terms associated with low (<90%) or high (>90%) adherence.

Terms associated with low adherence revealed no real surprises:

• disruption in daily schedule
• adverse effects
• socio-economic factors
• stigma
• cognitive factors smoking

Terms associated with high adherence suggest ways that patients, and healthcare providers can work together to overcome barriers:

• fixed medication intake timing
• no adverse effects
• positive psychological state

These researchers make a point that all healthcare providers need to remember: patients master skills associated with good adherence over time, and repeated patient-pharmacist interviews are critical to emphasize continuing adherence. Pharmacists should remember to praise and congratulate good adherence. When patients' adherence is low, communicating with prescribers, and other members of the HIV team can ensure that every member emphasizes adherence with the patient.

This study, which appears in Patient Education & Counseling, confirmed known themes affecting ARV adherence. The researchers identified some emerging themes: interprofessional communication, the patient-healthcare practitioner communication style, and comorbidity.

Reference

Kamal S, Nulty P, Bugnon O, Cavassini M, Schneider MP. Content analysis of antiretroviral adherence enhancing interview reports. Patient Educ Couns. 2018 May 17. pii: S0738-3991(18)30243-X. doi: 10.1016/j.pec.2018.05.013. [Epub ahead of print]