Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology

First Advisor

Robert A DiTomasso, PhD, ABPP, Chairperson

Second Advisor

Barbara A Golden, PsyD, ABPP

Third Advisor

Deborah A Chiumento, PsyD


Treatment nonadherence is a significant problem that can affect not only the healthcare industry, but also more importantly, a patient’s health. Appointment-keeping adherence is expected to supersede all other types of adherence in terms of its importance and sequence. Various interventions have been used to treat nonadherence including appointment-keeping nonadherence within medical practices. Some of these interventions include different types of reminders (phone, letter, cards, etc.) and different types of therapy (motivational interviewing (MI) and cognitive behavioral therapy). Both reminders and MI have been effective in the past in treating appointment-keeping nonadherence. Therefore, will an MI-formatted letter reminder improve appointment-keeping adherence better than a non-MI-formatted letter reminder, phone reminder, and no reminder? Archival data from a university-based primary-care practice that implemented a protocol using varying reminder systems were examined and analyzed for this study. One hundred ninety four patients were randomly selected. The data displayed that MI-formatted reminders (80%) were not significantly better (p = .239) than non-MI-formatted letter reminders (75%), phone reminders (82%), or no reminders (66%). However, reminders as a whole (MI, non-MI and phone combined) were significantly better than no reminders (p = .049). Age was also indicated as a significant predictor (r2 = .048, p = .002) for adherence, but gender was not. Therefore, one can conclude that adding MI to an existing intervention may not improve appointment-keeping adherence; however, the use of a letter format may have hindered its efficacy along with other issues inherent in the study. Overall, reminders are an effective means to improve appointment-keeping adherence.