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2-14-2024

Implementing Motivational Interviewing to Improve Medication Implementing Motivational Interviewing to Improve Medication

Adherence: A Staff Education Project Adherence: A Staff Education Project

Marlon Medina Walden University

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Walden University

College of Nursing

This is to certify that the doctoral study by

Marlon Medina

has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made.

Review Committee Dr. Barbara Niedz, Committee Chairperson, Nursing Faculty

Dr. Allison Terry, Committee Member, Nursing Faculty

Chief Academic Officer and Provost Sue Subocz, Ph.D.

Walden University 2024

Abstract

Implementing Motivational Interviewing to Improve Medication Adherence: A Staff

Education Project

by

Marlon Medina

MS, Walden University, 2019

BS, Walden University, 2013

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2024

Abstract

Medication nonadherence is a major health issue among psychiatric patients as studies

show a significantly high rate of medication nonadherence among psychiatric patients.

This impacts the health outcomes of patients taking psychotropic medications.

Psychiatric nurses have a major role to play in implementing strategies to improve

medication adherence among patients. This project proposes the implementation of

psychoeducation based on motivational interviewing to improve medication adherence

among psychiatric patients. An educational workshop was provided to four nurses over 4

weeks to improve the knowledge, skills, and attitudes of staff members at an outpatient

care clinic, ultimately, to improve the patients’ medication adherence. The project was

informed by the evidence-based practice model, and Orem’s self-care theory. The staff

members’ level of knowledge, skills, and attitude were assessed using questionnaire

(rated on a scale of 0–4) and a pretest–posttest method. The mean for the four knowledge

questions improved from 7.50 to 14.25; a score of 16 indicates correct answers. The

mean for skill on seven questions improved from 11.00 to 24.50; a score of 28 indicates

strong agreement across the sample on all seven questions. Also, the mean for the nurses’

attitude improved from 3.50 to 10.75; a score of 12 on all three questions indicates strong

agreement and positive attitudes. The results indicate an improvement in knowledge,

skills, and attitudes among nurses. Enhancing nurses’ knowledge, skills and attitudes

toward medication adherence in psychiatric patients has the benefit of improved

adherence in patients, a positive social change.

Implementing Motivational Interviewing to Improve Medication Adherence: A Staff

Education Project

by

Marlon Medina

MS, Walden University, 2019

BS, Walden University, 2013

Project Submitted in Partial Fulfillment

of the Requirements for the Degree of

Doctor of Nursing Practice

Walden University

February 2024

Dedication

I am dedicating this project to three people that mean the world to me, my wife

and two children. I have always derived much pride and motivation in my family. I want

to thank them for giving me a peace of mind to complete my project, the sleepless nights,

and time I was away conducting my staff education.

Acknowledgments

I would like to express my special thanks to my project advisor and mentor, Dr.

Barbara Niedz, for her time and efforts in guiding me through this process. She dedicated

herself to helping me through this project and providing constructive feedback. Your

useful advice and feedback were really helpful to me during the completion of the

project.

i

Table of Contents

List of Tables ......................................................................................................................iii

List of Figures .....................................................................................................................iv

Section 1: Nature of the Project ...........................................................................................1

Introduction ....................................................................................................................1

Problem Statement .........................................................................................................2

Purpose Statement..........................................................................................................4

Nature of the Doctoral Project .......................................................................................5

Significance....................................................................................................................6

Summary ........................................................................................................................7

Section 2: Background and Context ....................................................................................9

Introduction ....................................................................................................................9

Concepts, Models, and Theories ....................................................................................9

Evidence-Based Practice Model ........................................................................... 10

Orem’s Self-Care Deficit Theory.......................................................................... 11

Relevance to Nursing Practice .....................................................................................13

Local Background and Context....................................................................................15

Role of the DNP Student..............................................................................................16

Role of the Project Team .............................................................................................17

Summary ......................................................................................................................17

Section 3: Collection and Analysis of Evidence ................................................................19

Introduction ..................................................................................................................19

ii

Practice-Focused Question...........................................................................................19

Sources of Evidence.....................................................................................................20

Published Outcomes and Research ....................................................................... 20

Evidence Generated for the Doctoral Project ....................................................... 21

Analysis and Synthesis ................................................................................................23

Summary ......................................................................................................................24

Section 4: Findings and Recommendations .......................................................................25

Introduction ..................................................................................................................25

Findings and Implications ............................................................................................25

Recommendations ........................................................................................................29

Contribution of the Doctoral Project Team .................................................................30

Strengths and Limitations of the Project......................................................................31

Summary ......................................................................................................................31

Section 5: Dissemination Plan ...........................................................................................33

Analysis of Self ............................................................................................................33

Summary ......................................................................................................................35

References ..........................................................................................................................36

Appendix A: Planning Grid for Psychoeducation Based on Motivational

Interviewing ...........................................................................................................40

Appendix B: Pretest and Posttest to Measure Knowledge, Skills, and Attitude................42

iii

List of Tables

Table 1. Descriptive Statistics Before Staff Education on Knowledge, Skills, and

Attitude...................................................................................................................... 27

Table 2. Descriptive Statistics After Staff Education on Knowledge, Skills, and Attitude.

................................................................................................................................... 27

iv

List of Figures

Figure 1. Mean Differences for Knowledge, Skills, and Attitudes Before and After Staff

Education .................................................................................................................. 28

1

Section 1: Nature of the Project

Introduction

In psychiatric care, the role of psychiatric nurses is to assess patients and

administer psychotropic medications to help improve their symptoms. According to

Dobber et al. (2020), the main aim of administering psychotropic medications is to treat

the symptoms associated with the psychiatric conditions and improve the patients’ quality

of life. However, adherence to medication is a crucial step to achieving the full benefit of

the prescribed or administered treatment regimen while also improving the health

outcomes of the patients. Harmanci and Budak (2022) found that there is a high rate of

medication nonadherence among psychiatric patients. Their study indicated that

approximately 49% of psychiatric patients stop taking their medications 3 months after

prescription. The high rate of nonadherence compromises the quality and efficiency of

the treatment process. For instance, according to Schroeder and Seegert (2023), lack of

medication adherence causes excess mortality and morbidity as well as an annual cost of

over 1 billion dollars. As a major health issue in the psychiatric care sector, improving

medication adherence among the patients through staff education has positive social

justice benefits for patients. This project focused on staff education using motivational

interviewing techniques for outpatient psychiatric nurses to potentially improve

medication adherence among patients. Improving medication adherence among the

patients was intended to improve the quality of the care process by training staff members

on the different components and aspects of motivational interviewing to implement

during the treatment process.

2

Problem Statement

Medication nonadherence is a prevalent problem among psychiatric care facilities.

A survey in the United States’ psychiatric hospitals revealed that 33% to 69% of patient

readmissions or hospital stays were associated with lack of or inconsistent medication

adherence among patients (Schroeder & Seegert, 2023). According to Harmanci and

Budak (2022), the rate of medication nonadherence is higher among psychiatric patients

because of the lack of motivation to take their medication after their symptoms have

improved and the lack of understanding of the importance of medication adherence.

In an outpatient behavioral health (BH) practice, the use of long-acting injections

such as Haloperidol are part of standard practice for helping restore the balance of certain

natural substances in the brain (Grubor et al., 2020). The medication is often given with

self-monitoring tools and reminders to help patients adhere to the medications. However,

patients with BH problems are often on more than one BH medication, many of which

require daily dosing. Patients with BH problems often experience side effects which can

be debilitating. Thus, when symptoms are under control and to avoid the side effects,

patients often do not adhere to the medication regimen as ordered. Lack of adherence can

cause periods of exacerbation with threats to self or others, resulting in admissions and

readmissions. Semahegn et al. (2020) indicated that the rate of admissions among the

psychiatric patients is still high and attributable to lack of adherence to medication

treatment plan.

Prior to the DNP project, the RNs at the outpatient site provided very basic and

traditional methods to address patient education needs. Maybe a pharmaceutical company

3

brochure was used, or nothing at all. One of the most frequently used instructional

strategies used by RNs in outpatient facilities includes the use of reminders and self-

monitoring. However, problems in medication adherence are recurring, and booster

sessions are often required to consolidate and reinforce gains. Melbye et al. (2020) found

that despite the use of reminders and self-monitoring strategies among BH patients, there

was still a high rate of reported lack of motivation among the patients, which directly

affects the rate of medication nonadherence. Semahegn et al. (2020) found that

psychiatric patients stop taking their medication 18 months after discharge. Among

schizophrenic patients, medication nonadherence rate is approximated at 75% (Dobber et

al., 2020). During this time, the patients often feel their symptoms have been relieved,

which results in them stopping their medications. However, psychotropic medications are

meant for long-term care, in different mental health disorders. For example, patients

suffering from schizophrenia need to take their medications for at least 3 years. This

requires a long-term commitment on the part of the patients. Thus, implementing

interventions that improve the patients’ motivation and understanding of their role in the

treatment process helps in enhancing their ability to commit to compliance with their

medication instructions.

Despite the use of reminders and self-monitoring strategies among patients, there

is still a high rate of nonadherence to medication, which results in unplanned emergency

department visits as well as admissions and readmissions to inpatient facilities.

According to Gewirtz and Minen (2019), the use of reminders is meant to notify patients

when to take their medication, which has been used to improve their medication

4

compliance. Psychiatric nurses within the outpatient practice conduct the implementation

of any treatment process. With the high rate of medication nonadherence among patients,

this project focuses on educating the staff members, psychiatric nurses, to implement

psychoeducation based on motivational interviewing, which has been shown to be

effective to address the problem in psychiatric patients (Semahegn et al. 2020). The aim

is to influence a change in practice from the use of Haloperidol, reminders, and self-

monitoring as the preferred medication adherence strategies to the implementation of

psychoeducation based on motivational interviewing.

Purpose Statement

As found by Semahegn et al. (2020), the lack of motivation and education among

the patients play an important role in increasing the rate of medication nonadherence.

This suggests a significant gap in outpatient nursing practice and suggests the need for a

more educative and motivational approach with outpatient staff, who can potentially

implement strategies with patients. According to Lehane et al. (2019), the implementation

of evidence-based practice interventions is more effective by developing an education

system that supports the healthcare professional in acquiring competencies required to

implement the interventions. Thus, the purpose of the project is to conduct a staff

education program for four nurses with the aim of improving their knowledge and skills

in implementing psychoeducation based on motivational interviewing. The guiding

practice-based question is as follows: To what extent will nurses’ knowledge, skills, and

attitudes, towards psychoeducation, including understanding the patient’s own

5

motivations, resisting righting reflex, listening with empathy, and their ability to

empower and educate patients, improve after an educational workshop?

The staff education was premised on four principles, including resisting righting

reflex, understanding the patient’s own motivations, listening with empathy, and

educating and empowering patients to take charge of their medications, and took 4 weeks

to complete. As such, the project seeks to assess the level of knowledge, skills, and

attitudes among nurses’ in the implementation of psychoeducation based on motivational

interviewing using questionnaires and measuring the impact after the training.

Nature of the Doctoral Project

The intended setting for the project implementation was an outpatient BH clinic

located in northeastern Pennsylvania that provides care for the psychiatric patients. The

psychiatric nurses in the facility are responsible for implementing treatment plans and

administering psychotropic medications to help the patients recover from the various

mental health problems. The project mainly focused on educating the staff members on

the importance and the strategies for implementing psychoeducation based on

motivational interviewing and assesses their knowledge, skills, and attitudes on the

intervention using questionnaires. As such, four psychiatric nurses participated in the

project. I used questionnaires to assess their knowledge, skills, and attitudes based on the

four principles, namely understand the patient’s own motivations, resist the righting

reflex, listen with empathy, and empower the patients through education on their illness,

treatment strategies and managing medication side effects.

6

Questionnaires were used to assess their knowledge and skills on the four

principles before and after the implementing the staff education project. A comparison of

the questionnaire results was done to understand whether they have improved their

knowledge and skills in the implementation of psychoeducation based on motivational

interviewing. The aim was to ensure staff members acquire the knowledge and skills to

implement motivational interviewing and psychoeducation for psychiatric patients. By

empowering and educating staff members, the project improved the competencies of the

staff members to implement the evidence-based intervention and improve the psychiatric

patients’ medication adherence. Educating the staff members allowed them to acquire the

knowledge and skills to empower and motivate patients to improve their medication

compliance and close the practice gap.

Significance

Patients and the nurse caregivers in the outpatient setting are the key stakeholders

in the DNP project. The primary aim of administering psychotropic medications to

psychiatric patients is to manage their symptoms and improve their health outcomes.

However, the high rate of medication nonadherence has become problematic leading to

the exacerbation of their illness, reduction of the effectiveness of the medications, and

unresponsiveness to subsequent treatments (Semahegn et al. 2020). According to

Schroeder and Seegert (2023), approximately 33%–69% of hospital stays and

readmissions in psychiatric care facilities are linked to medication nonadherence.

Lassemo et al. (2021) found that the rate of readmission is increased by at least 32%

7

when patients stop taking their medication before the prescribed period. All these factors

demonstrate the need for improved medication adherence among psychiatric patients.

As a standard practice, reminders and self-monitoring instructions have been used

as methods to ensure the patients comply with their medication instructions. However,

the lack of motivation among patients is a major contributing factor in the high rate of

medication nonadherence (Semahegn et al., 2020). This project seeks to introduce an

intervention that focuses on motivating and educating patients on medication adherence.

The project mainly focused on staff education to improve the nurses’ knowledge, skills,

and attitudes in implementing psychoeducation based on motivational interviewing. By

improving the nurses’ knowledge, skills, and attitudes, the project can potentially

influence the integration of the intervention as part of the treatment process while also

improving the patients’ motivation and understanding of the need for their compliance

with the medication instructions. As such, the project is a staff education initiative that

will influence practice change and ultimately improve psychiatric patients’ outcome.

Summary

This section introduced the topic and staff education DNP project. The purpose

statement, nature of the project, problem statement, and significance of the project are all

discussed. The section laid the foundation for the project and identified the gaps in

practice that must be bridged to improve the quality of care among psychiatric patients.

For instance, the introduction highlighted the high rate of medication nonadherence

among psychiatric patients and provided statistics that show the need to address the

8

problem. Section 2 includes a description of the major concepts and theories that guide

the project, in addition to an overview of the published research that support the project.

9

Section 2: Background and Context

Introduction

The project focused on educating staff on the use of motivational interviewing

and psychoeducation to improve medication adherence among psychiatric patients, which

is a pressing problem in BH patients. The purpose of conducting staff education was to

improve the knowledge, skills, and attitudes of staff members in effectively

implementing psychoeducation based on motivational interviewing to improve

medication adherence among psychiatric patients. As such, the project sought to answer

the project question: To what extent will nurses’ knowledge, skills, and attitudes, towards

psychoeducation, including understanding the patient’s own motivations, resisting

righting reflex, listening with empathy, and their ability to empower and educate patients

improve after an educational workshop? To answer the practice question, theories in

nursing provide the framework and models for nursing practice. Theories expand the

“what” question by addressing the “how” and “why” these educational strategies

proposed by the project and their components might or might not be effective. This

project used of different theoretical frameworks and models to help understand why and

how the project was implemented under the set conditions. In this regard, this section

explores the theoretical frameworks, concepts, and models that helped in the

implementation of the project.

Concepts, Models, and Theories

As a staff education project, the purpose was to improve the knowledge, skills,

and attitudes of staff members in effectively implementing psychoeducation based on

10

motivational interviewing to improve medication adherence among psychiatric patients.

Different theoretical models that help in understanding the significance of the project in

practice include evidence-based practice model and self-care deficit theory by Dorothea

Orem.

Evidence-Based Practice Model

The classic definition of evidence-based practice model was advanced by Dr.

David Sackett. He defined evidence-based practice as “the conscientious, explicit, and

judicious use of current best practice in making decisions about the care of an individual

patient. It means integrating individual clinical expertise with best available external

clinical evidence from systematic research” (Sackett, 1997, p. 3). The Johns Hopkins

evidence-based practice model helped guide the scholarly project. According to Dang et

al. (2022), this model is a powerful problem-solving approach that is adapted to clinical

decision-making processes. The project adopted the model’s three-step process called the

practice question, evidence, and translation (PET). In the PET process, a practice

question is developed to help guide the project plan. For instance, in this project plan, the

practice question relates to whether improving staff knowledge, skills, and attitudes in

using psychoeducation based on motivational interviewing can help improve medication

adherence among psychiatric patients at an outpatient BH facility. In the second step, the

intervention (staff education) was implemented in a psychiatric outpatient facility and

data obtained to understand its impact on improving medication adherence. In the last

step, the intervention was translated based on the data provided by implementing the

intervention in the psychiatric outpatient facility among four psychiatric nurses. The aim

11

was to understand the impact of improving the knowledge, skills, and attitudes of the

nurses concerning the use of psychoeducation based on motivational interviewing in

improving medication adherence among psychiatric patients.

Orem’s Self-Care Deficit Theory

Nursing theory is integral to any changes and improvements in healthcare. The

theories provide a foundation or basis for understanding different challenges within

healthcare. The self-care deficit theory by Orem supports the project. This theory focuses

on the ability of every individual to perform self-care (Ali, 2018). According to Ali

(2018), self-deficit theory focuses on improving one’s capacity and empowering

individuals to take part in the care process. This project emphasized staff education. Staff

education also empowers healthcare professionals by improving their knowledge and

skills to implement evidence-based interventions. According to Zdravkovic et al. (2022),

patients make their recovery more effective if they also take responsibility and initiatives

to comply with their medication instructions or commit to their medication process.

Through staff education, the project improves the knowledge, skills, and attitudes of

psychiatric nurses to implement psychoeducation based on motivational interviewing to

enhance the patients’ understanding of their responsibility in the treatment process while

also motivating them to comply with the medication instructions. Therefore, the self-care

deficit theory is relevant and supports the project plan.

Educating staff members on psychoeducation based on motivational interviewing

requires an understanding of the key components and concepts associated with

motivational interviewing and psychoeducation. According to Bischof et al. (2021),

12

motivational interviewing aims at motivating patients to comply with their medication

process while psychoeducation improves their understanding of self-responsibility and

importance of complying with the medication instructions. The education process

focused on improving the nurses’ knowledge on key components such as the patient’s

own motivations, resisting righting reflex, listening with empathy, and their ability to

empower and educate patients. The process helps in improving the nurses’ knowledge

and skills in implementing these components to improve patients’ motivation to perform

self-care, collaborate, and cooperate with the care providers to implement the medication

process fully and effectively (Çakmak & Kapucu, 2021). In this regard, because self-

deficit theory focuses on improving one’s capacity and empowering them to take care in

the care process, staff education equipped staff members with the knowledge, skills, and

attitude to motivate and improve their patient’s capacity to perform self-care. Thus,

Orem’s self-care theory was relevant in the implementation of the project.

The key terms in this project are motivational interviewing and psychoeducation.

Motivational interviewing is a client or patient-centered counselling approach aimed at

eliciting behavioral change by helping patients explore and resolve ambivalence (Bischof

et al. 2021). Psychoeducation, on the other hand, is the process of educating patients and

their families regarding the treatment process, their role in the treatment process, and the

need for compliance with the medication process. These terms are key to the

implementation of the project.

13

Relevance to Nursing Practice

Nursing is an evidence-based practice. This means that evidence is integral in

improving practice and patient outcomes. The project focuses on staff education, with an

emphasis on improving the psychiatric nurses’ knowledge, skills, and attitudes in using

psychoeducation based on motivational interviewing. The overall goal is to improve

medication adherence among psychiatric patients. This project is relevant to nursing

practice because it focuses on improving practice among psychiatric nurses. According to

Alley et al. (2021), the role of RNs at the outpatient site provides very basic and

traditional methods to address patient educational needs. This also includes implementing

treatment strategies and ensuring patients have the required knowledge and motivation to

comply with their medications or treatment plans. In this regard, by improving the

knowledge, skills, and attitudes of the RNs regarding the use of psychoeducation based

on motivational interviewing, they will be able to provide the patients with their

educational needs and motivate them to comply with their medication instructions. As a

result, the patients’ motivation and education should improve their medication adherence.

Therefore, the project’s focus on staff education is relevant to nursing practice. The goal

is to improve practice by enhancing RNs knowledge, skills, and attitudes regarding the

use of psychoeducation based on motivational interviewing, which helps in improving

medication adherence among psychiatric patients in outpatient care facilities.

A number of researchers have discussed the link between staff education and

patient outcomes. A study by Garzonis et al. (2019) emphasized the importance of staff

training in improving health outcome. In psychiatric practice, the authors found that

14

professionals training in skills including communication, referral, and diagnosis

experienced an improved level of quality in their practice and thus an improvement in the

health outcomes of their patients. Matzke et al. (2021) also conducted a prospective,

single group, pretest-posttest study to establish the correlation between staff education

and patient outcomes. The authors found that staff training improved patient outcome

through improved collaboration between patients and providers. The staff members

acquired the communication skills to improve their interrelation with their patients. In

other words, staff education remains an important approach in improving practice. In the

current project, the aim is to improve the staff members’ knowledge and skills in

implementing psychoeducation based on motivational interviewing. By improving the

staff members’ knowledge and skills, the aim was to enhancing patient outcome through

improved medication adherence. In this regard, staff education is an effective strategy in

ensuring the staff members are equipped to implement psychoeducation based on

motivational interviewing to improve medication adherence among psychiatric patients.

Psychiatric-informed practice is diverse. Recommendations to improve

psychiatric practice include developing skills to effectively interact and communicate

with patients. Caulfield et al. (2019) explained that staff training should emphasize

improving professionals’ ability to conduct effective and meaningful interaction with

their patients. For instance, Caulfield et al. found that establishing a collaborative

relationship with patients improved their motivation to comply with the instructions

provided by care providers. Stuber et al. (2021) also highlighted the importance of

enhancing the knowledge of health professionals in implementing different psychological

15

or psychiatric approaches. Regularly expanding the health professionals’ evidence-based

knowledge on diagnoses and treatment creates the need to constantly train staff members.

For instance, there are constant changes and developments in psychiatric care. Staff

training helps improve and update the staff members’ knowledge and skills to improve

their practice. This project proposed staff education because of its impact on improving

staff knowledge and skills. Motivational interviewing and psychoeducation are

developing areas of practice in psychiatric care. In this regard, by expanding the staff

members’ knowledge and skills on motivational interviewing, the project seeks to

improve the patients’ health outcome through training. Thus, staff education was integral

in improving practice within the care environment.

Local Background and Context

The intended setting for the project implementation is an outpatient BH clinic

located in northeastern Pennsylvania that provides care for the psychiatric patients. The

psychiatric nurses in the facility are responsible for implementing treatment plans and

administering psychotropic medications to help the patients recover from the various

mental health problems. The project mainly focuses on educating the staff members on

the importance and the strategies for implementing psychoeducation based on

motivational interviewing and assesses their knowledge, skills, and attitudes on the

intervention using questionnaires. As such, four psychiatric nurses were the participants

of the project. The project used questionnaires to assess the nurses’ knowledge and skills

based on the four principles, namely understanding the patient’s own motivations,

resisting righting reflex, listening with empathy, and their ability to empower and

16

educating patients. After implementation of the staff education project, questionnaires

were used to assess the nurses’ knowledge and skills on the same four principles. A

comparison of the questionnaire feedback was done to understand whether participants

improved their knowledge and skills in the implementation of psychoeducation based on

motivational interviewing.

Role of the DNP Student

The project proposes an effective strategy for improving medication adherence

among psychiatric patients. As a psychiatric nurse with a few years of practice, I

understand the need to improve medication adherence among psychiatric patients.

Medication nonadherence compromises the quality of the care process. As a DNP

student, I understand my role in influencing change and improving the quality of the care

process. In this regard, my primary role is to present the project to the relevant

stakeholders and discuss its implication in practice.

In this project, my role as a DNP student included conducting a needs assessment.

The project aimed to influence practice change through staff education. In this regard,

resistance to change presents a major challenge to the implementation process. I focused

on performing a needs assessment within the organization to identify the gaps in practice

and the need for the DNP project implementation. I also analyzed the system within the

organization, identified key stakeholders, and formed a relationship with the stakeholders

for the successful implementation of the project. In this regard, as the DNP student, I

played an important role in the implementation of the project within the project site.

17

Role of the Project Team

The project team involved key stakeholders within the organization. To identify

the key stakeholders, I considered the target population, the purpose of the project, and its

potential implication to practice. In this regard, the role of the project team was to

implement the project within the project site. The project proposed a staff education

exercise with the aim of educating them on the key components of motivational

interviewing and the approaches needed to conduct psychoeducation. The key

stakeholders and project members were the four practice nurses within the organization.

The team members were integral in the implementation process. They took part in the

staff education process, provided feedback on the project implementation, and helped in

the interpretation of the project. As the project leader, I was tasked with conducting the

education process. This involved educating and training the four nurses about the

components of motivational interviewing and psychoeducation, as well as the approaches

to use in the implementation process. I also interpreted feedback from the nurses and

evaluated evidence to support the project outcomes.

Summary

In this section, I provided the theoretical basis of the project, the relevance of the

project to nursing practice, the local background and context, the role of the DNP student,

and the role of team members. The section focused on providing an understanding the

theoretical premise of the project and its implementation process. Thus, explaining the

role of team members and the DNP student, as well as the relevance of the project to

nursing practice elucidated the project and provided the rationale for its implementation.

18

Section 2 provided the basis for the intervention; the next section identifies the specific

ways to operationalize.

19

Section 3: Collection and Analysis of Evidence

Introduction

This section of the project highlights the project-focused questions, sources of

evidence, and analysis and synthesis of the project. The project is a staff education

project that focuses on improving nurses’ knowledge and understanding of

psychoeducation based on motivational interviewing as an intervention for improving

medication adherence among psychiatric patients. In this regard, this section provides the

practice-focused questions and sources of evidence to support the project, as well as the

synthesis and analysis methods to be used.

Practice-Focused Question

The use of Haloperidol, reminders, and patient self-monitoring to improve

medication adherence has been ineffective at the project site, an outpatient BH clinic in

northeastern Pennsylvania that provides care for the psychiatric patients, resulting in

increased rate of medication nonadherence and inpatient admissions among psychiatric

patients. The project explores the impact of implementing the psychoeducation based on

motivational interviewing by assessing the knowledge, skills, and attitudes of four nurses

before and after the implementation of the project. According to Alizioti and Lyrakos

(2021), psychoeducation focuses on empowering patients to take charge of their

treatment process. In motivational interviewing and psychoeducation, emphasis is placed

on affirmations, reflective listening, understanding roles and responsibility, and engaging

in collaborative care. The project assessed and educated the nurses on four key principles,

namely the ability to understand the patient’s own motivations, resisting righting reflex,

20

listening with empathy, and their ability to empower patients. As such, the project was

guided by the following practice-focused question:

To what extent will nurses’ knowledge, skills, and attitudes, towards

psychoeducation, including understanding the patient’s own motivations, resisting

righting reflex, listening with empathy, and their ability to empower and educate

patients improve after an educational workshop?

Sources of Evidence

The literature on medication compliance in the BH patient is abundant. Harmanci

and Budak (2022) justified the need to address the problem by highlighting the rate of

medication nonadherence and how it impacts the process of treatment among psychiatric

patients. Lassemo et al. (2021) also reiterated that unplanned readmissions among

psychiatric patients is 47% more likely a result of medication nonadherence than other

causes, and improving medication adherence helps reducing the readmission rates. Murad

et al. (2022) reflected similar findings in their study, attributing readmission of

psychiatric patients to nonadherence to medication. The likelihood of readmission for

patients that do not adhere to medication was increased by 37%. Thus, the findings of the

studies justify the need to improve medication adherence among psychiatric patients.

Published Outcomes and Research

In supporting the project, I conducted a literature review to establish the gaps in

practice, the effectiveness of current standard practices, and the effectiveness of staff

education on improving health outcomes. To identify the relevant studies, the practice-

focused question provided the key terms. Particularly, key terms such as staff education,

21

psychoeducation, motivational interviewing, medication adherence, and patient outcomes

formed the basis of the search. The search was conducted in different databases including

PubMed, ScienceDirect, Medline, Cochrane Library, and Google Scholar. These

databases helped in identifying the relevant literature to support the project. The scope of

reviewing the studies emphasized the impact of staff education on health outcomes, the

current practices aimed at improving medication adherence, the limitations of the current

practices, and the impact of improving staff members’ knowledge on psychoeducation

based on motivational interviewing on the rate of medication adherence. By reviewing

studies covering these topics, I aimed to support the staff education project and establish

the need to improve staff members’ knowledge, skills, and attitude in using

psychoeducation based on motivational interviewing technique in their practice.

Evidence Generated for the Doctoral Project

In every project, identifying the participants and procedures for collecting

evidence is key to implementing the project. This section identifies the participants in the

project, the procedures for collecting evidence, and the protections relating to ethical

considerations.

Participants

Participants were four psychiatric nurses at the project site. The nurses

volunteered to take part in the project. An email detailing the nature of the project, its

impact on practice within the project site, and the role of each participant, was sent to

eight staff members at the site. Four psychiatric nurses wrote back accepting and

22

volunteering to take part in the project. As such, the four psychiatric nurses underwent

the staff training.

Procedures

The training process took 4 weeks. Before and after the training process, the four

psychiatric nurses were provided with questionnaires to assess their knowledge and skills

of the four principles highlighted. The curriculum (see Appendix A) included four 30-

minute workshop sessions over a span of 7 days. Each session was focused on training

the staff members on a single component of motivational interviewing and

psychoeducation approaches. For instance, the first session focused on resisting righting

reflex, the second session, understanding patients’ own motivations, the third session,

listening with empathy, and the last session, empowering of patients.

Data were collected through pretest and posttest questionnaires from the four

participating nurses. Because this a staff education project, data were based on the

participants’ knowledge of the subject discussed in the project. For instance, the first

pretest questionnaire assessed the staff members’ knowledge of motivational

interviewing technique and their approaches in psychoeducation. The questionnaire also

determined whether the staff members have used psychoeducation and motivational

interviewing techniques in providing psychiatric care to patients. The second phase of

data collection took place after the staff education. The posttest questionnaire assessed

their knowledge of the different components of motivational interviewing and

psychoeducation, specifically, resisting righting reflex, listening with empathy,

recognizing patients’ own motivations, and empowerment of patients. These components

23

were key in assessing the staff members’ knowledge, skill, and attitude in using

psychoeducation and motivational interviewing in practice. The instruments used as

pretest and posttest to assess knowledge, skills, and attitude can be found in Appendix B.

Protections

The role of Walden University Institutional Review Board (IRB) is to protect the

rights, welfare, and privacy of the human subjects. In this project, participants are four

psychiatric nurses. By reviewing the steps taken to ensure ethical considerations are

addressed as per the Walden manual for staff education DNP projects, I protected the

rights, privacy, and welfare of the participants. The Walden IRB process for staff

education projects and Form A was after the approval of the proposal.

Analysis and Synthesis

The aim of this staff education project was to educate and train four psychiatric

nurses on the key aspects of motivational interviewing, how to implement motivational

interviewing, and assess its impact on medication adherence among psychiatric patients.

The project was a comparative analysis of two questionnaires of the four psychiatric

nurses identified for the project.

In analyzing the data obtained from the questionnaire, a pretest–posttest approach

was used. For instance, the questionnaire rated the staff members’ responses on a 5-point

scale, with 4 indicating the staff members’ understanding of the concepts and 0 indicating

the staff members’ lack of understanding of the concepts. A comparative analysis was

conducted to identify understand whether the nurses’ have improved in knowledge, skills,

and attitude with regard to the implementation of psychoeducation based on motivational

24

interviewing. The aim was to improve their skills, knowledge, and attitude in

implementing the intervention to improve medication adherence among patients.

A sum total of participants’ responses to knowledge, skill, and attitude questions

was calculated and averaged for the responses in the pretest and the responses in the

posttest questionnaires. The total on the three subscale average was compared to establish

the effectiveness of implementing the project. The scores for each participant were

recorded in the tables below and the pretest and posttest mean averages compared to

demonstrate the staff members improvement in knowledge, skills, and attitude.

Summary

This section provided key steps in analyzing and synthesizing the project. The

practice-focused questions guided the data collection and analysis process. The

procedures provided a step-by-step breakdown of how the project was conducted.

Questionnaires were used to extract data before and after the implementation of staff

education. The analysis focused on assessing the staff members’ knowledge on the use of

psychoeducation based on motivational interviewing to improve medication adherence

among patients.

25

Section 4: Findings and Recommendations

Introduction

This section presents the results and findings of the project. I conducted a staff

education for four nurses at an outpatient clinic. Before the staff education, participants

were presented with the pretest questionnaire (see Appendix B) to assess their

knowledge, skills, and attitudes in the use and implementation of motivational

interviewing and psychoeducation techniques to improve medication adherence among

psychiatric patients. After the staff education, the four nurses were asked to complete a

posttest questionnaire (see Appendix B) to reassess their knowledge, skills, and attitude

after their participation in the training. This section provides the results and findings of

the pretest and posttest questionnaire responses.

Findings and Implications

I conducted a staff education for four nurses who work in an outpatient mental

health facility. The aim of the project was to improve the staff members’ knowledge,

skills, and attitudes in implementing motivational interviewing and psychoeducation

techniques to improve medication compliance among psychiatric patients at the facility.

As established by research, the use of motivational interviewing and psychoeducation

techniques are effective strategies in improving patients’ medication adherence, mainly

because they focus on empowering and motivating patients to comply with their

medication instructions. Harmanci and Budak (2022) found that the implementation of

psychoeducation based on motivational interviewing improved medication adherence

among schizophrenic patients by 31%. The educational intervention focused on

26

implementing the components of motivational interviewing such as resisting righting

reflex, listing with empathy, recognizing patients’ own motivation, and empowering

patients. By improving the nurses’ knowledge, skills, and attitude in implementing the

intervention, the project sought to improve the patients’ medication adherence.

The four nurses who underwent the staff education all have a background in

psychiatric nursing and work in the outpatient psychiatric setting, but none have

prescriptive rights. Before the staff education, the four staff members completed a pretest

questionnaire assessing their knowledge, skills, and attitudes. The questionnaire rated the

staff members’ responses on a scale ranging between 0 and 4, with 4 indicating the staff

members understanding of the concepts and 0 indicating the staff members’ lack of

understanding of the concepts. The knowledge subscale had four items, thus a high score

of 16 indicated a positive outcome and a low score of 0 indicated low knowledge for

those four questions. Similarly, skills were measured using seven questions, with the

highest score of 28 indicating a positive outcome and 0 indicating low or lack of skills.

Attitude was using three items with a score of 12 indicating positive outcome and 0

indicating no attitude among the nurses. With only four nurses participating, an

inferential analysis was not performed due to the very small sample size. However, the

descriptive statistics support the positive outcome of the project.

The mean and standard deviation of pretest results were calculated and presented

in a table format (see Table 1). After the staff education, the nurses were again

administered with the posttest questionnaire assessing their knowledge, skills, and

attitude after participation in the psychoeducation and motivational interviewing

27

techniques educational workshop. The aim of asking the same questions as in the pretest

questionnaire was to assess whether the nurses’ knowledge, skills, and attitudes improved

after the staff education. The means were calculated for each dimension (knowledge,

skills, and attitudes) and presented in Table 2.

Table 1

Descriptive Statistics Before Staff Education on Knowledge, Skills, and Attitude

Item N Minimum Maximum Mean Std. Dev.

Knowledge 4 6.00 8.00 7.50 1.00

Skills 4 8.00 13.00 11.00 2.16

Attitude 4 2.00 5.00 3.50 1.29

Table 2

Descriptive Statistics After Staff Education on Knowledge, Skills, and Attitude

Item N Minimum Maximum Mean Std. Dev.

Knowledge 4 14.00 15.00 14.25 .50

Skills 4 24.00 25.00 24.50 .58

Attitude 4 9.00 12.00 10.75 1.26

The results of project show an improvement in knowledge, skills, and attitude

after the staff education. Before the staff education, the mean for the nurses’ knowledge

on the use of motivational interviewing and psychoeducation techniques was 7.50 with a

standard deviation of 1.00. The mean of their skill in the use of motivational interviewing

28

and psychoeducation was 11.00 with a standard deviation of 2.16. The mean for their

attitude towards the use of the intervention was 3.50 with a standard deviation of 1.29.

However, after the staff education, there was an improvement in knowledge, skill, and

attitude. The mean for knowledge improved from 7.50 to 14.25 with a standard deviation

of .50. The mean average for skill improved from 11.00 to 24.50 with a standard

deviation of .58. Also, the mean for the nurses’ attitude improved from 3.50 to 10.75 with

a standard deviation of 1.26. These improvements demonstrated the effectiveness of the

staff education in instilling the knowledge, skills, and attitudes on the nurses to use

motivational interviewing and psychoeducation techniques in improving their patients’

medication adherence. Figure 1 is the graphical presentation of the mean difference for

knowledge, skills, and attitudes.

Figure 1 Mean Differences for Knowledge, Skills, and Attitudes Before and After Staff Education

29

Recommendations

The project emphasizes the need to improve nurses’ knowledge, skills, and

attitudes in implementing motivational interviewing and psychoeducation techniques to

improve medication adherence among psychiatric patients. As stated by Harmanci and

Budak (2022), the lack of motivation among patients is the major contributing factor to

the high rate of medication nonadherence. With nurses incorporating motivational

interviewing and psychoeducation techniques into the treatment process, they are able to

empower patients and improve their motivation to comply with their medication

instructions. As a staff education project, this project demonstrates how educating staff

members can help improve their knowledge of the key components of motivational

interviewing and psychoeducation, their skills in implementing these strategies, and their

attitude in incorporating the strategies into practice. Thus, staff education was integral in

improving practice and enhancing the effectiveness of the treatment strategies for

psychiatric conditions.

This project involved a staff education of only four nurses. Medication

nonadherence is a major health issue in psychiatric care. With Semahegn et al. (2020)

indicating that approximately 49% of psychiatric patients stop taking their medication at

least 3 months after prescription, it is important to implement strategies that will help

address the problem. However, nurses are integral in the treatment process because they

administer the treatment strategies. Improving the staff members’ knowledge, skills, and

attitudes in implementing strategies such as motivational interviewing and

psychoeducation can help improve the effectiveness of the treatment process. Including

30

standardized education for newly hired nurses on the implementation of motivational

interviewing and psychoeducation for patients’ treatment process will have a positive

impact on the quality of the psychiatric care process. As such, using a larger sample

population would improve the project’s generalizability and its implementation in

practice, mainly because of the impact of medication nonadherence on the quality of care.

Contribution of the Doctoral Project Team

The project team was effective in conducting the staff education, collecting data,

and analyzing data. The doctoral project team was comprised of myself as the project

leader and coordinator, my project advisor, and four outpatient staff nurses. I coordinated

the staff education exercise by distributing the PowerPoint presentation detailing different

concepts of motivational interviewing and psychoeducation. I administered the pretest

questionnaire before the staff education process, and collected and analyzed the pretest

data. I also administered the posttest questionnaire after the education process and

analyzed the data. I then conducted an analysis of the data and developed the project. My

project advisor was helpful in guiding me through the whole project implementation

process. Through feedback, she was able to make contributions as to how the project

could be improved. The four nurses were integral in the implementation of the project.

They provided feedback before and after the staff education, which was central to the

project. Thus, every member of the doctoral team played an important part in the success

of the project.

31

Strengths and Limitations of the Project

The main strength of the project is its impact on practice. The project highlights

the importance of improving nurses’ knowledge, skills, and attitude in implementing

strategies such as motivational interviewing and psychoeducation. By using a pretest and

posttest approach, the project comparatively assesses the impact of improving the nurses’

knowledge, skills, and attitudes, which demonstrate how the staff education exercise can

help improve practice. The major limitation is the small sample size. The project

recommends the use of motivational interviewing and psychoeducation in improving

medication adherence in psychiatric care, which is a major health issue. A small sample

size may create difficulties in the generalizability of the findings. Thus, a larger sample

size would be recommended for future projects.

Summary

The findings of the project indicate a positive improvement of the knowledge,

skills, and attitudes of nurses after the staff education. Improving the knowledge, skills,

and attitudes of nurses in implementing effective strategies for care practice can have a

positive impact on the quality of care for psychiatric patients. In this project, the aim was

to improve their knowledge, skills, and attitudes in implementing motivational

interviewing and psychoeducation strategies to improve patients’ medication adherence.

The findings indicate the effectiveness of staff education, which may have a positive

influence of practice within psychiatric care settings. Psychiatric care facilities may be

influenced by the findings to establish standardized educational practices for existing and

newly hired nurses with the aim of improving their knowledge, skills, and attitudes in the

32

implementation of motivational interviewing and psychoeducation. Thus, the findings of

the project may influence a change in practice in the outpatient mental health facility.

33

Section 5: Dissemination Plan

The project was meaningful at the site, and recommendations included integrating

staff training program for both existing and new nurses. The project demonstrates how

staff training is effective in improving the knowledge, skills, and attitudes of staff

members in implementing different interventions. By improving the knowledge, skills,

and attitudes of staff members in implementing effective interventions, the project site

stands to benefit by improving the quality of their care process. This project’s findings

will be disseminated using a PowerPoint presentation to the facility’s management and

the human resources department. The human resources department and management

teams are key in decision-making and can help in the integration of the staff education

programs in the project site. Workshops will be organized to present the project findings.

The aim is to present why staff education on the use of motivational interviewing and

psychoeducation can help the project site improve psychiatric care through improved

medication adherence among patients. There is also the potential for disseminating the

training to other BH sites in the region through the local nurse practitioner specialty

organization for psychiatric nurse practitioners.

Analysis of Self

The project was conducted as a response to the high medication nonadherence at

the outpatient clinic. As a psychiatric nurse, I understand the need for constant

improvement in practice. Medication nonadherence among psychiatric patients

negatively impact on the quality of the care process. In the outpatient clinic, the nurses

indicated that there was an increase in the number of readmissions, mainly as a result of

34

the high rate of medication nonadherence. This project focused on improving the nurses’

knowledge, skills, and attitudes in implementing motivational interviewing and

psychoeducation as strategies to improve medication adherence among the patients. The

dissemination will be conducted through a PowerPoint presentation at a workshop. The

audience will be the nurses at the clinic and the leadership. The aim will be to help them

understand the importance of staff education and why improving their nurses’

knowledge, skills, and attitudes in implementing motivational interviewing and

psychoeducation can help improve the patients’ medication adherence.

The project provided me an opportunity, as a DNP student, to translate evidence

into practice. The role of DNP-prepared nurses is to strengthen practice and care delivery

by providing the highest level of competent care. This includes identifying health issues

within their respective practice environment, conducting research, and translating the

research findings into practice. The project was a perfect opportunity to help address the

high rate of medication nonadherence by assessing the effectiveness of staff education.

Nurses provide primary care to patients. As such, improving their knowledge, skills, and

attitudes in implementing certain effective strategies helps improve the care process. The

findings of the project demonstrate my role as the project manager, scholar, and

practitioner in improving practice. My professional goal is to use my skills in evidence

translation skills to improve practice in psychiatric care. Thus, the project was an

opportunity to demonstrate how the implementation of my evidence translation skills can

have a social impact on the project site.

35

Summary

I conducted a staff education project to improve nurses’ knowledge, skills, and

attitudes in implementing motivational interviewing and psychoeducation in the

treatment process for psychiatric patients. I found that, after the staff education, the

nurses’ knowledge, skills, and attitudes improved significantly. The mean average of the

pretest and posttest questionnaire responses were compared, indicating how the staff

education was integral in improving practice. By improving the knowledge, skills, and

attitude of the nurses in using motivational interviewing and psychoeducation techniques

to improve medication adherence among psychiatric patients, this project made a positive

contribution to social change.

36

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02905-2

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Appendix A: Planning Grid for Psychoeducation Based on Motivational Interviewing

Learning Outcome(s): Improving staff members’ knowledge and skills in implementing

psychoeducation and motivational interviewing techniques to improve medication adherence

among psychiatric patients.

Nursing Professional Development:

• Learning how to resist righting reflex when providing care to patients.

Staff members will learn how to explore patient’s motivation to change and how to partner

with patient and acknowledge their expertise about themselves.

• Learning how to listen to patients with empathy.

Staff members will learn to actively listening to patients and how to balance between listening

and talking to patients.

• Learning how to understand and interpret patient’s motivations.

Staff members will learn how to evoke patients’ reason for change and how to connect health

behavior change to the patients’ own interests

• Learning how to empower patients.

Staff members will learn how to honor patients’ autonomy and acknowledging patients’ right

and freedom to change.

Patient Outcome:

• Improved motivation to comply with the medication instructions.

• Improved knowledge and understanding of the need to adhere to medication

instructions.

Organizational Outcome:

• Reduced medication nonadherence among psychiatric patients.

• Reduced admission and readmission rates for psychiatric patients.

Topical Content

Outline

Time

frame

References Teaching method/learner

engagement and

evaluation method

Topic: Resisting

righting reflex

Teaching/Learning

Objectives:

- Learning how to

explore patient’s

motivation to

change.

- Learning how to

partner with patient

and acknowledge

their expertise

about themselves.

30

minutes

Frey, A. J., Lee, J., Small, J.

W., Sibley, M., Owens, J. S.,

Skidmore, B., ... & Moyers,

T. B. (2021). Mechanisms of

motivational interviewing: A

conceptual framework to

guide practice and research.

Prevention Science, 22, 689-

700.

https://doi.org/10.1007/s111

21-020-01139-x

Method: Role playing

and collaborative

training. Role playing

will be based on

fictitious patient

scenarios.

Evaluation:

Questionnaire to explore

the staff members’

knowledge and skill.

41

Listening with

Empathy

Teaching/Learning

Objectives:

- Learning to

actively listening to

patients.

- Learning how to

balance between

listening and

talking to patients.

30

minutes

Frey, A. J., Lee, J., Small, J.

W., Sibley, M., Owens, J. S.,

Skidmore, B., ... & Moyers,

T. B. (2021). Mechanisms of

motivational interviewing: A

conceptual framework to

guide practice and research.

Prevention Science, 22, 689-

700.

https://doi.org/10.1007/s111

21-020-01139-x

Method: Role playing

and collaborative

training. Role playing

will be based on

fictitious patient

scenarios.

Evaluation:

Questionnaire to explore

the staff members’

knowledge and skill.

Understanding

Patients’ Motivations

Teaching/Learning

Objectives:

- Learning how to

evoke patients’

reason for change.

- Connecting health

behavior change to

the patients’ own

interests.

30

minutes

Zweben, A., Piepmeier, M.,

& Leak, K. (2022). Training

Incoming Social Work

Students in Motivational

Interviewing Skills: An

Experiential Lab Model for

Advancing Social Work

Education. Advances in

Social Work, 22(1), 178-196.

https://doi.org/10.18060/254

78

Method: Role playing

and collaborative

training. Role playing

will be based on

fictitious patient

scenarios.

Evaluation:

Questionnaire to explore

the staff members’

knowledge and skill.

Empowering Patients

Teaching/Learning

Objectives:

- Learning how to

honor patients’

autonomy.

- Acknowledging

patients’ right and

freedom to change.

30

minutes

Zweben, A., Piepmeier, M.,

& Leak, K. (2022). Training

Incoming Social Work

Students in Motivational

Interviewing Skills: An

Experiential Lab Model for

Advancing Social Work

Education. Advances in

Social Work, 22(1), 178-196.

https://doi.org/10.18060/254

78

Method: Role playing

and collaborative

training. Role playing

will be based on

fictitious patient

scenarios.

Evaluation:

Questionnaire to explore

the staff members’

knowledge and skill.

42

Appendix B: Pretest and Posttest to Measure Knowledge, Skills, and Attitude

Pretest/Posttest Questionnaire: Motivational Interviewing

Participant’s Code: Role in the Project Site:

Title:

Knowledge, skill, and attitude assessment questions for measuring motivational

interviewing and psychoeducation

Knowledge Assessment

Q1: Motivating a patient requires my ability to resist the righting reflex.

Strongly disagree 0 1 2 3 4 strongly agree Q2: As a practitioner, I must listen to my patients with empathy.

Strongly disagree 0 1 2 3 4 strongly agree Q3: As a practitioner, I must understand the patient’s motivations before recommending a

treatment plan.

Strongly disagree 0 1 2 3 4 strongly agree Q4: When interviewing and assessing a patient, I must focus on empowering them by

emphasizing on their strengths. Strongly disagree 0 1 2 3 4 strongly agree

Skill Assessment

Q1: I understand what is needed to explore the patient’s motivation to change. Strongly disagree 0 1 2 3 4 strongly agree

Q2: I understand how to actively listen to my patients during assessment. Strongly disagree 0 1 2 3 4 strongly agree Q3: I know how to balance between listening and talking to my patients.

Strongly disagree 0 1 2 3 4 strongly agree Q4: I understand how to evoke patient’s reason for change.

Strongly disagree 0 1 2 3 4 strongly agree Q5: I can connect health behavior change to the patients’ own interests. Strongly disagree 0 1 2 3 4 strongly agree

Q6: I honor my patients’ autonomy during treatment. Strongly disagree 0 1 2 3 4 strongly agree

Q7: I acknowledge the patients’ rights and freedom to change. Strongly disagree 0 1 2 3 4 strongly agree

Attitude Assessment

Q1: I understand the need motivate patients to comply with their medications. Strongly disagree 0 1 2 3 4 strongly agree

Q2: My aim as a practitioner is to implement strategies that motivate my patients to take their medication.

Strongly disagree 0 1 2 3 4 strongly agree

Q3: I have a role to place in educating patients on their medication process. Strongly disagree 0 1 2 3 4 strongly agree