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Evaluating the effectiveness of motivational interviewing techniques on medication adherence in patients with glaucoma: A systematic review
*Corresponding author: Bintu Mohammed Lamba, Department of Ophthalmology, Federal Medical Centre, Keffi, Nigeria. lamba.bintu@yahoo.com
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Received: ,
Accepted: ,
How to cite this article: Lamba BM, Bature M. Evaluating the effectiveness of motivational interviewing techniques on medication adherence in patients with glaucoma: A systematic review. Global J Cataract Surg Res Ophthalmol. 2026;5:8-26. doi: 10.25259/GJCSRO_13_2026
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, and effective management largely depends on long-term adherence to prescribed medications. However, adherence to anti-glaucoma therapy remains suboptimal due to multiple patient-, treatment-, and provider-related factors. This systematic review evaluated the effectiveness of motivational interviewing (MI) techniques in improving medication adherence among patients with glaucoma. A comprehensive search of PubMed, Scopus, Web of Science, and EMBASE was conducted using predefined keywords and the population, intervention, comparison, and outcome framework. Eligible studies published in English within the last 10 years included randomised controlled trials, observational studies, and systematic reviews that assessed MI interventions and reported medication adherence outcomes. A total of 3,912 articles were identified, of which 24 met the inclusion criteria. The findings demonstrated that MI interventions consistently improved medication adherence, with mean adherence increasing from 59.8% at baseline to 74.5% post-intervention, and some studies reporting adherence rates as high as 90%. MI was also associated with improved patient satisfaction, self-efficacy, and eye drop instillation techniques. Common barriers to adherence included forgetfulness, high cost of medications, side effects, complex treatment regimens, and poor patient understanding, while facilitators included improved patient education, motivation, and use of reminder strategies. Despite generally good reporting quality and external validity, many studies showed limitations in internal validity. Overall, MI appears to be an effective, patient-centred approach to enhancing medication adherence in glaucoma management, although sustained benefits may require repeated interventions. Further high-quality studies are recommended to assess long-term effectiveness .
Keywords
Behavioural counselling
Eye drops
Glaucoma
Medication adherence
Motivational interviewing
Patient compliance
INTRODUCTION
Glaucoma is the second leading cause of blindness worldwide and the leading cause of irreversible blindness.[1-3] It is responsible for 8% of blindness. The number estimated to be bilaterally blind from glaucoma worldwide is expected to increase from 8.4 million in 2010 to 11.1 million in 2020. From the global assessment of blindness from glaucoma, Africa has twice the global figure and 8 times that of the Western Pacific sub-region.[3] The most prevalent type is the primary open-angle glaucoma (POAG), especially among individuals of European and African origin, with Africa having a high prevalence of 4.20% (2.08–7.35%), which is projected to increase from 8.73% in 2020 to 16.26% in 2040.[4] The Nigerian National Blindness and Visual Impairment Survey reported that glaucoma accounts for 16.7% of blindness in adults aged 40 years and above, which is 4.2% of the total blindness in this age group.[5] Glaucoma is a long-term, progressive disease that causes the retinal ganglion cells to degenerate, which gradually reduces the visual field. Maintaining the current visual field by stopping further deterioration is the primary objective of glaucoma treatment. The only proven way to decrease or stop the progression of visual field loss is to lower intraocular pressure (IOP).[6] IOP is the only modifiable risk factor to halt or delay glaucoma progression.[7] Glaucoma can be treated medically, using laser and surgically with either minimally invasive glaucoma surgeries, non-penetrating glaucoma procedures or filtration surgeries. The end point that is continuously assessed in glaucoma patients is the IOP, appearance of the optic nerve head and status of the visual field.[8] The primary aim of current glaucoma treatments is to maintain visual function by reducing IOP to a level that helps prevent additional damage to the optic nerve. Patients must be informed about their disease condition, its various treatment options, such as surgery, adherence to topical medication and the need to follow-up to monitor IOPs.[9] However, patients are unlikely to gain the full clinical benefit of these treatments if they do not consistently follow their prescribed medication regimen.[10] Topical medical therapy is the most common initial treatment for glaucoma, and treatment adherence is vital to prevent blindness.[8] At present, various types of eye drops are used to lower IOP in the treatment of glaucoma. These include parasympathomimetic agents, sympathomimetic agents, β-blockers, carbonic anhydrase inhibitors, prostaglandin analogues, α1-blockers and α2-adrenergic agonists. These medications are frequently combined into fixed-combination eye drops to enhance effectiveness and simplify treatment.[6] Because of their great efficacy and comparatively minimal risk of side effects, topical treatments are recommended as the first-line alternative among the available medicines. An optimal treatment plan should effectively manage glaucoma with minimal risk and side effects, while also maintaining the patient’s visual function and overall quality of life.[11] These minimal adverse effects usually result from the main active agent or the additive agents, particularly preservatives such as benzalkonium chloride, used in many drugs as a preservative, which is supposed to extend the shelf-life of the drug.[6] These drugs may cause several adverse effects. Some may result in conjunctival injection, corneal erosion and superficial punctate keratitis caused by benzalkonium chloride. Systemic adverse effects such as bradycardia, hypotension and asthma episodes are linked to beta-blockers such as timolol and betaxolol, which work by controlling aqueous humour, and α1-blockers, accelerating uveoscleral outflow, examples include: Localised reactions such as eyelash growth, eyelid pigmentation, upper eyelid deepening and iris colour changes are frequently caused by prostaglandin analogues that lower IOP by accelerating uveoscleral outflow, examples include latanoprost and travoprost. Inhibitors of carbonic anhydrase, like dorzolamide and brinzolamide, reduce IOP by inhibiting the ciliary epithelium and controlling aqueous formation and can cause conjunctival allergy and hyperaemia, while acetazolamide causes dysaesthesia of the fingers, nausea, vomiting, frequent urination and a metallic aftertaste.[6] Patients do not usually get a detailed explanation of the natural history of glaucoma and the need for adherence to their medication during their encounter with the ophthalmologist because of the busy nature of most clinics.[12] It is believed that enhancing knowledge and awareness in glaucoma patients can improve their adherence to treatment and follow-up visits as well as help them better understand their condition and prognosis. In addition, well-informed patients are more likely to encourage their family members to get screened for glaucoma.[13] Delivering accurate information can help lessen emotional and psychological distress, anxiety and pain, all of which can hinder a patient’s ability to cope with their condition.[14] Constructive patient counselling could be of help to improve glaucoma knowledge and adherence to medication.[15] The role of a counsellor in a busy hospital setting is to assist in providing information to the patient concerning their disease condition and treatment, thereby giving more time to doctors to be efficient in other clinical activities, rather than spending most of the day counselling patients.[16] This relationship between the counsellor and the patient is built on trust and honesty. For counselling to be effective, the patient should view the counsellor as a supportive guide, recognising that the process involves mutual participation.[16] Counselling sessions may take place individually or in small groups, often structured as interviews or question-and-answer formats. The approach can vary: In directive counselling, the patient is given specific instructions or encouraged to adopt certain behaviours; in non-directive counselling, the patient learns by observing the counsellor’s behaviour and in cooperative counselling, the process relies on the patient’s full participation and collaboration.[17] Lacey et al.[18] reported barriers to medication adherence as poor education, lack of motivation, forgetfulness, drop application and other practical issues. Low medication adherence by glaucoma patients is a significant obstacle to reaping the benefits of drugs that have been proven in clinical trials to be more beneficial than harmful.[19] A study in Nigeria also reported barriers to adherence such as inconvenience or disruptive regimen, forgetfulness, cost, lack of availability, tiredness, busy schedule, falling asleep and missing night doses, assistance required, side effects and loss of prescription.[20] Due to the lack of noticeable symptoms in glaucoma and the need for lifelong treatment without obvious personal improvement, patients are at a higher risk of not adhering to their prescribed therapy. Motivational interviewing (MI) has been recognised for its ability to facilitate a change process and increase the acceptance of clients who work towards achieving their personal goals.[21] It has potentially been utilised as a style of counselling that can help resolve the ambivalence that prevents clients from achieving the optimum quality of life from glaucoma medication use. By eliciting and analysing a person’s unique reasons for change in a caring and encouraging setting, MI seeks to increase that person’s drive and dedication to a certain objective.[22] Rollnick and Miller defined MI as a goal-oriented, client-focused counselling approach that promotes behaviour change by assisting individuals in exploring and resolving their ambivalence.[22] MI works by enhancing counsellors’ empathetic attitudes and active listening skills, which in turn foster patients’ motivation to change.[23] Accessibility to adequate therapeutic interventions and patient adherence are critical for successfully managing glaucoma.[24,25] Findings from this study compared data on the effectiveness of MI techniques in improving medication adherence, thereby improving the overall outcome of glaucoma patients.
MATERIALS AND METHODS
This study was a systematic review of the literature, conducted online across the following search engines: PubMed, Scopus, Embase and Web of Science, using key terms accessed through the University of Edinburgh student portal. It involved the existing literature on MI for increasing medication adherence among glaucoma patients.
As this was a systematic review of published literature, ethical approval was not required, the Clinical Ophthalmology School of Medical and Veterinary Sciences at the University of Edinburgh granted permission for the study. The included studies were those that involved patients diagnosed with glaucoma (including primary open-angle glaucoma, ocular hypertension or other relevant subtypes); studies that reported adult populations (e.g., ≥18 years); studies that evaluated MI techniques (e.g., patient-centred counselling and behavioural counselling) as the primary or adjunctive intervention; studies that compared MI with usual care, standard ophthalmic care, no intervention or other medication adherence strategies (e.g., educational programmes and reminders) and studies that reported medication adherence as a measurable outcome – such as medication refill rates, self-reported adherence (e.g., validated scales), persistence or compliance metrics or reduction in IOP (indirect measure).
Excluded studies were those not specific to glaucoma, those focusing solely on pharmacological or surgical interventions without a behavioural component, studies that do not include an adherence outcome (e.g., purely qualitative or descriptive studies), as well as case reports, editorials or opinion pieces.
The primary outcome variables included the rate of medication adherence (both self-reported and objective measures), changes in adherence before and after the MI intervention, persistence with glaucoma medication as prescribed following the MI intervention and reduction in missed doses. The secondary outcome variables were patient-reported satisfaction with treatment and the MI intervention, IOP control and quality of life measures.
The primary search engines resulted in a total of 3,912 articles. Following a review of titles and abstracts, 24 publications were included based on the inclusion criteria.
The systematic review of literature followed the guidelines of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. The review followed the PRISMA 2020 guidelines, which include a 27-item checklist to ensure transparent and complete reporting for systematic reviews.
The search strategy was performed using PubMed and EMBASE following the population, intervention, comparison, outcome framework. Population: Patients with glaucoma. Intervention: MI techniques. Comparison: Usual care, no intervention or other adherence interventions. Outcome: Medication adherence (e.g., compliance, persistence or patient-reported outcomes). The electronic databases were searched using key terms identified from the title, abstract, keywords or medical subject headings (glaucoma OR ‘ocular hypertension’) AND (‘motivational interviewing’ OR ‘behavioural counselling’ OR ‘patient-centred counselling’ OR ‘motivational techniques’) AND (‘medication adherence’ OR ‘treatment compliance’ OR ‘medication persistence’ OR ‘adherence behaviour’ OR ‘therapeutic compliance’). The search terms were adapted from previous review studies with a similar purpose. In addition, manual searches of references from available literature were conducted.
Extracted data were categorised as follows: Title, authors, journal, year of publication, country, socio-demographic factors, study design, sampling technique, sample size, data collection method, type of glaucoma, severity of glaucoma, setting, duration of follow-up, baseline adherence levels, duration and frequency of MI, MI delivery format (face-to-face, telephone, video), MI provider, medication adherence (self-report, pharmacy refill data, electronic monitoring, clinical indicators such as IOP changes) and level of satisfaction with MI.
After extraction, the data were organised into an Excel summary table to avoid bias. Using the Downs and African American criteria, the lead investigator and an additional reviewer assessed the methodological quality of each article.[26] Disagreements were resolved through consensus. The study was registered with PROSPERO (registration number CRD420251074761).
RESULTS
The vast majority of the studies had high reporting standards and external validity but low ratings for internal validity. All studies reported objectives, outcome measures, interventions completed, main findings, adverse events, losses to follow-ups and related conclusions. The most common studies reviewed were randomised controlled trials (RCTs), while others were interventional studies and an observational pilot study. Other study designs included a narrative review, uncontrolled/pre-post intervention, prospective and mixed methods. Sample sizes ranged from 39 to 230 participants.
Distribution of the level of medication adherence in glaucoma patients
The mean baseline adherence in all the reviewed studies is 59.8%. The vast majority of the studies had high reporting standards and external validity but low ratings for internal validity [Table 1]. The mean post-intervention adherence is 74.5%, while some reached up to a level of 90%. The mean change in adherence is 14.7% [Table 2]. The most common barriers to medication adherence were found to be: (1) Forgetfulness, (2) Side effects of medications, (3) Cost/affordability, (4) Poor administration of eye drops and (5) The eye drop schedule not favourable for the patients [Table 3].
| Studies included in the quality assessment | Cook et al.[20] | Killeen et al.[25] | Cook et al.[26] | Miller et al.[27] | Newman-Casey et al.[28] | Poleon et al.[29] | Dreer et al.[30] |
|---|---|---|---|---|---|---|---|
| Reporting | |||||||
| Is the hypothesis/aim/objective of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the main outcomes to be measured clearly described in the introduction or methods section? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the characteristics of the patients included in the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the interventions of interest clearly described? | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
| Are the distributions of principal confounders in each group of subjects to be compared clearly described? | 1 | 1 | 1 | 1 | 0 | 0 | 1 |
| Are the main findings of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Does the study provide estimates of the random variability in the data for the main outcomes? | 1 | 1 | 1 | 1 | 0 | 0 | 0 |
| Have all important adverse events that may be a consequence of the intervention been reported? | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Have the characteristics of patients lost to follow-up been described? | 1 | 1 | 1 | 0 | 0 | 1 | 1 |
| Have actual probability values been reported (e.g. 0.035 rather than <0.05) for the main outcomes except where the probability value is less than 0.001? | 1 | 1 | 1 | 1 | 0 | 0 | 0 |
| External validity | |||||||
| Were the subjects asked to participate in the study representative of the entire population from which they were recruited? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Were those subjects who were prepared to participate representative of the entire population from which they were recruited? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Were the staff, places, and facilities where the patients were treated, representative of the treatment majority of patients receive? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Internal validity-bias | |||||||
| Was an attempt made to blind study subjects to the intervention they have received? | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was an attempt made to blind those measuring the main outcomes of the intervention? | 1 | 1 | 0 | 0 | 0 | 0 | 0 |
| f any of the results of the study were based on “data dredging”, was this made clear? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| In trials and cohort studies, do the analyses adjust for different lengths of follow-up of patients, or in case-control studies, is the time period between the intervention and the outcome the same for cases and controls? | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
| Were the statistical tests used to assess the main outcomes appropriate? | 1 | 1 | 1 | 1 | 0 | 0 | 0 |
| Was compliance with the interventions reliable? | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
| Were the main outcome measures used accurate (valid and reliable)? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Internal validity-confounding (selection bias) | |||||||
| Were the patients in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited from the same population? | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
| Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
| Were study subjects randomised to intervention groups? | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was the randomised intervention assignment concealed from both patients and health care staff until recruitment was complete and irrevocable? | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was there adequate adjustment for confounding in the analysis from which the main findings were drawn? | 1 | 0 | 0 | 1 | 0 | 0 | 0 |
| Were losses of patients to follow-up taken into account? | 1 | 1 | 1 | 0 | 0 | 0 | 1 |
| Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%? | 1 | 0 | 0 | 0 | 0 | 1 | 0 |
| Studies included in the quality assessment | Abid and Baxter[31] | Newman-Casey et al.[32] | Hollenhorst et al.[33] | Dreer et al.[34] | Schneider et al.[35] | Ha et al.[36] | Newman- Casey et al.[37] |
| Reporting | |||||||
| Is the hypothesis/aim/objective of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the main outcomes to be measured clearly described in the introduction or methods section? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the characteristics of the patients included in the study clearly described? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the interventions of interest clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the distributions of principal confounders in each group of subjects to be compared clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the main findings of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Does the study provide estimates of the random variability in the data for the main outcomes? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Have all important adverse events that may be a consequence of the intervention been reported? | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
| Have the characteristics of patients lost to follow-up been described? | 0 | 1 | 0 | 1 | 0 | 1 | 1 |
| Have actual probability values been reported (e.g. 0.035 rather than <0.05) for the main outcomes except where the probability value is less than 0.001? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| External validity | |||||||
| Were the subjects asked to participate in the study representative of the entire population from which they were recruited? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Were those subjects who were prepared to participate representative of the entire population from which they were recruited? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Were the staff, places, and facilities where the patients were treated, representative of the treatment majority of patients receive? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Internal validity-bias | |||||||
| Was an attempt made to blind study subjects to the intervention they have received? | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was an attempt made to blind those measuring the main outcomes of the intervention? | 0 | 1 | 0 | 0 | 1 | 1 | 1 |
| If any of the results of the study were based on “data dredging”, was this made clear? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| In trials and cohort studies, do the analyses adjust for different lengths of follow-up of patients, or in case-control studies, is the time period between the intervention and the outcome the same for cases and controls? | 0 | 0 | 1 | 0 | 1 | 1 | 0 |
| Were the statistical tests used to assess the main outcomes appropriate? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Was compliance with the interventions reliable? | 1 | 1 | 1 | 1 | 1 | 0 | 1 |
| Were the main outcome measures used accurate (valid and reliable)? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Internal validity-confounding (selection bias) | |||||||
| Were the patients in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited from the same population? | 0 | 1 | 1 | 0 | 0 | 1 | 0 |
| Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
| Were study subjects randomised to intervention groups? | 0 | 0 | 0 | 0 | 0 | 1 | 0 |
| Was the randomised intervention assignment concealed from both patients and health care staff until recruitment was complete and irrevocable? | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was there adequate adjustment for confounding in the analysis from which the main findings were drawn? | 1 | 1 | 0 | 0 | 0 | 1 | 0 |
| Were losses of patients to follow-up taken into account? | 0 | 1 | 0 | 0 | 1 | 1 | 1 |
| Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%? | 0 | 1 | 1 | 0 | 0 | 0 | 0 |
| Studies included in the quality assessment | Abaidoo et al.[38] | Newman-Casey et al.[23] | Cate et al.[39] | Abdull et al.[21] | Newman- Casey et al.[14] | Carpenter et al.[9] | Friedman et al.[40] |
| Reporting | |||||||
| Is the hypothesis/aim/objective of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the main outcomes to be measured clearly described in the introduction or methods section? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the characteristics of the patients included in the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the interventions of interest clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Are the distributions of principal confounders in each group of subjects to be compared clearly described? | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Are the main findings of the study clearly described? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Does the study provide estimates of the random variability in the data for the main outcomes? | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Have all important adverse events that may be a consequence of the intervention been reported? | 0 | 0 | 1 | 1 | 0 | 1 | 1 |
| Have the characteristics of patients lost to follow-up been described? | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Have actual probability values been reported (e.g. 0.035 rather than <0.05) for the main outcomes except where the probability value is less than 0.001? | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| External validity | |||||||
| Were the subjects asked to participate in the study representative of the entire population from which they were recruited? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Were those subjects who were prepared to participate representative of the entire population from which they were recruited? | 1 | 1 | 1 | 1 | 1 | 1 | 0 |
| Were the staff, places, and facilities where the patients were treated, representative of the treatment majority of patients receive? | 1 | 1 | 0 | 1 | 1 | 0 | 1 |
| Internal validity-bias | |||||||
| Was an attempt made to blind study subjects to the intervention they have received? | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Was an attempt made to blind those measuring the main outcomes of the intervention? | 0 | 0 | 1 | 1 | 0 | 1 | 0 |
| If any of the results of the study were based on “data dredging”, was this made clear? | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| In trials and cohort studies, do the analyses adjust for different lengths of follow-up of patients, or in case-control studies, is the time period between the intervention and the outcome the same for cases and controls? | 0 | 0 | 1 | 0 | 0 | 1 | 1 |
| Were the statistical tests used to assess the main outcomes appropriate? | 1 | 0 | 1 | 1 | 0 | 1 | 1 |
| Was compliance with the interventions reliable? | 1 | 1 | 1 | 1 | 0 | 1 | 1 |
| Were the main outcome measures used accurate (valid and reliable)? | 0 | 1 | 1 | 1 | 1 | 1 | 1 |
| Internal validity-confounding (selection bias) | |||||||
| Were the patients in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited from the same population? | 1 | 0 | 1 | 1 | 0 | 1 | 1 |
| Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? | 1 | 0 | 1 | 1 | 0 | 1 | 1 |
| Were study subjects randomised to intervention groups? | 0 | 1 | 0 | 1 | 0 | 0 | 0 |
| Was the randomised intervention assignment concealed from both patients and health care staff until recruitment was complete and irrevocable? | 0 | 0 | 0 | 1 | 0 | 0 | 1 |
| Was there adequate adjustment for confounding in the analysis from which the main findings were drawn? | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Were losses of patients to follow-up taken into account? | 0 | 1 | 1 | 1 | 0 | 1 | 0 |
| Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%? | 0 | 1 | 1 | 1 | 0 | 1 | 1 |
| Studies included in the quality assessment | Wu and Choy.[41] | Moore et al.[42] | Do et al.[43] | Total score | |||
| Reporting | |||||||
| Is the hypothesis/aim/objective of the study clearly described? | 1 | 1 | 1 | 24 | |||
| Are the main outcomes to be measured clearly described in the introduction or methods section? | 1 | 1 | 1 | 24 | |||
| Are the characteristics of the patients included in the study clearly described? | 0 | 1 | 1 | 22 | |||
| Are the interventions of interest clearly described? | 1 | 1 | 1 | 23 | |||
| Are the distributions of principal confounders in each group of subjects to be compared clearly described? | 1 | 1 | 1 | 20 | |||
| Are the main findings of the study clearly described? | 1 | 1 | 1 | 24 | |||
| Does the study provide estimates of the random variability in the data for the main outcomes? | 0 | 1 | 1 | 18 | |||
| Have all important adverse events that may be a consequence of the intervention been reported? | 0 | 0 | 0 | 5 | |||
| Have the characteristics of patients lost to follow-up been described? | 0 | 1 | 1 | 16 | |||
| Have actual probability values been reported (e.g. 0.035 rather than <0.05) for the main outcomes except where the probability value is less than 0.001? | 0 | 1 | 1 | 18 | |||
| External validity | |||||||
| Were the subjects asked to participate in the study representative of the entire population from which they were recruited? | 1 | 1 | 1 | 23 | |||
| Were those subjects who were prepared to participate representative of the entire population from which they were recruited? | 1 | 1 | 1 | 23 | |||
| Were the staff, places, and facilities where the patients were treated, representative of the treatment majority of patients receive? | 1 | 1 | 1 | 22 | |||
| Internal validity-bias | |||||||
| Was an attempt made to blind study subjects to the intervention they have received? | 0 | 0 | 0 | 1 | |||
| Was an attempt made to blind those measuring the main outcomes of the intervention? | 0 | 0 | 0 | 9 | |||
| If any of the results of the study were based on “data dredging”, was this made clear? | 1 | 1 | 1 | 24 | |||
| In trials and cohort studies, do the analyses adjust for different lengths of follow-up of patients, or in case-control studies, is the time period between the intervention and the outcome the same for cases and controls? | 0 | 0 | 0 | 8 | |||
| Were the statistical tests used to assess the main outcomes appropriate? | 0 | 1 | 1 | 17 | |||
| Was compliance with the interventions reliable? | 0 | 1 | 1 | 20 | |||
| Were the main outcome measures used accurate (valid and reliable)? | 1 | 1 | 1 | 22 | |||
| Internal validity-confounding (selection bias) | |||||||
| Were the patients in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited from the same population? | 0 | 1 | 1 | 12 | |||
| Were study subjects in different intervention groups (trials and cohort studies) or were the cases and controls (case-control studies) recruited over the same period of time? | 0 | 1 | 1 | 11 | |||
| Were study subjects randomised to intervention groups? | 0 | 1 | 1 | 6 | |||
| Was the randomised intervention assignment concealed from both patients and health care staff until recruitment was complete and irrevocable? | 0 | 1 | 0 | 3 | |||
| Was there adequate adjustment for confounding in the analysis from which the main findings were drawn? | 0 | 1 | 1 | 12 | |||
| Were losses of patients to follow-up taken into account? | 0 | 1 | 1 | 14 | |||
| Did the study have sufficient power to detect a clinically important effect where the probability value for a difference being due to chance is less than 5%? | 0 | 1 | 0 | 10 | |||
Yes=1, No=0, Unable to determine=0
| Author’s name | Country | Mean Age | Race | Study design | Sampling | Sample size |
|---|---|---|---|---|---|---|
| Cook et al. (2017)[20] | USA | 65 years | African American | RCT | Randomisation | 201 |
| Killeen et al. (2023)[25] | USA | 64 years | 49% African American, 44% Caucasian participant | Uncontrolled intervention study | Purposive | 39 |
| Cook et al. (2010)[26] | USA | 57.9 years | 50% Caucasian participant, 50% African American. | Interventional | Randomisation | 51 |
| Miller et al. (2022)[27] | USA | 63.9 years | 44% Caucasian participant, 49% African American | Prospective | Purposive | 39 |
| Newman-Casey et al. (2013)[23] | USA | - | - | RCT | Randomisation | 230 |
| Poleon et al. (2025)[29] | USA | 70.9 years | 69.2% African American, 30.8% Caucasian participant | Systematic review | Database searches | 12 |
| Dreer et al. (2013)[30] | UK | 65 years | African Americans | Community-based participatory qualitative | Nominal group technique | 98 |
| Newman-Casey et al. (2020)[14] | USA | 66.4 years | African American | Uncontrolled intervention study with a pre-post design | Consecutive | 48 |
| Hollenhorst et al. (2020)[33] | USA | 40 years | - | Concurrent mixed-methods process analysis | Stratified | 39 |
| Dreer et al. (2016)[34] | USA | 61 years | African American | - | Consecutive | 11 |
| Schneider et al. (2021)[35] | USA | 64 years | 40% Caucasian participant | Interventional | Consecutive | 38 |
| Newman-Casey et al. (2018)[37] | USA | 40 years and above | - | Interventional cohort study | - | 57 |
| Abaidoo et al. (2025)[38] | Ghana | 53.9±8.5 | African | Descriptive cross-sectional methodological design | Randomisation | 24 |
| Ha et al. (2022)[36] | USA | - | - | Systematic review | Database searches | 19 RCTs comprising a total of 4981 individuals |
| Newman-Casey et al. (2013)[23] | USA | - | - | Systematic review | Database searches | 8 |
| Cate et al. (2012)[39] | UK | - | - | RCT | Randomisation | |
| Abdull et al. (2015)[11] | Nigeria | - | Africans | RCT | Randomisation | 70 |
| Newman-Casey et al. (2020)[14] | USA | 70.6 years | 83% Caucasians | Prospective, mixed-methods | - | 102 |
| Carpenter et al. (2017)[9] | USA | 65.8 years | 36% African American, 64% Non-African American | Cohort | Questionnaire | 279 |
| Friedman et al. (2008)[40] | USA | 40 years | 74.7% Caucasian participant, 25.3% Other racial/ethnic backgrounds | Retrospective database and chart reviews in combination with prospective patient surveys | Research database | 236 |
| Wu and Choy (2023)[41] | China | - | - | Systematic review | Database searches | 17 studies |
| Moore et al. (2023)[42] | USA | - | - | Systematic review | Database searches | 475 |
| Do et al. (2016)[43] | South India | 60.3–60.9 years | - | Prospective randomised controlled trial. | Randomisation | 399 |
| Author’s name | Data collection | Glaucoma type | Baseline adherence level (%) | Medication adherence (%) | Duration of MI | Level of satisfaction with MI |
| Cook et al. (2017)[20] | 18 months | POAG, OHT | 78.20 | 66.30 | 12 weeks | 53% satisfied |
| Killeen et al. (2023)[25] | 19 months | 60 | 81 | 7 months | 80% satisfied | |
| Cook et al. (2010)[26] | 6 months | Primary or secondary open-angle glaucoma | 63.30 | 73 | 6 months | 85–100% satisfied |
| Miller et al. (2022)[27] | 7 months | All | 59.90 | 83.60 | 6 months | >80% satisfied |
| Newman-Casey et al. (2013)[23] | 6 months | All | 59.90 | 81.30 | 6 months | Satisfied |
| Poleon et al. (2025)[29] | 3 months | POAG, OHT | 72.20 | 74.20 | 4 months | Satisfied |
| Dreer et al. (2013)[30] | 12 months | POAG, OHT | - | - | - | - |
| Abid and Baxter (2024)[31] | - | - | - | - | - | 95% satisfied |
| Newman-Casey et al. (2020)[14] | 3 months | All | 59.90 | 81.30 | 6 months | 95% satisfied |
| Hollenhorst et al. (2020)[33] | 7 months | All and OHT | 59.90 | 81.30 | 7 months | 100% satisfied |
| Dreer et al. (2016)[34] | 1 month | POAG | 43 | 64 | 4 weeks | - |
| Schneider et al. (2021)[35] | 7 months | All and OHT | - | - | - | - |
| Newman-Casey et al. (2018)[37] | 3 months | Glaucoma (including glaucoma suspect and OHT) | - | - | 6 months | 100% satisfied |
| Abaidoo et al. (2025)[38] | 6 months | All | - | - | 90 min | - |
| Ha et al. (2022)[36] | 1.2 months | Glaucoma, OHT | - | - | - | - |
| Cate et al. (2012)[39] | 8 months | POAG, OHT, glaucoma suspect | - | - | - | - |
| Abdull et al. (2015)[11] | 5 months | Advanced glaucoma | - | - | - | - |
| Carpenter et al. (2017)[9] | 8 months | All | 39.8 | 59 | 8 months | - |
| Friedman et al. (2008)[40] | 6 months | OAG | - | - | - | - |
| Moore et al. (2023)[42] | 6 months | - | - | - | - | - |
| Do et al. (2016)[43] | - | POAG, PACG, PXG | 49.1–52.2 | 86.9–90.6 | 12 months | 93.1–94.6% satisfied |
MI: Motivational interviewing, POAG: Primary open-angle glaucoma, RCT: Randomised controlled trials, PACG: Primary angle-closure glaucoma, PXG: Pseudoexfoliation glaucoma, OHT: Ocular hypertension
| Patient-related factors | Treatment-related factors | Provider-related factors |
|---|---|---|
| Forgetfulness[20,25] | The high cost of medications[25-28] | Poor communication by the doctor[28] |
| Patient education and health beliefs[20,26] | Treatment regimen and physical burden[26] | Poor understanding of glaucoma and its treatment[29] |
| Scepticism, where patients believe that glaucoma will not cause vision loss when it is asymptomatic[25] | Lack of availability of medications[27] | - |
| Lack of motivation[20] | Side effects[25,28] | - |
| Tiredness[27] | Loss of prescription[27] | - |
| Busy schedule[27] | Difficulties with properly instilling the medication[25] | - |
| Falling asleep and missing night doses[27] | - | - |
| Assistance required[27] | - | - |
During the follow-up period, the average adherence was 67% (standard deviation [SD] = 22%), which was significantly higher than baseline pre-programme adherence (mean = 60%, SD = 18%, ρ = 0.0393) but significantly lower than adherence during the support, educate, empower (SEE) programme (mean = 81%, SD = 18%, ρ < 0.0001). The biggest monthly losses happened at months 1 (mean = 7%, ρ = 0.0001) and 4 (mean = 6%, ρ = 0.0077).
Participants’ ability to avoid touching the skin (ρ = 0.025), eyelashes (ρ = 0.020) or ocular surface (ρ = 0.046) with the bottle tip significantly improved pre- and post-intervention. On the eye drop technique self-efficacy scale score, eye drop instillation self-efficacy increased significantly from an average score of 2.6 (SD, 0.3) to 2.8 (SD, 0.2) (ρ = 0.007). The SEE programme raised eye drop instillation self-efficacy and significantly reduced eye drop bottle contamination, hence increasing medication adherence.
Factors affecting medication adherence among glaucoma patients
The most common barriers to medication adherence were found to be: (1) Forgetfulness, (2) Side effects of medications, (3) Cost/affordability, (4) Poor administration of eye drops and (5) The eye drop schedule not favourable for the patients.
While the most prevalent facilitators were: (1) Fear or thoughts of the consequences of not taking eye drops, (2) Using memory aids, cues or strategies, (3) Keeping a routine or schedule for administering eye drops, (4) Being able to afford eye drops and (5) Keeping eye drops in the same location.
The impact of MI on improving medication adherence among glaucoma patients
According to medication event monitoring systems, reminder calls improved adherence compared to usual care (ρ = 0.005) and self-report (ρ = 0.04). Although the effect was non-significant, MI increased satisfaction more than reminder calls (ρ = 0.007). There were noticeable behavioural differences between groups, and treatment fidelity was high on the majority of measures. Due to their high baseline adherence, none of the groups had many chances for change. Over time, the glaucoma educator’s patients showed improvements in adherence and motivation. In a busy ophthalmology practice, it was possible to introduce a glaucoma educator.
During the final SEE session, medication adherence increased by 23.7%, from an average of 59.9% at baseline to 83.6%. Patient-level factors associated with relatively larger improvements in medication adherence through the SEE programme included higher global disease severity, fewer glaucoma medications and lower income. These results show that the SEE programme can improve glaucoma self-management even among participants who face social and psychological obstacles to medication adherence.
Among those who completed the SEE programme, 59% demonstrated adherence of >80%. Findings: Participants in the SEE programme demonstrated statistically significant and clinically meaningful improvements in glaucoma medication adherence.
Prompts, MI, health coaching and knowledge shaping were thought to be most helpful in the daily management of POAG and improved medication adherence.
Most of these studies have shown that a multi-component empowerment framework served as the foundation for the resulting health promotion programme, which improved glaucoma medication adherence through glaucoma education, MI and problem-solving training.
MI provides a high level of satisfaction among the study subjects, up to about 93%, which shows the significance of change from the current method of counselling patients. Although MI can affect patient- and provider-related factors, the long-term efficacy is uncertain, as most follow-ups were at 6–12 months. Thus, there is a need for recurrent MI sessions.
DISCUSSION
This review examined 24 studies, including RCTs, uncontrolled intervention studies and mixed-methods analyses. Participants’ ages ranged from 40 to 70.9, with a mean of 55.4 years. When MI techniques were applied, results consistently indicated a positive trend in adherence. Motivational interviews lasted anywhere from 90 min to 12 months. The average duration is 6 months.
The impacts of MI on medication adherence
All the studies reviewed had an average baseline adherence of 59.8%, which increased by a percentage mean of 14.7–74.5% after the intervention was implemented. MI techniques were integrated into and delivered through many successful programmes. The SEE programme, which was one of the programmes that individualised the glaucoma counselling programme and aimed to enhance adherence to glaucoma medication in all its forms, including the ability to correctly and efficiently administer eye drop medications. In this programme, Schneider et al. showed that eye drop application self-efficacy was increased, and eye drop bottle contamination was dramatically reduced.[35] It was noted that adherence levels increased from 59.9% to 83.6%, which was a statistically significant improvement (ρ < 0.0001). Following the SEE programme, Hollenhorst et.al interviewed the participants, and they explained how their interactions with the glaucoma coach aided in their motivation to improve their glaucoma medication-taking behaviour.[33] Miller et.al.[27] reported that participants with lower to middle income brackets had a greater increase in glaucoma medication adherence than those with higher income. The study also noted that those using fewer glaucoma medications had better adherence rates.
A study by Do et.al.[43] revealed that all the counselling interventions tested in the study showed improvements in glaucoma knowledge, poor knowledge retention and poor long-term follow-up compliance, which suggested that a repetition of counselling may be important in preventing regression in glaucoma knowledge. This is in contrast to a study by Miller et.al.,[27] which demonstrated improved knowledge of glaucoma, but with poor follow-up rates. Dreer et.al.[34] studied the efficacy of being culturally informed and health promotion and subsequently revealed that every patient (100%) expressed great satisfaction with the level of assistance they received and believed that the sessions improved their ability to manage their glaucoma medication, as the glaucoma medication adherence rose to 64% after the programme from 43%.
The factors that affect medication adherence among glaucoma patients
Patient-related factors
Forgetfulness
An important finding in the current study was forgetfulness, which is a common motif in chronic medication non-adherence. This result supports the findings of other investigations. Davis et al. (2019),[44] for example, discovered that one of the most often reported causes of missing glaucoma medication was forgetfulness. Similarly, it was shown by Friedman et.al (2009)[45] that amnesia was a factor in more than 30% of non-adherence cases.
Cognitive decline may make this problem worse, particularly in elderly persons who make up the majority of glaucoma patients. It has been suggested that carer participation, educational interventions and the usage of reminders (such as mobile applications or alarms) can help prevent forgetting.
Lack of motivation and scepticism
The study identifies scepticism – the conviction that glaucoma won’t result in visual loss because it is asymptomatic – and a lack of drive as important contributing factors. This is supported by Newman-Casey et al., who highlighted that glaucoma’s asymptomatic condition hinders patients’ motivation.[28]
When symptoms do not appear right away, patients might not understand how urgent treatment is. The health belief model states that adherence behaviours are highly influenced by a patient’s perceived severity and vulnerability. It is crucial to implement interventions that focus on patient perceptions and raise awareness of the disease’s progression, even in the absence of symptoms.[20]
Poor understanding of glaucoma
The chronic nature of glaucoma and its potential for irreversible visual loss were also not well understood. This is supported by studies that demonstrate a negative correlation between adherence and a lack of knowledge about the disease, such as those conducted by Hoevenaars et.al. (2005)[12] and Poleon et.al. (2025).[29] Adherence has been demonstrated to be enhanced by educational programmes, particularly those that are tailored to the patient’s reading levels and are presented in their preferred language.[27]
Busy schedule, tiredness and falling asleep
A lack of routine integration is reflected in lifestyle-related hurdles such as fatigue, hectic schedules and falling asleep before administering night doses. These results are in line with those of Zaharia et.al. (2022),[10] who discovered that routines related to work and lifestyle seriously impair adherence.
This problem might be lessened by adjusting medication regimens to patients’ daily routines and utilising fixed-combination therapy to lower the frequency of doses.[30]
Loss of prescription and need for assistance
Physical restrictions (such as arthritis or tremors) or insufficient health system navigation may be the cause of prescription loss and the need for help administering drops. These problems were documented in studies like Miller et.al (2022),[27] which pointed out that poor adherence was caused by physical impairments and a lack of assistance.
Treatment-related factors
High cost of medications
One known obstacle is the price of antiglaucoma drugs. High cost is a recurrent feature in the current findings. This is consistent with findings from research done in environments with limited resources. For example, Abdull et.al. (2015)[11] and Kyari et.al. (2015)[5] in Nigeria noted that the cost of medication considerably hindered patient adherence. The availability of generic drugs, insurance coverage and healthcare subsidies is an important legislative solution to this problem.
Side effects
Adherence was found to decrease due to reported side effects, such as stinging, redness and eye discomfort. The results of Newman-Casey et al., who showed that patients commonly stop taking drugs because of adverse effects, particularly with beta-blockers and prostaglandin analogues, are in line with this.[28] When possible, healthcare professionals should keep an eye on side effects and think about moving to more tolerable substitutes. Tolerance and adherence may also be enhanced by patient counselling of anticipated adverse effects.[30]
Treatment regimen and physical burden
Physical difficulties and intricate routines related to applying eye drops were observed. In a similar vein, Poleon’s (2025) study discovered that patients who were taking more than one drug or taking numerous doses per day were less likely to stick to their regimen.[29] Adherence has been demonstrated to increase with the use of simplified regimens, such as once-daily dosing and fixed-dose combos. Furthermore, research like Schwartz et.al. (2018)[46] addressed physical stress, such as the dexterity required to inject drops, and promoted the use of assistive equipment and carer support.
Availability of medications
Medication stockouts and unavailability in local pharmacies discourage consistent use. This factor is prevalent in developing countries, as noted by Tham et.al. (2014).[2] Strengthening pharmaceutical supply chains and ensuring a consistent drug supply in public hospitals are necessary strategies.
Provider-related factors
Poor communication by healthcare providers
One important factor contributing to non-adherence was found to be inadequate communication. Friedman et.al. (2008)[40] found that good doctor–patient communication greatly improves medication adherence, which lends credence to this finding. Clear directions on how to take medications, sympathetic communication and shared decision-making are essential. In addition to encouraging enquiries and using visual aids, providers must evaluate patients’ comprehension during clinic sessions.
Patient education and health beliefs
Education plays a part in communicating. According to the study, poor adherence may be caused by a lack of knowledge about the course of the disease, how to take medications and possible consequences.[20] This is consistent with research by Poleon et.al (2025),[29] which highlighted the importance of patient education in managing chronic illnesses. When tailored to the patient’s reading level and cultural background, educational interventions – such as counselling, group sessions and the engagement of patient advocates – have shown promise in enhancing medication adherence in glaucoma patients.
CONCLUSION
The usefulness of MI strategies in enhancing medication adherence among glaucoma patients has been confirmed by this systematic review, which synthesised findings from 24 studies, including RCTs and mixed-methods analyses. Following MI treatments, the average baseline adherence of 59.8% rose by 14.7%, demonstrating the potential usefulness of these interventions in clinical practice. Initiatives such as the SEE programme have shown notable gains in patients’ self-efficacy, technical proficiency in administering eye drops and adherence. In addition, the results indicate that adherence treatments are more effective for patients with lower-to-middle incomes and those taking fewer prescriptions. A wide range of factors pertaining to the patient, the treatment and the provider affects adherence to glaucoma medication. Forgetfulness, a lack of drive, a poor grasp of the disease, expensive medications, adverse effects, complicated regimens and poor provider communication are some of the main obstacles. These results highlight the complexity of adherence and demand an all-encompassing, patient-focused strategy for intervention.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent is not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Prevalence of glaucoma in a Nigerian hospital. J Pharm Bioresour. 2014;11:22-8.
- [CrossRef] [Google Scholar]
- Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology. 2014;121:2081-90.
- [CrossRef] [PubMed] [Google Scholar]
- The current status of glaucoma and glaucoma care in sub-Saharan Africa. Asia Pac J Ophthalmol (Phila). 2018;7:375-86.
- [Google Scholar]
- The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006;90:262-7.
- [CrossRef] [PubMed] [Google Scholar]
- A population-based survey of the prevalence and types of glaucoma in Nigeria: Results from the Nigeria national blindness and visual impairment survey. BMC Ophthalmol. 2015;15:176.
- [CrossRef] [PubMed] [Google Scholar]
- Managing adverse effects of glaucoma medications. Clin Ophthalmol. 2014;8:903-13.
- [CrossRef] [PubMed] [Google Scholar]
- Normal tension glaucoma: Review of current understanding and mechanisms of the pathogenesis. Eye (Lond). 2018;32:924-30.
- [CrossRef] [PubMed] [Google Scholar]
- What is practical in glaucoma management? Eye (Lond). 2005;19:1125-32.
- [CrossRef] [PubMed] [Google Scholar]
- Communication predicts medication self-efficacy in glaucoma patients Delesha. Physiol Behav. 2017;176:139-48.
- [Google Scholar]
- Adherence to therapy in glaucoma treatment-a review. J Pers Med. 2022;12:514.
- [CrossRef] [PubMed] [Google Scholar]
- Primary open angle glaucoma in northern Nigeria: Stage at presentation and acceptance of treatment. BMC Ophthalmol. 2015;15:111.
- [CrossRef] [PubMed] [Google Scholar]
- Knowledge base and preferred methods of obtaining knowledge of glaucoma patients. Eur J Ophthalmol. 2005;15:32-40.
- [CrossRef] [PubMed] [Google Scholar]
- Effects of preparatory patient education for radiation oncology patients. Cancer. 1985;56:1056-61.
- [CrossRef] [PubMed] [Google Scholar]
- A glaucoma-specific brief motivational interviewing training program for ophthalmology para-professionals: Assessment of feasibility and initial patient impact. Health Commun. 2020;35:233-41.
- [CrossRef] [PubMed] [Google Scholar]
- Effectiveness of counseling provided by primary care doctors and nurses in increasing glaucoma screening rates. J Ophthalmol. 2014;2014:306795.
- [CrossRef] [PubMed] [Google Scholar]
- An Introduction to Counselling (5th ed). London: Open University Press; 2013. p. :856.
- [Google Scholar]
- Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2014;2014:CD000011.
- [CrossRef] [PubMed] [Google Scholar]
- Barriers to adherence with glaucoma medications: A qualitative research study. Eye (Lond). 2009;23:924-32.
- [CrossRef] [PubMed] [Google Scholar]
- Self-reported adherence rates in glaucoma patients in Southwest Nigeria. J Clin Sci. 2016;13:51-7.
- [CrossRef] [Google Scholar]
- Motivational interviewing or reminders for glaucoma medication adherence? Results of a multi-site randomized controlled trial. Psychol Health. 2017;32:145-65.
- [CrossRef] [PubMed] [Google Scholar]
- Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: Study protocol for a randomized controlled trial. Trials. 2014;15:149.
- [CrossRef] [PubMed] [Google Scholar]
- What is motivational interviewing? Behav Cogn Psychother. 1995;23:325-34.
- [CrossRef] [Google Scholar]
- Systematic review of educational interventions to improve glaucoma medication adherence. Semin Ophthalmol. 2013;2(8):191-201.
- [CrossRef] [PubMed] [Google Scholar]
- Interventions to improve the use of EMRs in primary health care: A systematic review and meta-analysis. BMJ Health Care Inform. 2019;26:1-7.
- [CrossRef] [PubMed] [Google Scholar]
- Glaucoma medication adherence 1 year after the support, educate, empower personalized glaucoma coaching program. Ophthalmol Glaucoma. 2023;6:23-8.
- [CrossRef] [PubMed] [Google Scholar]
- Feasibility of motivational interviewing delivered by a glaucoma educator to improve medication adherence. Clin Ophthalmol. 2010;4:1091-101.
- [CrossRef] [PubMed] [Google Scholar]
- Demographic, clinical, and psychosocial predictors of change in medication adherence in the support, educate, empower program. Ophthalmol Glaucoma. 2022;5:47-57.
- [CrossRef] [PubMed] [Google Scholar]
- The support, educate, empower personalized glaucoma coaching trial design. Clin Trials. 2023;20:192-200.
- [CrossRef] [PubMed] [Google Scholar]
- A taxonomy of behavior change techniques for improving medication adherence in primary open-angle glaucoma. J Ophthalmol 2025:9917724.
- [CrossRef] [PubMed] [Google Scholar]
- Glaucoma medication adherence among African Americans: Program development. Optom Vis Sci. 2013;90:883-97.
- [CrossRef] [PubMed] [Google Scholar]
- Breaking barriers in behavioral change: The potential of artificial intelligence-driven motivational interviewing. J Glaucoma. 2024;33:473-7.
- [CrossRef] [PubMed] [Google Scholar]
- The impact of the support, educate, empower personalized glaucoma coaching pilot study on glaucoma medication adherence. Ophthalmol Glaucoma. 2020;3:228-37.
- [CrossRef] [PubMed] [Google Scholar]
- Patient experience during the support, educate, empower glaucoma coaching program to improve medication adherence: A pilot study. Ophthalmol Glaucoma. 2020;3:238-52.
- [CrossRef] [PubMed] [Google Scholar]
- Feasibility, patient acceptability, and preliminary efficacy of a culturally informed, health promotion program to improve glaucoma medication adherence among African Americans: 'Glaucoma management optimism for African Americans living with glaucoma' (GOAL) Curr Eye Res. 2016;41:50-8.
- [CrossRef] [PubMed] [Google Scholar]
- Impact of the support, educate, empower personalized glaucoma coaching program pilot study on eye drop instillation technique and self-efficacy. Ophthalmol Glaucoma. 2021;4:42-50.
- [CrossRef] [PubMed] [Google Scholar]
- Interventions for glaucoma medication adherence improvement: A network meta-analysis of randomized controlled trials. Ophthalmology. 2022;129:1294-304.
- [CrossRef] [PubMed] [Google Scholar]
- Personalized behavior change program for glaucoma patients with poor adherence: A pilot interventional cohort study with a pre-post design. Pilot Feasibility Stud. 2018;4:128.
- [CrossRef] [PubMed] [Google Scholar]
- Development of a patient-centred toolkit for improving glaucoma medication adherence: A motivational interviewing approach. Health Sci Investig J. 2025;6:892-902.
- [CrossRef] [Google Scholar]
- Protocol for a randomised controlled trial to estimate the effects and costs of a patient centred educational intervention in glaucoma management. BMC Ophthalmol. 2012;12:57.
- [CrossRef] [PubMed] [Google Scholar]
- Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the glaucoma adherence and persistency study. Ophthalmology. 2008;115:1320-7.e1.3.
- [CrossRef] [PubMed] [Google Scholar]
- Psychological interventions to reduce intraocular pressure (IOP) in glaucoma patients: A review. Graefes Arch Clin Exp Ophthalmol. 2023;261:1215-27.
- [CrossRef] [PubMed] [Google Scholar]
- Factors affecting glaucoma medication adherence and interventions to improve adherence: A narrative review. Ophthalmol Ther. 2023;12:2863-80.
- [CrossRef] [PubMed] [Google Scholar]
- Effectiveness of glaucoma counseling on rates of follow-up and glaucoma knowledge in a south Indian population. Am J Ophthalmol. 2016;163:180-9.e4.
- [CrossRef] [PubMed] [Google Scholar]
- Glaucoma patient preferences for video education on eye drop technique. Optom Vis Sci. 2019;96:325-30.
- [CrossRef] [PubMed] [Google Scholar]
- Risk factors for poor adherence to eyedrops in electronically monitored patients with glaucoma. Ophthalmology. 2009;116:1097-105.
- [CrossRef] [PubMed] [Google Scholar]
- Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2018;53:57-68.
- [CrossRef] [PubMed] [Google Scholar]