Behavioral medicine trial design: Time for a change

摘要

We read with great interest the recent editorial on the efficacy of motivational interviewing (MI) for improving medication adherence and thank the authors for drawing attention to the results of the recent Osteoporosis Telephonic Intervention to Improve Medication Adherence (OPTIMA) trial. The authors highlighted that "protocolizing" an MI intervention for large-scale implementation may undermine its effectiveness by moving away from its client-centered, individualized approach, and we agree. You cannot strictly protocolize an MI intervention and call it MI. Trials of MI must tailor the design of their interventions to remain faithful to the theoretical and practical underpinnings of MI.3 The fact that the OPTIMA trial included 10 sessions that each dealt with a specific (predetermined) educational topic suggests that the intervention may have been too structured, thus comprising the integrity of the MI content and the success of the trial.