Developing a Nursing Program Using Motivational Interviewing to Improve Clinical Outcomes in Adolescent Patients with Attention-Deficit Hyperactivity Disorder
DOI:
https://doi.org/10.64767/trcn.2025.272690Keywords:
nursing program, motivational interviewing, medication adherence, attention deficit hyperactivity disorder (ADHD), adolescentAbstract
This study aimed to develop and study the effects of a nursing program using motivational interviewing to improve clinical outcomes in adolescents with attention-deficit/hyperactivity disorder (ADHD). The program was developed following the five-step framework of Maijel et al., including: (1) problem identification; (2) needs assessment for program content and activities; (3) experimental program design; (4) content validation, feasibility, and acceptability assessment; and (5) outcome evaluation. The participants included 62 adolescents diagnosed with ADHD and their caregivers, who were randomly assigned to an experimental group or a control group, with 31 participants in each. Research instruments included: the Nursing Program for Motivational Interviewing (Content Validity Index, CVI = 0.84), the Medication Adherence Assessment Scale, and the ADHD Behavior Assessment Scale (reliability = 0.76, 0.82 respectively). Data were collected before and after the participants entered the intervention and analyzed using the Wilcoxon Signed Ranks Test and the Mann-Whitney U-test.
The study found that (1) the nursing program was developed based on problem assessment and literature review and consisted of 7 activities. (2) After receiving the intervention, the experimental group showed a statistically significant improvement in medication adherence and a significant reduction in ADHD behaviors (p < .001 (3). Comparison of post-test scores between the experimental and control groups using the Mann–Whitney U-test revealed no statistically significant differences in either variable (p>.05).
Conclusion: The nursing program utilizing motivational interviewing was effective in improving medication adherence and reducing ADHD behaviors in adolescents with ADHD at the individual level. However, no significant difference was observed between the experimental and control groups. Further studies with larger sample sizes and longer follow-up periods are recommended to confirm the effectiveness of outcomes in adolescents with ADHD.
References
Ayano G, Demelash S, Gizachew Y, Tsegay L, Alati R. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: an umbrella review of meta-analyses. J Affect Disord 2023:339:860-6. DOI: https://doi.org/10.1016/j.jad.2023.07.071
Cénat JM, Kokou Kpolou CK, Blais Rochette C, Morse C, Vandette MP, Dalexis RD, et al. Prevalence of ADHD among black youth compared to white, Latino and Asian youth: a meta analysis. J Clin Child Adolesc Psychol 2024;53(3):373-88. DOI: https://doi.org/10.1080/15374416.2022.2051524
Visanuyothin T, Pavasuthipaisit C, Wachiradilok P, Arunruang P, Buranasuksakul T. The prevalence of attention deficit/hyperactivity disorder in Thailand. Journal of Mental Health of Thailand 2013;21(2):66-75. (in Thai)
Department of Mental Health. Incidence and prevalence of attention deficit hyperactivity disorder (ADHD) in Thai children aged 6-15 years, fiscal years 2023–2024 (January–November): Health Data Center (HDC) [Internet]. Nonthaburi: Department of Mental Health Knowledge Repository; 2024 [cited 2025 Apr 8]. Available from: https://dmh-elibrary.org/items/show/1802
Salari N, Ghasemi H, Abdoli N, Rahmani A, Shiri MH, Hashemian AH, et al. The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Ital J Pediatr 2023;49(1):48. DOI: https://doi.org/10.1186/s13052-023-01456-1
Austgulen A, Skram NKG, Haavik J, Lundervold AJ. Risk factors of suicidal spectrum behaviors in adults and adolescents with attention deficit/hyperactivity disorder – a systematic review. BMC Psychiatry 2023;23(1):612. DOI: https://doi.org/10.1186/s12888-023-05099-8
Powell V, Riglin L, Hammerton G, Eyre O, Martin J, Anney R, et al. What explains the link between childhood ADHD and adolescent depression? Investigating the role of peer relationships and academic attainment. Eur Child Adolesc Psychiatry 2020;29(11):1581-91. DOI: https://doi.org/10.1007/s00787-019-01463-w
Upadhyay N, Chen H, Mgbere O, Bhatara VS, Aparasu RR. The impact of pharmacotherapy on substance use in adolescents with attention deficit/hyperactivity disorder: variations across subtypes. Subst Use Misuse 2017;52(10):1266-74. DOI: https://doi.org/10.1080/10826084.2016.1273955
Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015;56(3):345-65. DOI: https://doi.org/10.1111/jcpp.12381
Alghamdi T, Helou M, Jeyaseelan L, Sultan MA. Stress level of parents of children diagnosed with attention deficit/hyperactivity disorder (ADHD) in Dubai, United Arab Emirates. Emirates Med J 2023;4(2): e170323214707. DOI: https://doi.org/10.2174/04666230317110616
Cortese S, Adamo N, Del Giovane C, Mohr Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018;5(9):727-38. DOI: https://doi.org/10.1016/S2215-0366(18)30269-4
Johnson M, Åsberg Johnels J, Östlund S, Cedergren K, Omanovic Z, Hjalmarsson K, et al. Long term medication for ADHD and development of cognitive functions in children and adolescents. J Psychiatr Res 2021;142:204-9. DOI: https://doi.org/10.1016/j.jpsychires.2021.07.055
Peterson BS, Trampush J, Maglione M, Bolshakova M, Rozelle M, Miles J, et al. Treatments for ADHD in children and adolescents: a systematic review. Pediatrics 2024;153(4):e2024065787. DOI: https://doi.org/10.1542/peds.2024-065787
Sibley MH, Kuriyan AB, Evans SW, Waxmonsky JG, Smith BH. Pharmacological and psychosocial treatments for adolescents with ADHD: an updated systematic review of the literature. Clin Psychol Rev 2014;34(3):218-32. DOI: https://doi.org/10.1016/j.cpr.2014.02.001
Ching C, Eslick GD, Poulton AS. Evaluation of methylphenidate safety and maximum-dose titration rationale in attention-deficit/hyperactivity disorder: a meta-analysis. JAMA Pediatr 2019;173(7):630-9. DOI: https://doi.org/10.1001/jamapediatrics.2019.0905
Rashid MA, Lovick S, Llanwarne NR. Medication taking experiences in attention deficit hyperactivity disorder: a systematic review. Fam Pract 2018;35(2):142-50. DOI: https://doi.org/10.1093/fampra/cmx088
Sibley MH, Graziano PA, Coxe SJ, Bickman L, Martin P. Effectiveness of motivational interviewing enhanced behavior therapy for adolescents with attention deficit/hyperactivity disorder: a randomized community based trial. J Am Acad Child Adolesc Psychiatry 2021;60(6):745-56. DOI: https://doi.org/10.1016/j.jaac.2020.07.907
Kamimura-Nishimura KI, Brinkman WB, Froehlich TE. Strategies for improving ADHD medication adherence. Curr psychiatr 2019;18(8):25-38.
Rosenau PT, Dietrich A, van den Hoofdakker BJ, Hoekstra PJ. ADHD medication adherence reduces risk of committing minor offenses in adolescents. J Child Psychol Psychiatry 2024;65(11):1478-85. DOI: https://doi.org/10.1111/jcpp.13997
Sibley MH, Graziano PA, Coxe S, Page TF, Martin P. Three year effects of motivational interviewing enhanced behavior therapy for adolescents with attention deficit/hyperactivity disorder: a randomized community based trial. J Am Acad Child Adolesc Psychiatry 2024:S0890-8567(24)01948-8.
Palacio A, Garay D, Langer B, Taylor J, Wood BA, Tamariz L. Motivational interviewing improves medication adherence: a systematic review and meta analysis. J Gen Intern Med 2016;31(8):929–40. DOI: https://doi.org/10.1007/s11606-016-3685-3
Van Meijel B, Gamel C, van Swieten-Duijfjes B, Grypdonck MHF. The development of evidence based nursing interventions: methodological considerations. J Adv Nurs 2004;48(1):84-92. DOI: https://doi.org/10.1111/j.1365-2648.2004.03171.x
Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press; 2013.
Raksawong N, Buala S, Mueansunthon S. The effect of motivational interviewing on medication adherence of patients and families in the use of ADHD medication. In: Dechkong T, editor. Proceedings of 23rd Annual International Mental Health Conference 2024; 2024 Jul 30-31, Aug 1; Bangkok, Thailand. Nonthaburi: Department of Mental Health, Ministry of Public Health; 2024. p.125. (in Thai)
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Arlington, VA: American Psychiatric Publishing; 2022. DOI: https://doi.org/10.1176/appi.books.9780890425787
Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas 1970;30(3):607-10. DOI: https://doi.org/10.1177/001316447003000308
Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.
Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford Press; 1991.
Morisky DE, Ang A, Krousel Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008;10(5):348-54. DOI: https://doi.org/10.1111/j.1751-7176.2008.07572.x
Sakthong P, Chabunthom R, Charoenvisuthiwongs R. Psychometric properties of the Thai version of the 8 item morisky medication adherence scale in patients with type 2 diabetes. Ann Pharmacother 2009;43(5):950-7. DOI: https://doi.org/10.1345/aph.1L453
Swanson J, Lerner M, March J, Gresham FM. Assessment and intervention for attention deficit/hyperactivity disorder in the schools: lessons from the MTA study. Pediatr Clin North Am 1999;46(5):993-1009. DOI: https://doi.org/10.1016/S0031-3955(05)70168-1
Pityaratstian N, Booranasuksakul T, Juengsiragulwit D, Benyakorn S. ADHD screening properties of the Thai version of Swanson, Nolan, and Pelham IV scale (SNAP IV) and Strengths and Difficulties Questionnaire (SDQ). J Psychiatr Assoc Thailand 2014;59(2):97-110. (in Thai)
Boontavee S, Sethabouppha H, Thamthai K. Effect of the motivational interviewing program with parental participation on game addiction behaviors of adolescents with attention deficit hyperactivity disorders. J Psychiatr Nurs Ment Health 2024;38(1):1-14. (in Thai)
Miller WR, Rollnick S. Motivational interviewing: helping people change and grow. 4th ed. New York: Guilford Press; 2023.
Khan MU, Aslani P. Exploring factors influencing medication adherence from initiation to discontinuation in parents and adolescents with attention deficit hyperactivity disorder. Clin Pediatr (Phila) 2020;59(3):285-96. DOI: https://doi.org/10.1177/0009922819900973
Charach A, Ickowicz A, Schachar R. Stimulant treatment over five years: adherence, effectiveness, and adverse effects. J Am Acad Child Adolesc Psychiatry 2004;43(5):559-67. DOI: https://doi.org/10.1097/00004583-200405000-00009
Gau SS, Shen HY, Soong WT, Gau CS. An open-label, randomized, active-controlled equivalent trial of osmotic release oral system methylphenidate in children with attention-deficit/hyperactivity disorder in Taiwan. J Child Adolesc Psychopharmacol 2006;16(4):441-55. DOI: https://doi.org/10.1089/cap.2006.16.441
Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002;111(2):279-89. DOI: https://doi.org/10.1037//0021-843X.111.2.279
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