Impact of the Support, Educate, Empower Personalized Glaucoma Coaching Program Pilot Study on Eye Drop Instillation Technique and Self-Efficacy

Abstract

Purpose: To assess the Support, Educate, Empower (SEE) personalized glaucoma coaching program impact on (1) eye drop instillation technique and (2) eye drop instillation self-efficacy.

Design: Prospective pre-post pilot study.

Participants: Patients with a diagnosis of glaucoma or ocular hypertension taking ≥1 glaucoma medication, ≥40 years old, spoke English, self-administered their eye drops, and ≤80% adherent to their glaucoma medication by electronic monitoring.

Methods: Eye drop administration was video recorded before the first SEE in-person coaching session, which included teaching eye drop instillation techniques using a motivational interviewing-based approach. At the third and final in-person counseling session 6 months later, eye drop administration was video recorded. Participants' self-efficacy was assessed using the validated Eye Drop Technique Self-Efficacy Scale (EDTSES) survey at baseline and 1 month after completion of the program. Before and after intervention videos were assessed by an observer masked to time point. Before versus after intervention comparisons were made using McNemar's and paired t tests.

Main outcome measures: The main outcome was change in participants' eye drop instillation technique as measured by (1) accuracy of an eye drop landing on the eye, (2) ability to instill an eye drop on the first attempt, and (3) contaminating the bottle by contact with ocular surface, eyelashes, and skin. The secondary outcome measure was before versus after change in the EDTSES score (6 items, each assessed on a 3-point Likert scale, with higher scores indicating better self-efficacy).

Results: Thirty-nine participants completed the SEE intervention, 38 with before and after EDTSES scores and 31 with video recordings. Six of 31 participants instilling drops outside the eye before intervention improved their technique after intervention, whereas 2 participants worsened (P = 0.157). From before to after intervention, participants demonstrated significant improvement in not touching the ocular surface (P = 0.046), the eyelashes (P = 0.020), or the skin (P = 0.025) with the bottle tip. A significant increase was found in eye drop instillation self-efficacy from an average score of 2.6 (standard deviation [SD], 0.3) to 2.8 (SD, 0.2) on the EDTSES score (P = 0.007).

Conclusions: The SEE program significantly decreased eye drop bottle contamination, increased eye drop instillation self-efficacy, and demonstrated an insignificant increase in ability to instill drops successfully and accurately.

Trial registration: ClinicalTrials.gov NCT03159247.

Keywords: Adherence to eye drops; Eye drop adherence; Eye drop instillation; Eye drop instillation technique; Eye drop technique; Motivational interviewing; Personalized coaching program.

Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

Flow diagram for study population showing the number of participants at exclusion points and the number of participants lost to followup. The numbers of participants are included for each point of dropout. EDTSES = Eye Drop Technique Self-Efficacy Scale; SEE = Support, Educate, Empower.

Figure 2.

Screenshot showing the eye drop instillation guide on the Support, Educate, Empower program web-based tool. The step-by-step eye drop instillation guide is for counselors to use during the in-person participant sessions and for participants to access independently outside of the clinic. Icons R, Q, P provide drop-down prompts useful for the counselor to elicit participant perspective and to individualize each session.