Culturally Adapted Motivational Interviewing for Pediatric Acute Lymphoblastic Leukemia Adherence: Feasibility and Acceptability

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Abstract

Objective: Acute lymphoblastic leukemia (ALL) treatment mandates 2 to 3 years of maintenance therapy that includes daily oral 6-mercaptopurine (6-MP). Unfortunately, 6-MP nonadherence is linked with progressive relapse risk. This study evaluated feasibility, acceptability, and fidelity of a motivational interviewing (MI) intervention targeting 6-MP adherence during pediatric ALL maintenance therapy. Methods: We randomized 80 caregivers to receive a single MI session and 42 to an education-only control condition. Participants completed self-report measures about demographics, 6-MP adherence, and intervention acceptability. MI sessions were delivered during a routine clinic visit and were fidelity-coded using Motivational Interviewing Treatment Integrity 4.2.1 coding. Results: Findings confirmed MI feasibility and acceptability during routine outpatient clinic visits. In the MI condition, 92.5% of caregivers completed the MI session and 96.20% reported strong MI acceptability. We found no differences in enrollment, completion, or MI acceptability by cultural group. All Spanish-delivered MI sessions addressed social contextual stressors and/or culture-specific values. Conclusions: MI may represent a “no-risk” approach to improving adherence and potentially enhancing cure. This study demonstrates feasibility and acceptability of MI during routine clinic visits, providing the basis for a larger randomized trial. Implications for Impact Statement This study evaluated MI feasibility and acceptability to promote oral chemotherapy adherence during pediatric acute lymphoblastic leukemia treatment. We found strong evidence for feasibility and acceptability among majority and ethnic minority participants. Additional study is needed to evaluate intervention effectiveness. MI may present a new way to enhance oral chemotherapy adherence.

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