MOTIVATIONAL INTERVIEWING: LIT REVIEW 1

Effectiveness of Motivational Interviewing on Medication Adherence in Psychiatric Population:

Literature Review

Savanna Hilles

Azusa Pacific University

GNRS 507

Scientific Writing

Corinne McNamara, M.A.

July 22, 2018

MOTIVATIONAL INTERVIEWING: LIT REVIEW 2

Effectiveness of Motivational Interviewing on Medication Adherence in Psychiatric Population:

Literature Review

Antipsychotic medications are crucial for the long-term treatment of patients diagnosed

with schizophrenia; however, a big issue with patients who have mental illnesses is medication

non-adherence (Chien, Mui, Gray, & Cheung 2016). Non-adherence will have a negative impact

on health outcomes for mental health patients (Dahan, Behrbalk, Stolovy, & Greenberger 2016).

It increases the risk of readmission and is linked to increased rates of suicide and aggressive

incidents (Meijer, Barkhof, Sonneville, Linszen, & Haan 2013). About 50% of patients

diagnosed with mental illnesses are not compliant with their treatment. Increasing adherence to

treatment in these individuals is essential (Dahan et al., 2016). New treatment recommendations

that focus on the individual challenges of the patient may be helpful in increasing medication

adherence. Motivational interviewing is a technique that nurses can use to explore the patient’s

feelings to help develop internal motivation to change his or her behaviors (Meijer et al., 2013).

When used specifically to target medication adherence, this technique may be useful in

increasing adherence among those with psychiatric disorders (Dahan et al., 2016). The purpose

of this paper is to compare 5 experimental studies conducted to determine how motivational

interviewing affects medication adherence among patients with psychiatric illnesses.

Summaries of the Studies

Increased Medication Adherence

In 2016, Chien et al. investigated the effects of motivational-interviewing-based

adherence therapy on patients diagnosed with schizophrenia. In the study, there were 134

patients from an outpatient clinic between the ages of 18 and 24 who had been diagnosed with

schizophrenia. Half of the participants received the motivational interviewing intervention, while
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the other half of the participants received normal psychiatric care. Unlike normal care, the

intervention focused on addressing the attitudes towards drug therapy using motivational

interviewing. The adherence therapy group attended 6 sessions over a 12-week period. Chien et

al. found that the patients who received the motivational-interviewing-based adherence therapy

had significantly higher rates of medication adherence (p<0.05). In addition, they had higher

rates of better patient outcomes overall including increased functioning and improved psychiatric

symptoms. There were some limitations to this study, including a small, convenience sample and

self-reported data. Further research needs to be conducted to generalize results to a broader

population.

Dahan et al. conducted a study in 2016 to determine if a treatment plan focusing on

adherence would increase treatment compliance and change beliefs regarding medications for

those diagnosed with schizophrenia. The subjects included 60 patients between the ages of 18

and 60 who were hospitalized for schizophrenia. The control group received routine psychiatric

care, while the other group received motivational interviewing sessions focused on the

challenges of medication compliance. Both groups went to sessions one to two times a week for

a total of 6 sessions. Dahan et al. found that the integrative intervention significantly improved

attitudes about the drugs and increased adherence to medication therapy as compared to routine

care (p<0.5). There was a positive relationship between the frequency and length of the

intervention and the attitudes and adherence. The researchers stated that more studies needed to

be done due to the small sample size and self-report data collection procedure.

Hamrin and Iennaco in 2017 performed a study to examine the effectiveness of

motivational interviewing in improving medication compliance among adolescents who are

prescribed antidepressants and mood stabilizers. The study also investigated whether attitudes
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toward medicines were related to compliance. The study included 48 adolescents gathered from

an outpatient psychiatric clinic ranging from 12 to 18 years old. The subjects took a pretest and a

posttest after the motivational interviewing intervention over the course of 2 months. Hamrin and

Iennaco found that on the pretest, only 43.9% of the subjects were following their medication

regime. On the posttest, 70.7% of the subjects were taking their medication over 80% as

prescribed. Motivational interviewing improved the drug compliance in these subjects. The

majority of the subjects had positive attitudes about their medication treatment as well. The size

of the sample as well as the broad inclusion criteria for the sample were limitations to the study.

In the 2014 study, Mckenzie and Chang aimed to examine the impact of motivational

interviewing on medication compliance in patients diagnosed with bipolar disorder. Fourteen

subjects over the age of 18 were obtained from an outpatient psychiatric clinic. The study

utilized a pretest and a posttest to determine the effectiveness of motivational interviewing on

medication compliance. The intervention consisted of an in-person session as well as two follow-

up phone calls completed over 3 weeks. Mckenzie and Chang found that there were considerable

improvements in compliance with drug treatment as well as self-efficacy and motivation to

change after the intervention (p<0.001). There were limitations to this study including a small,

convenience sample and the self-report nature of the data.

No Change in Medication Adherence

Meijer et al. in 2013 conducted a study to determine the impact of motivational

interviewing on patients with schizophrenia. Subjects were obtained from both inpatient and

outpatient facilities and consisted of patients between the ages of 18 and 65 who had been

diagnosed with schizophrenia. The experimental group was provided motivational interviewing,

while the control group was provided health education sessions. Each group received 8 sessions
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over a 26 week time period. Meijer et al. followed up with participants 6 months later as well.

Results showed that there was not a significant difference between the group that received

motivational interviewing and the group that received health sessions. The researchers attribute

these results to the heterogeneity of the groups. More research should be done with a more

homogenous sample.

Comparison of the Studies

Medication adherence is essential in the management of psychiatric diseases. Increasing

the adherence among patients with psychiatric illnesses is crucial for providers. All five of the

articles in this paper had similar purposes. They all aimed to determine how motivational

interviewing affected medication adherence among patients with psychiatric illnesses. However,

the samples differed in each study. Chien et al., Dahan et al., and Meijer et al. gathered subjects

who were diagnosed with schizophrenia. Hamrin and Iennaco obtained adolescent patients taking

antidepressants and mood stabilizers, while Mckenzie and Chang utilized patients who had been

diagnosed with bipolar disorder. The subjects were gathered from different clinics as well. Chien

et al., Mckenzie and Chang, and Hamrin and Iennaco obtained participants from outpatient

psychiatric clinics. Dahan et al. gathered the study’s sample from inpatient psychiatric

institutions, while Meijer et al. acquired subjects from both inpatient and outpatient facilities.

Each article had slightly different methods. Chien et al., Dahan et al., and Meijer et al. conducted

their study using a control group and an experimental group. In each study the experimental

group was given motivational interviewing sessions focused on drug adherence, while the

control group received routine care sessions. Hamrin and Iennaco along with Mckenzie and

Chang utilized the same group for their studies. The subjects were given a pretest and a posttest

after the motivational interviewing intervention. The results were similar in all except the study
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conducted by Mckenzie and Chang. Chien et al., Dahan et al., Meijer et al., and Hamrin and

Iennaco found that medication adherence increased with motivational interviewing. Mckenzie

and Chang found that there was no significant difference in medication compliance between the

group receiving motivational interviewing and the group receiving routine care.

Limitations and Recommendations

The researchers all addressed limitations to their studies. Chien et al. stated that over 60%

of the patients were excluded from the study due to inclusion criteria. Most of the subjects who

participated in the study held a job, had a short duration of the illness and had adequate housing

and family support. Meijer et al. acknowledged that their study had a high refusal rate (39%) and

a high dropout rate (18% for the experimental group and 14% for the control group). Dahan et al.

stated that the sample size was small and obtained based on convenience. Due to these factors

the researchers noted, the results for the sample might not pertain to a broader population. Both

Hamrin and Iennaco and Mckenzie and Chang did not use a control group so the results may be

caused by another factor other than the motivational interviewing intervention. In addition, in all

5 studies, the data was gathered through self-report instead of biological assays making the data

unreliable.

Further study needs to be done on medication adherence among patients diagnosed with

psychiatric disorders. Hamrin and Iennaco recommended starting off with a larger sample

because subjects may drop out part way through the study like Meijer et al. experienced. Dahan

et al. recommended gathering the subject’s attitude toward their medications in addition to

adherence due to the unreliable nature of self-reported drug adherence. Mckenzie and Chang

addressed the lack of follow-up. Research with long-term follow-up is essential to determine if

motivational interviewing techniques are effective for the patient in the future. Mckenzie and
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Chang suggested doing research on the effectiveness of different motivational interviewing

techniques as well.

Conclusion

Medication adherence is important for patients diagnosed with psychiatric illnesses

(Chien et al, 2016). Motivational interviewing can be an effective tool for nurses to use to

improve attitudes of drug therapy and increase medication compliance among patients with

mental disorders (Dahan et al., 2016). The studies compared in this paper explored the

effectiveness of motivational interviewing on medication adherence in patients with psychiatric

diseases. Four of the studies found that medication adherence is increased with motivational

interviewing techniques while Mckenzie and Chang found that medication adherence remains

unchanged with motivational interviewing as opposed to routine care. However, there were

numerous limitations to each study and more research is recommended to generalize results to a

broader population.
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References

Chien, W., Mui, J., Gray, R., & Cheung, E. (2016). Adherence therapy versus routine

psychiatric care for people with schizophrenia spectrum disorders: A randomised

controlled trial. BMC Psychiatry,16(42), 1-14. doi:10.1186/s12888-016-0744-6

Dahan, S., Behrbalk, P., Stolovy, T., & Greenberger, C. (2016). Improving adherence in

hospitalized patients diagnosed with schizophrenia: An integrative one-on-one

intervention. Archives of Psychiatric Nursing,30(6), 660-665.

doi:10.1016/j.apnu.2016.03.002

Hamrin, V., & Iennaco, J. D. (2017). Evaluation of motivational interviewing to improve

psychotropic medication adherence in adolescents. Journal of Child and Adolescent

Psychopharmacology,27(2), 148-159. doi:10.1089/cap.2015.0187

Meijer, C., Barkhof, E., Sonneville, L. D., Linszen, D., & Haan, L. D. (2013). The effect

of motivational interviewing on medication adherence and hospitalization rates in

nonadherent patients with multi-episode schizophrenia. Schizophrenia Bulletin,39(6),

1242-1251. doi:10.1093/schbul/sbt138

Mckenzie, K., & Chang, Y. (2014). The effect of nurse-led motivational interviewing

on medication adherence in patients with bipolar disorder. Perspectives in Psychiatric

Care,51(1), 36-44. doi:10.1111/ppc.12060