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 glaucoma medications. African Americans and people with lower socio-economic status are more likely to experience poor medication adherence and adverse vision outcomes. Because improved adherence is related to decreased glaucomatous vision loss, there is a critical need to improve education and counseling to meet the diverse self-management needs of people with glaucoma, using readily available clinical personnel and resources. 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 previous National Eye Institute-funded work demonstrating the need for improved self-management support for patients with glaucoma. Rigorous, 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 receive MI-based counseling and personally tailored education from a trained non-physician eye care professional alongside reminders through the SEE Program will improve their medication adherence. 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. It is essential to better utilize health care team members to provide support to glaucoma patients with poor adherence. Our study will test the model of using health educators trained as glaucoma coaches to provide tailored education and counseling to improve glaucoma medication adherence. Impact: Upon completion of the trial, we will have rigorously evaluated an intervention that, by leveraging para-professional staff, is highly scalable and sustainable. The evidence from this study will inform effective behavior-change strategies and approaches to address race and income-based disparities in glaucoma outcomes. Ultimately, robust findings will shape clinical practice guidelines by promoting evidence-based models that will improve overall medication adherence and visual outcomes.
