ORIGINAL ARTICLE: BEHAVIORAL AND SOCIAL SCIENCES Enhancing homework adherence of Chinese older adults: A case study using Instrumental Reminiscence Intervention Vivian Wei Qun Lou, 1,2 Judith Wing Nam Au 2 and Jacky Chak Pui Choy 2 1 Sau Po Centre on Ageing, The University of Hong Kong, and 2 Department of Social Work & Social Administration, The University of Hong Kong Aim: The present study aimed to examine effective clinical strategies that facilitate homework adherence among Chinese older adults who participated in group therapy using Instrumental Reminiscence Intervention (IRI) to reduce depressive symptoms. Methods: Examination was based on IRI for 15 groups of older adults, with four to eight participants in each group. Homework assignment was included as a core component of the intervention in each session, except the first session. Particular emphasis was put on both homework design and assignment strategies. Results: Two effective strategies were developed. The first was the development of a tactic card as a tool for homework content and assignment. The second strategy was interventionist training. Clinical examples are used to illustrate how these strategies can enhance homework adherence in a Chinese context. Conclusions: The two clinical strategies were found to be effective in enhancing homework adherence among Chinese older participants in a group therapy setting. These strategies are recommended for use in group clinical settings for Chinese participants. Geriatr Gerontol Int ••; ••: ••–••. Keywords: Chinese older adults, group therapy, homework adherence, Instrumental Reminiscence Interventions. Introduction Homework is an essential element of cognitive behav- ioral therapy (CBT). It has been widely reported that good homework adherence is associated with better intervention outcomes. 1–6 Conversely, non-adherence has been found to be a great threat to achieving positive change. 2,7–9 Homework adherence has been found to be especially challenging for older adults and those with depression in particular. 10 A recent meta-analysis on homework effects in cognitive and behavioral therapy has supported this general finding that homework adherence is a factor linked with positive change, but has underlined that published studies are often lacking in details of homework content and assignment strate- gies for specific target groups. 11 It is well acknowledged that psychotherapy is a cul- turally relevant phenomenon, in which cultural context influences motivation to seek psychotherapy and the patient–therapist relationship, as well as how patients respond to therapist intervention. Homework adher- ence is an important issue that deserves cultural-specific understanding so as to guide culturally competent prac- tices. Unfortunately, only a few studies have been pub- lished in the past decade on homework and CBT among Asian populations. For example, awareness training and tension reduction were effective strategies. 12 Formatting homework as action, such as scheduling social events, was suggested. 13 Other research suggested using work- sheets and reading materials. 14 The present study aimed to fill the gap by examining effective strategies that can enhance homework adherence in a Chinese population. The study used a therapeutic group intervention for reducing depressive symptoms, namely Instrumental Reminiscence Intervention (IRI). Based on the quanti- tative analyses in regard to the effectiveness of Instru- mental Reminiscence Intervention - Hong Kong (IRI- HK) in reducing depressive symptoms, the present study aimed to consolidate clinical experiences in effec- tive homework strategies for Chinese older adults; and draw clinical implications to a wider context for apply- ing cognitive-behavioral interventions for low educated older adults in a group setting. IRI-HK for reducing depressive symptoms The present study was part of a larger study examining the effectiveness of IRI for reducing depressive symptoms Accepted for publication 4 July 2015. Correspondence: Dr Vivian WQ Lou PhD, Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam Road, Hong Kong. Email: wlou@hku.hk Geriatr Gerontol Int 2015 © 2015 Japan Geriatrics Society doi: 10.1111/ggi.12595 | 1