The Evaluation of Motivational Interviews Influence for The

Medication Adherence of Chronic Disease: A Systematic Review

Diny Kusumawardani

, Budi Utomo

and Erna Dwi Wahyuni

Faculty of Nursing Universitas Airlangga, Kampus C Jl. Mulyorejo Surabaya, Indoensia

Faculty of Medicine Universitas Airlangga, Dharmahusada, Surabaya, Indonesia

Keywords: Motivational interview, Medication adherence, Chronic disease.

Abstract: Chronic disease is a prolonged illness and rarely heals. Although not all chronic diseases are life-

threatening, it will create an economic burden for individuals, families, and society as a whole. Long-term

care and rehabilitation is needed in chronic diseases, therefore awareness to adhere the medication is

necessary to maintain the condition and improve the health status of patients with chronic diseases.

Motivational Interviewing (MI) is one form of cognitive therapy in the form of individual-focused

counseling techniques designed to help individuals explore and overcome ambivalence in changing their

behavior. The objective of this study is to conduct a systematic review of recent studies using randomized

controlled trials, the effect of motivational interviews on medication adherence in patients with chronic

disease. The reviewed articles that were identified through database searches: Sage, Pro Quest, Springer

links, Science Direct, and Ebso Host. The year search limit used was 7 years (2010 -2017). The search

results obtained 8 articles that met the criteria. This systematic review generally recommends psychological

interventions: motivational interviews in improving medication adherence in patients with chronic disease.

However, further research needs to be done by using RCTs that focus on one chronic disease so that the

effectiveness of the intervention is known. This is due to a variety of factors that can promote medication

adherence to any disease, especially chronic disease.

1 BACKGROUND

Chronic disease is a serious health problem and the

biggest cause of death in the world. In 2008, chronic

disease caused deaths in 36 million people

worldwide or equivalent to 36% of deaths in the

world (WHO, 2013). Based on Riskesdas findings in

2013, chronic disease is the top ten cause of death in

Indonesia (Ministry of Health, 2013). Mattson (in

Bradford, 2002) explains that chronic disease is a

long-term and lethal disease, and a disease

associated with damage or decline in physical and

mental function. Chronic disease is a long-standing

disorder or disease (eg month or year), for example

hypertension, diabetes mellitus, leprosy, epilepsy,

tuberculosis, AIDS, leukemia, and so on. In order

for the healing process of patients suffering from

chronic disease to materialize rapidly, cooperation

between patients, families of patients and health care

providers must go well.

Associated with the treatment process, many

problems occur especially in chronic diseases such

as physiological problems caused by long-term use

of drugs, can cause side effects of organ damage

such as liver, kidney or other organs. In addition to

physiological problems, psychological problems can

also occur that the emergence of feelings of distress

in the patient. This is because patients are required

to conduct regular and continuous treatment

programs and take medication every day throughout

their lives.

Various other side effects may also arise, which

are caused by treatment programs or drugs

consumed. In addition, problems can also arise in

terms of family or community environment. Often,

families or societies are less likely to accept the

patient's condition when diagnosed with a chronic

disease. The various problems described above are

the causes of the tendency of patients with chronic

disease not to conduct treatment process in

accordance with the suggested by the medical team,

so in the end decide to stop taking medication or

stop taking the drug (Lailatusifah, 2012). According

to some previous studies on Schaffer et al (2004),

Kusumawardani, D., Utomo, B. and Wahyuni, E.

The Evaluation of Motivational Interviews Inﬂuence for the Medication Adherence of Chronic Disease.

DOI: 10.5220/0008325303610365

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 361-365

ISBN: 978-989-758-336-0

361

Malbasa et al (2007), Hayes et al (2009) showed that

in most patients with chronic diseases, non-

adherence to treatment was more than 50%, even in

Jarbose (2002 ) states that patients who are not

adherent will eventually be followed by the

termination of patients for medication.

Motivational Interview (MI) is one of counseling

techniques that aims to encourage individuals to

explore and find reasons in themselves that have

never thought to change his behavior (Notoatmodjo,

2010). Motivational interview encourages

individuals to create agendas and goals based on

their own desires in achieving a goal (Lakhanpal et

al., 2007). The application of MI has been performed

on a number of areas of behavior change. The

research conducted by Solomon et al (2010),

suggests that motivational interviews as

interventions prove to be good results in HIV cases,

reduce risk factors and substance abuse and improve

medication adherence in HIV patients.

Implementation of motivational interviews is

expected to improve patient behavior in medication

adherence, as in this case individual awareness is

instilled to adhere to the principle of medication

based on his/her own desire to recover. Various

interventions have been made to improve medication

adherence in patients with chronic disease. One of

them is the provision of motivational interview

interventions. Motivational interview as one of the

interventions is considered as one effective way to

cultivate and develop motivation in individuals

based on their own beliefs and desires.

2 METHODS

The search strategy for English literature relevant to

this topic was taken through several major databases

such as ProQuest, Sciencedirect, Spinger link,

Sagepub, and EbscoHost by entering keywords that

matched the titles taken: Motivational Interview,

Medication Adherence, and Chronic Disease. The

year limit used was 7 years (2010) - 2017). Full text

and abstract articles were reviewed to determine the

literature that fitted the inclusion criteria.

The inclusion criteria in this article were:

Interventions of motivational interview using

modification or without modification, and in patients

with chronic (infectious or non-infectious) diseases,

aged over 20 years. Articles were excluded if the

target population focuses on children or adolescents.

Search results with keywords created based on these

criteria were obtained from eight selected journal

articles from 40 journal articles found. The article

used as a sample was an article that used a

Randomized Control Trial.

3 RESULTS

Eight journals have been collected, reviewed and

assessed to obtain results. The eight journals

reviewed by using a randomized controlled trial

study. Eight journals examined the effects of

motivational interviews on different types of chronic

diseases, among others: HIV, CVD, hypertension,

osteoporosis, dialysis patients, and cardiovascular

disease. Seven of the eight articles reviewed showed

a significant effect of medication adherence proved

statistically significant, comparing the delivery of

MI interventions with standard room treatments.

Boveda et al (2015), in his article showed no

significant differences in both groups in terms of

total cholesterol, LDL-cholesterol and triglyceride

levels, but caused a reduction in all lipid parameters,

among others, the risk of heart disease, weight loss,

adherence against the Mediterranean diet and

medication adherence. The medication adherence

assessment in this study used the Haynes-Sackett

and Morisky-Green test, the implementation of MI

in this study was performed by physicians who had

received previous training. In contrast to research

conducted by Solomon et al (2010) that MI can

significantly improve medication adherence in

patients with osteoporosis, where an MI session is

performed by a nurse.

Boveda et al (2015) and Solomon et al (2010) in

the article had similarities that the application of MI,

done via phone and short-message-service for 12

months. Meanwhile, research conducted by Garcı et

al (2014) on the effects of MI in improving the

adherence and wellbeing of dialysis patients showed

that MI as a psychological intervention was

significantly able to improve medication adherence

(Morisky-Green test), decreased anxiety and

depression, also increased HRQL.

The MI intervention in this study was conducted

for 6 months by a psychologist, in which the patient

was asked to attend each counseling session.

Torres et al (2015) in the 9-month study, MI

interventions conducted collaboratively by doctors

and nurses, showed a significant effect (p <0.001) on

improved adherence treatment in elderly with

chronic illness, in which most of the respondents

were women with higher education. This was in line

with the results of the McDonnell et al (2011) study

that MI might serve as an intervention by nurses in

promoting adherence to HIV-positive women in

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

362

taking antiretroviral drugs, risk reduction behaviors,

and improving quality of life. In addition, Mehdi et

al (2016) in his study of patients with heart disease

undergoing Arter Bypass Surgery, that MI with a

combination of educational short-message-service

might improve medication adherence, improved

quality of life, and decreased mortality. Drug

adherence was measured in the article using

Medication Adherence Rating Scale (MARS),

quality of life with Short Form-36, and survival

status following client circumstances for 18 months

after Coronary Artery By Pass (CABG).

The influence of motivational interviews on

improving medication adherence in patients with

hypertension was found in two articles: Huang et al

(2014) and Hedegaard et al (2015), in his study of

the effects of MI interventions by pharmacists in

patients with hypertension (HT) significant on

treatment adherence for the intervention group with

a decrease in blood pressure where p <0.05 (Huang

et al., 2014). The adherence enhancement resulting

from MI intervention in HT patients was also found

by Hedegaard et al (2015), but did not have a

significant effect on the decrease in blood pressure

and secondary outcome. A study conducted by

Hedegaard et al (2015), MI interventions performed

by nurses through an interview session followed by

a six-month telephone sessions.

4 DISCUSSION

This systematic review explains the effect of

motivational interview intervention (MI) on patient’s

medication adherence with various chronic diseases.

Based on the eight journals reviewed, seven journals

were obtained to have a significant impact on

improved medication adherence, in terms of taking

medication, diet, and regularity in dialysis. While

one other journal showed no significant direct

differences between the two groups, but indirectly

led to lipid changes that reduced the risk of heart

disease, adherence to diet, and improve adherence to

treatment. The provision of interventions was

undertaken in all eight reviewed journals, having a

good diversity of the types of chronic disease

suffered, MI implementation techniques,

combinations made on MI, the intervention giver,

and intervening intervals. So, differences in results

obtained were allowed.

Meeting the basic needs of the patient especially

in terms of psychology is necessary for success in

treatment, especially in the treatment of chronic

diseases. Noncompliance of the treatment by the

patient can cause enormous negative effects. Based

on some previous studies, such as Schaffer & Tian's

(2004), Malbasa et al. (2007), Hayes et al (2010),

showed that in many chronic diseases patients who

did not adhere to treatment were more than 50%,

even in the Jarbose (2002) study suggesting that

non-adherent patients would eventually be followed

by treatment termination. Some of the effects of

noncompliance with treatment in terms of

consuming drugs are explained by Hayes et al.,

2010, namely: the occurrence of side effects of drugs

that may endanger the health of patients, the

swelling of medical expenses and hospitals. In

addition, patients can also experience resistance to

certain drugs. There are some drugs that when

stopped before the prescribed time limit may result

in having to repeat the treatment program back from

the beginning. In HIV/AIDS, noncompliance can

lead to unresolved viral suppression, ongoing

infection, the emergence of virus-resistant strains,

and limited treatment options in the future.

Other examples of non-adherence to TB

treatment, non-adherence to take medication that

should be done sequentially for six months may

cause the tuberculosis patient to repeat the treatment

again from the beginning even if the patient has been

drinking for 1-2 consecutive weeks. This of course

will take more time and cost and the healing of the

patient becomes obstructed / longer. In the case of

hypertension, medication adherence will also reduce

the risk of death, the risk of damage to important

organs and the risk of heart disease. Whereas, in

cases of chronic renal failure, non-compliance of

patients in the treatment in this case dialysis action

and adherence to the diet can cause death.

Motivational interviews are one of the client-

centered interventions with a psychological

approach, aimed at improving readiness in changing

behavior by helping clients explore and overcome

their imbalance of feelings (Miller, R & Rollnick,

2012). Doctors in this case do maintenance through

the process of interviewing with clients so that it can

make clients relax. Implementation of clinical MI

interventions makes it easier to understand the

psychological condition and experience of the client

so that doctors or other medical personnel can

motivate clients to gradually realize and desire in

making behavioral changes, in this case the behavior

of adherence to medication.

Recent meta-analysis showed that motivational

interviews were equivalent or better than other

treatments such as cognitive behavioral therapy

(CBT) or pharmacotherapy, and superior placebo

and non-treatment controls to reduce alcohol and

The Evaluation of Motivational Interviews Inﬂuence for the Medication Adherence of Chronic Disease

363

drug use in adults and adolescents (Riper et al.,

2013). Motivational interviews also proved

efficacious in other health conditions, such as

smoking cessation behavior, reduced risky sexual

behavior, improved adherence to drugs and diabetes

management. The study supported the

implementation of motivational interviews for HIV

care, such as improving adherence to antiretroviral

therapy and reducing drug use among HIV positive

men and women (Dilorio et al., 2011). Thus,

motivational interviews are an important therapeutic

technique that is widely applied in health settings to

clients in motivating to change.

Behavior adherence in treatment is a major

aspect in the treatment of chronic diseases, so this

becomes the focus in efforts to achieve patient

health status. This behavior can be seen from the

extent to which patients follow or adhere to

treatment plans agreed by patients and medical

professionals to produce targeted therapeutic therapy

(Frain et al., 2009). Nurses as medical professionals

may intervene MI, as it is a form of cognitive

therapy. Therefore, nurses are expected to intervene

with their therapeutic communication skills, to

motivate clients with chronic disease, in changing

their behavior especially in behavioral adherence to

medication. The assessment of medication

adherence may use some MMAS tools Morisky

Medication Adherence Scale), in Morisky et al.,

2009, CSA (Single Continuous Interval Treatment

Availability), MPR (Medication Possession Ratio)

and CMG (Continuous Multiple Interval Medication

Gaps), developed by Krousel- Wood et al., 2009,

and PDC (Proportion of Days Covered) by

Choudhry et al., 2009.

5 CONCLUSIONS

Motivational interviews have been conducted in

several studies in various countries. One of them

aims to improve treatment adherence in patients with

chronic disease. Most studies showed that MI

intervention had a significant effect on adherence

improvement especially in patients with chronic

disease. But in practice most were still done not by

nurses but other professionals such as:

psychologists, doctors and even pharmacists.

Therefore, nurses are expected to intervene MI as an

effort to perform nurse function as a counselor by

utilizing therapeutic communication skills

possessed.

In the future it is expected that more research

will be conducted to find out the effectiveness of

motivational interview interventions conducted by

nurses, especially in the development of nursing

science including bio, psycho, socio and spiritual

aspects. RCT studies should also continue to be done

to determine the actual effects and avoid for possible

bias in the study.

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