Support, Educate, Empower: The SEE Personalized Glaucoma Coaching Trial

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PROJECT ABSTRACT Despite the availability of effective treatments, glaucoma causes more people to become irreversibly blind than any other disease worldwide, especially among socially and economically disadvantaged groups. 80% of patients do not adhere to their prescribed glaucoma medications. African Americans and people with lower socio-economic status are more likely to experience poor medication adherence and adverse vision-related outcomes. Because improved adherence is associated with decreased vision loss from glaucoma, there is a critical need to better support the diverse self-management needs of people with glaucoma. Our long-term goal is to substantially increase glaucoma medication adherence among patients from diverse backgrounds by more effectively engaging them in glaucoma self-management behaviors. Our scientific premise is based on prior rigorous National Eye Institute-funded work demonstrating the need for improved self-management support for patients with glaucoma. Evidence-based communication, education, and outreach strategies, such as tailored education, motivational-interviewing (MI) based counseling and reminder systems, can improve adherence and outcomes for diverse patients. Our central hypothesis is that glaucoma patients with poor adherence who participate in the Support, Educate and Empower (SEE) Program will improve their medication adherence. In the SEE Program, participants receive 1) Personally tailored education generated by an eHealth application delivered in-person combined with MI-based counseling from a health educator trained as a glaucoma coach and 2) reminders tailored to participant preference including audible or visual alerts and/or text or phone calls when a dose is missed. Our overall objective is to test whether the SEE Program, compared to standard care, improves medication adherence through a randomized clinical trial among 230 glaucoma patients with poor medication adherence at enrollment. An essential component of the SEE Program is its inclusion of non-physician health care providers—health educators— to provide the education, counseling, and support that glaucoma patients with poor adherence require. Impact: Upon completion of the trial, we will have rigorously evaluated an intervention that is highly scalable and sustainable due to its application of eHealth technologies and use of non-physician providers. The evidence from this study will inform effective behavior-change strategies and approaches to address racial and socioeconomic disparities in glaucoma outcomes. Ultimately, our findings will inform and shape clinical practice guidelines by promoting evidence-based models that improve medication adherence and visual outcomes.