Methodological Issues in the Assessment of Diabetes Treatment Adherence
Psychosocial Aspects (Korey Hood, Section Editor)
First Online: 29 September 2011 DOI:
Cite this article as: Gonzalez, J.S. & Schneider, H.E. Curr Diab Rep (2011) 11: 472. doi:10.1007/s11892-011-0229-4 Abstract
Improving treatment adherence in patients with diabetes remains an important objective of behavioral science research. However, progress is often limited by the heterogeneity in methods used to measure treatment adherence and difficulties in generalizing across methodologies. Various measurement methods are often used with little attention paid to questions regarding validity. Doubts about validity of adherence measurement often lead investigators to measure distal clinical outcomes instead, such as glycemic control, resulting in a loss of information. This article provides an overview of the literature on diabetes medication adherence, with a focus on measurement issues. We also consider work conducted in other chronic illnesses, particularly HIV/AIDS, that may have value in guiding future directions of diabetes medication adherence research. We highlight the need for focused investigation on how characteristics of self-report methodologies affect the validity of patient responses and conclude with practical recommendations based on the current state of the science.
Keywords Diabetes Adherence Validity Self-report Compliance Medication adherence Treatment adherence Measurement Reliability Methodologic issues References Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Lerman I. Adherence to treatment: The key for avoiding long-term complications of diabetes. Arch Med Res. 2005;36(3):300–6.
Odegard P, Capoccia K. Medication taking and diabetes: a systematic review of the literature. Diabetes Educ. 2007;33(6):1014–29.
Pladevall M, Williams LK, Potts LA, et al. Clinical outcomes and adherence to medications measured by claims data in patients with diabetes. Diabetes Care. 2004;27(12):2800–5.
Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care. 2004;27(9):2149–53.
Ho PM, Rumsfeld JS, Masoudi FA, et al. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med. 2006;166(17):1836–41.
Rubin RR. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 2005;118(5A):27S–34S.
Cramer J. A systematic review of adherence with medications for diabetes. Diabetes Care. 2004;27(5):1218–24.
• Hansen RA, Kim MM, Song L, et al. Comparison of methods to assess medication adherence and classify nonadherence. Ann Pharmacother. 2009;43(3):413–22.
This article compared different methods to assess adherence: self-report, pharmacy refill, and MEMS data in patients with hypertension or heart failure. High concordance between pharmacy refill and MEMS data and weaker concordance was found between those methods and self-report
• Karve S, Cleves MA, Helm M, et al. An empirical basis for standardizing adherence measures derived from administrative claims data among diabetic patients. Med Care. 2008;46(11):1125–1133.
This article compared eight different ways of measuring adherence via pharmacy claims data in a population with diabetes to find which were most predictive of diabetes-specific hospitalizations
Farmer KC. Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice. Clin Ther. 1999;21(6):1074–90.
Murri R, Antinori A, Ammassari A, et al. Physician estimates of adherence and the patient-physician relationship as a setting to improve adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31:S158–62.
Walshe L, Saple D, Mehta S, et al. Physician estimate of antiretroviral adherence in India: poor correlation with patient self-report and viral load. AIDS Patient Care STDS. 2010;24(3):189–95.
Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002;25(6):1015–21.
Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353:487–97.
Cook CL, Wade WE, Martin BC, Perri M. Concordance among three self-reported measures of medication adherence and pharmacy refill records. J Am Pharm Assoc. 2005;45(2):151–9.
Ailinger RL, Black PL, Lima-Garcia N. Use of electronic monitoring in clinical nursing research. Clin Nurs Res. 2008;17(2):89–97.
Walker EA, Molitch M, Kramer M, et al. Adherence to preventive medications. Diabetes Care. 2006;29:1997–2002.
Hearnshaw H, Lindenmeyer A. What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements. Diabet Med. 2006;23(7):720–8.
•• Asche C, LaFleur J, Conner C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin Ther. 2011;33(1):74–109.
This article summarizes the empiric studies of the association between adherence and glycemic control, health care utilization, quality of life, and mortality in patients with diabetes
Glasgow RE, McCaul KD, Schafer LC. Self-care behaviors and glycemic control in type I diabetes. J Chronic Dis. 1987;40(5):399–412.
Toobert D, Hampson S, Glasgow R. The summary of diabetes self-care activities: results from 7 studies and a revised scale. Diabetes Care. 2007;23:943–50.
Morisky D, Green L, Levin D. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67–74.
• Cohen HW, Shmukler C, Ullman R, Rivera CM, Walker EA. Measurements of medication adherence in diabetic patients with poorly controlled HbA1c. Diabet Med. 2010;27(2):210–216.
This article compares self-reported adherence to pharmacy refill data and HbA
1c levels in patients with diabetes
•• Schneider H, Gonzalez JS, Psaros C, et al. Validating self-reported adherence in type 2 diabetes [abstract B-044]. Presented at the XXXII Society of Behavioral Medicine Conference. Washington, DC, April 27–30, 2011.
This study examines the validity of different self-report adherence questions through a comparison with MEMS data and glycemic control in adult patients with type 2 diabetes.
•• Lu M, Safren SA, Skolnik PR, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.
This article examines the validity of different self-report adherence questions over different time frames with MEMS data to determine what response format and time frame are most valid in patients with HIV/AIDS
Nichol MB, Venturini F, Sung JC. A critical evaluation of the methodology of the literature on medication compliance. Ann Pharmacother. 1999;33(5):531–40.
Morisky DE, An A, Krousel-Wood MA, Ward H. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens. 2008;10:348–54.
Krousel-Wood M, Islam T, Webber LS. New medication adherence scale versus pharmacy fill rates in seniors with hypertension. Am J Manag Care. 2009;15(1):59–66.
Paterson DL, Swindelis S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.
Chesney M. Adherence to HAART regimens. AIDS Patient Care STDS. 2003;17:169–77.
Llabre MM, Weaver KE, Duran RE, et al. A measurement model of medication adherence to highly active antiretroviral therapy and its relation to viral load in HIV-positive adults. AIDS Patient Care STDS. 2006;20(10):701–11.
Liu H, Golin C, Miller L, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134:968–77.
• Osborn CY, Egede LE. Validation on an Information-Motivation-Behavioral Skills model of diabetes self-care (IMB-DSC). Patient Educ Couns. 2010;79(1):49–54.
This article applied a latent variable approach to the measurement of diabetes treatment adherence in an evaluation of an information-motivation-behavioral skills model of factors that guide diabetes self-care
•• Wilson IB, Carter AE, Berg KM. Improving the self-report of HIV antiretroviral medication adherence: Is the glass half full or half empty? Curr HIV/AIDS Rep. 2009;6(4):177–186.
This review discusses research in cognitive psychology that is relevant for self-report measures; it also examines the association between self-report and objective methods of adherence in patients with HIV and related methodologic concerns
• Kalichman S, Amaral C, Cherry C, et al. Monitoring medication adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clin Trials. 2008;9(5):298–308.
This article presents the methodology and psychometric data that support the use of telephone-based pill counts as a practical method to assess patient adherence
Kalichman S, Amaral C, Swetsze C, et al. Monthly unannounced pill counts for monitoring HIV treatment adherence: tests for self-monitoring and reactivity effects. HIV Clin Trials. 2010;11(6):325–31.
Wysocki T. Behavioral assessment and intervention in pediatric diabetes. Behav Modif. 2006;30:72–92.
• Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics. 2009;124(6):1171–1179.
This meta-analysis consolidates findings from 21 studies on the relationship between treatment adherence and glycemic control in pediatric type 1 diabetes. Results suggest that the relationship is stable across methods of measurement and patient populations but modest in size
CrossRef Copyright information
© Springer Science+Business Media, LLC 2011