In-Person Session 1
Build trust and rapport Provide rationale/purpose for the program and importance of glaucoma medication management Introduce the structure of sessions Administer a brief quiz about glaucoma knowledge using the Glaucoma Eye-Q Test from the National Eye Health Education Program (NEHEP, 2006) Discuss barriers related to glaucoma medication management; prior attempts and successes or failures to overcome such obstacles Address fears and/or inaccurate perceptions of glaucoma and its management with medications -
Provide general glaucoma education and its management by reviewing educational resources: “Understanding and Living with Glaucoma” and “African Americans and Glaucoma” published by the Glaucoma Research Foundation; “Glaucoma: What you should know” published by the National Eye Institute (NEI); and the “Glaucoma Medication Management Workbook and Worksheets for African Americans” developed by the community-based participatory research team
Topics include: understanding glaucoma, symptoms, management, strategies for communicating with eye care providers and questions to ask, importance of medication adherence
Conduct MI techniques to evaluate readiness to change adherence behaviors and confidence in adhering (i.e., expressing empathy, rolling with resistance, developing discrepancies, supporting self-efficacy) Begin to help participant brainstorm on how these barriers related to management and adherence to glaucoma medication can be overcome by learning strategies from the health promotion program
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Phone Session 2
Review information from session 1 Review readiness to adhere to glaucoma medications and confidence for coping with barriers Review barriers and facilitators experienced by African Americans using the Glaucoma Medication Management Workbook for African Americans Introduce the problem-solving model and principles that can be applied to the management of chronic medical conditions such as glaucoma as well as other life problems (i.e., caregiving for grandchildren, financial difficulties, relationship problems, etc.) -
Provide an overview of problem-solving technique; work with the participant to develop a plan to adhere to glaucoma medications; and work through problem-solving skills
Review & reinforce MI techniques for challenging any negative problem orientation to medication adherence Define and break down the problem (e.g., participant forgets to take medications); help participant to establish realistic goals Generate multiple solution alternatives: Help subject brainstorm as many potential solutions as possible Remind participant that the purpose is not to judge solutions but to just brainstorm all possible solutions (e.g., place glaucoma medications near other medicines, set a timer/alarm as a reminder, ask spouse to remind the subject, place a post-it-note, integrate taking glaucoma medications with other daily morning/evening routines [e.g., brushing teeth]) Decision-making After going through a process of weighing pros and cons to each potential solution, participant will select one to implement over the course of the next week (e.g., subject will place a post-it-note on bathroom mirror) Solution implementation and evaluating the outcome At the next phone session the participant will share her experiences of the solution he or she selected (e.g., placing the post-it-note on the bathroom mirror)
Continue to address fears and/or inaccurate perceptions of glaucoma and its management with medications Continue to apply MI techniques to build readiness for change, confidence, and plan for action Assign homework based on problem solution
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Phone Sessions 3
Review homework assignment from previous phone call Determine whether subject experienced success in implementing solution from previous phone call (e.g. placed post-it-note to bathroom mirror) If yes, problem-solve barriers to other glaucoma medication management activities (e.g., side effects, beliefs about the impact of medication on health, costs) If no, evaluate and revise plan developed in previous phone session. Identify aspects of the plan that were unrealistic Problem-solve barriers to adhering to medications Address fears and/or inaccurate perceptions of glaucoma and its management with medications Continue MI techniques to build motivation and confidence for managing barriers/obstacles
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Phone Sessions 4
Review homework assignment from previous phone call Review problem-solving model and application Continue MI techniques to foster continued motivation and confidence for managing barriers/obstacles and to utilize health promotion resources in the future Discuss relapse prevention: strategies to maintain success and/or how to handle setbacks to prevent relapse into ineffective glaucoma medication adherence
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