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

Ana F. El-Behadli, Julie N. Germann, Chelsea Pratt, Dailyn Acosta, Raul Montiel-Esparza, Nancy Alvarez, NaomiWinick, Melissa A Faith

Research output: Contribution to journalArticlepeer-review


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 “norisk” 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.

Original languageEnglish (US)
JournalClinical Practice in Pediatric Psychology
StateAccepted/In press - 2022


  • Adherence
  • Chemotherapy
  • Fidelity
  • Motivational interviewing
  • Pediatric oncology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Clinical Psychology
  • Applied Psychology


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