AIDS and Behavior

, Volume 12, Issue 1, pp 86–94 | Cite as

Optimal Recall Period and Response Task for Self-Reported HIV Medication Adherence

  • Minyi Lu
  • Steven A. Safren
  • Paul R. Skolnik
  • William H. Rogers
  • William Coady
  • Helene Hardy
  • Ira B. Wilson
Original Paper


Self-reported measures of antiretroviral adherence vary greatly in recall time periods and response tasks. To determine which time frame is most accurate, we compared 3-, 7-day, and 1-month self-reports with data from medication event monitoring system (MEMS). To determine which response task is most accurate we compared three different 1-month self-report tasks (frequency, percent, and rating) to MEMS. We analyzed 643 study visits made by 156 participants. Over-reporting (self-report minus MEMS) was significantly less for the 1-month recall period (9%) than for the 3 (17%) or 7-day (14%) periods. Over-reporting was significantly less for the 1-month rating task (3%) than for the 1-month frequency and percent tasks (both 12%). We conclude that 1-month recall periods may be more accurate than 3- or 7-day periods, and that items that ask respondents to rate their adherence may be more accurate than those that ask about frequencies or percents.


Patient compliance HIV infection HIV infection/drug therapy Questionnaires 



This work was supported by NIDA (R01DA015679), NCRR (K24 RR020300), the Lifespan/Tufts/Brown Center for AIDS Research (P30 AI42853), and the Tufts-New England Medical Center General Clinical Research Center (M01-RR00054).


  1. Apter, A. J., Cheng, J., Small, D., Bennett, I. M., Albert, C., Fein, D. G., et al. (2006). Asthma numeracy skill and health literacy. The Journal of Asthma, 43, 705–710.CrossRefPubMedGoogle Scholar
  2. Arnsten, J. H., Demas, P. A., Farzadegan, H., Grant, R. W., Gourevitch, M. N., Chang, C. J., et al. (2001). Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring. Clinical Infectious Diseases, 33, 1417–1423.CrossRefPubMedGoogle Scholar
  3. Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS, 14, 357–366.CrossRefPubMedGoogle Scholar
  4. Bangsberg, D. R., Hecht, F. M., Clague, H., Charlebois, E. D., Ciccarone, D., Chesney, M., et al. (2001). Provider assessment of adherence to HIV antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 26, 435–442.PubMedGoogle Scholar
  5. Bova, C. A., Fennie, K. P., Knafl, G. J., Dieckhaus, K. D., Watrous, E., & Williams, A. B. (2005). Use of electronic monitoring devices to measure antiretroviral adherence: Practical considerations. AIDS and Behavior, 9, 103–110.CrossRefPubMedGoogle Scholar
  6. Chesney, M. A., Ickovics, J., Hecht, F. M., Sikipa, G., & Rabkin, J. (1999). Adherence: A necessity for successful HIV combination therapy. AIDS, 13(Suppl A), S271–S278.PubMedGoogle Scholar
  7. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient care committee and adherence working group of the outcomes committee of the adult AIDS clinical trials group (AACTG). AIDS Care, 12, 255–266.CrossRefPubMedGoogle Scholar
  8. Cohen, J. (1977). Statistical power analysis for the behavioral sciences. New York: Academic.Google Scholar
  9. Deschamps, A. E., Graeve, V. D., Van, W. E, De, S. V., Vandamme, A. M., Van, V. K., et al. (2004). Prevalence and correlates of nonadherence to antiretroviral therapy in a population of HIV patients using Medication Event Monitoring System. AIDS Patient Care STDS, 18, 644–657.Google Scholar
  10. Dykema, J., & Schaeffer, N. C. (2000). Events, instruments, and reporting errors. American Sociological Review, 65, 619–629.CrossRefGoogle Scholar
  11. Estrada, C., Barnes, V., Collins, C., & Byrd, J. C. (1999). Health literacy and numeracy. JAMA, 282, 527.CrossRefPubMedGoogle Scholar
  12. Gaito, J. (1982) Measurement scales and statistics: Resurgence of an old misconception. Psychological Bulletin, 87, 564–567.CrossRefGoogle Scholar
  13. Gao, X., Nau, D. P., Rosenbluth, S. A., Scott, V., & Woodward, C. (2000). The relationship of disease severity, health beliefs and medication adherence among HIV patients. AIDS Care, 12, 387–398.CrossRefPubMedGoogle Scholar
  14. Gazmararian, J. A., Baker, D. W., Williams, M. V., Parker, R. M., Scott, T. L., Green, D. C., et al. (1999). Health literacy among Medicare enrollees in a managed care organization. JAMA, 281, 545–551.CrossRefPubMedGoogle Scholar
  15. Giordano, T. P., Guzman, D., Clark, R., Charlebois, E. D., & Bangsberg, D. R. (2004). Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clinical Trials, 5, 74–79.CrossRefPubMedGoogle Scholar
  16. Golbeck, A. L., Ahlers-Schmidt, C. R., Paschal, A. M., & Dismuke, S. E. (2005). A definition and operational framework for health numeracy. American Journal of Prevntive Medicine, 29, 375–376.CrossRefGoogle Scholar
  17. Grymonpre, R. E., Didur, C. D., Montgomery, P. R., & Sitar, D. S. (1998). Pill count, self-report, and pharmacy claims data to measure medication adherence in the elderly. The Annals of Pharmacotherapy, 32, 749–754.CrossRefPubMedGoogle Scholar
  18. Hogg, R. S., Heath, K. V., Yip, B., Craib, K. J., O’Shaughnessy, M. V., Schechter, M. T., et al. (1998). Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA, 279, 450–454.CrossRefPubMedGoogle Scholar
  19. Liu, H., Golin, C. E., Miller, L. G., Hays, R. D., Beck, C. K., Sanandaji, S., et al. (2001). A comparison study of multiple measures of adherence to HIV protease inhibitors. Annals of Internal Medicine, 134, 968–977.PubMedGoogle Scholar
  20. Montori, V. M., Leung, T. W., Thompson, C. A., Chung, J. A., Capes, S. E., & Smith, S. A. (2004). Choice of risk representation to enable diabetes decision-making. Diabetes, 53(Suppl 2), A225.Google Scholar
  21. Montori, V. M., & Rothman, R. L. (2005). Weakness in numbers. The challenge of numeracy in health care. Journal of General Internal Medicine, 20, 1071–1072.CrossRefPubMedGoogle Scholar
  22. Nieuwkerk, P. T., & Oort, F. J. (2005). Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis. Journal of Acquired Immune Deficiency Syndromes: JAIDS, 38, 445–448.CrossRefPubMedGoogle Scholar
  23. Oyugi, J. H., Byakika-Tusiime, J., Charlebois, E. D., Kityo, C., Mugerwa, R., Mugyenyi, P., et al. (2004). Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting. Journal of Acquired Immune Deficiency Syndromes: JAIDS, 36, 1100–1102.CrossRefPubMedGoogle Scholar
  24. Palella, F. J., Jr., Delaney, K. M., Moorman, A. C., Loveless, M. O., Fuhrer, J., Satten, G. A. et al. (1998). Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV outpatient study investigators. The New England Journal of Medicine, 338, 853–860.CrossRefPubMedGoogle Scholar
  25. Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine, 133, 21–30.PubMedGoogle Scholar
  26. Pearson, C. R., Simoni, J. M., Hoff, P., Kurth, A. E., & Martin, D. P. (2007). Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. AIDS Behavior, 11, 161–173.CrossRefGoogle Scholar
  27. Peters, E., Vastfjall, D., Slovic, P., Mertz, C. K., Mazzocco, K., & Dickert, S. (2006). Numeracy and decision making. Psychological Science, 17, 407–413.CrossRefPubMedGoogle Scholar
  28. Preston, C. C., & Colman, A. M. (2000). Optimal number of response categories in rating scales: Reliability, validity, discriminating power, and respondent preferences. Acta Psychologica, 104, 1–15.CrossRefPubMedGoogle Scholar
  29. Rogers, W. H., Wilson, I. B., Bungay, K. M., Cynn, D. J., & Adler, D. A. (2002). Assessing the performance of a new depression screener for primary care (PC-SAD). Journal of Clinical Epidemiology, 55, 164–175.CrossRefPubMedGoogle Scholar
  30. Schaeffer, N. C., & Presser, S. (2003). The science of asking questions. Annual Review of Sociology, 29, 65–88.CrossRefGoogle Scholar
  31. Schwartz, L. M., Woloshin, S., Black, W. C., & Welch, H. G. (1997). The role of numeracy in understanding the benefit of screening mammography. Annals of Internal Medicine, 127, 966–972.PubMedGoogle Scholar
  32. Simoni, J. M., Kurth, A. E., Pearson, C. R., Pantalone, D. W., Merrill, J. O., & Frick, P. A. (2006). Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behavior, 10, 227–245.CrossRefGoogle Scholar
  33. Townsend, J. T., Hu, G. G., & Evans, R. J. (1984). Modeling feature perception in brief displays with evidence for positive interdependencies. Perception and Psychophysics, 36, 35–49.PubMedGoogle Scholar
  34. Vanhove, G. F., Schapiro, J. M., Winters, M. A., Merigan, T. C., & Blaschke, T. F. (1996). Patient compliance and drug failure in protease inhibitor monotherapy. JAMA, 276, 1955–1956.CrossRefPubMedGoogle Scholar
  35. Wagner, G. J., Kanouse, D. E., Koegel, P., & Sullivan, G. (2004). Correlates of HIV antiretroviral adherence in persons with serious mental illness. AIDS Care, 16, 501–506.CrossRefPubMedGoogle Scholar
  36. Wagner, G. J., & Rabkin, J. G. (1999). Measuring medication adherence: Is assessment of missed doses sufficient? [letter]. AIDS, 13, 2491–2492.CrossRefPubMedGoogle Scholar
  37. Walsh, J. C., Mandalia, S., & Gazzard, B. G. (2002). Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS, 16, 269–277.CrossRefPubMedGoogle Scholar
  38. Ware, J. J., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefPubMedGoogle Scholar
  39. Wilson, I. B., Tchetgen, E., & Spiegelman, D. (2001). Patterns of adherence with antiretroviral medications: An examination of between-medication differences. Journal of Acquired Immune Deficiency Syndromes, 28, 259–263.PubMedGoogle Scholar
  40. Woloshin, S., Schwartz, L. M., & Welch, H. G. (2005). Patients and medical statistics. Interest, confidence, and ability. Journal of General Internal Medicine, 20, 996–1000.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Minyi Lu
    • 1
  • Steven A. Safren
    • 2
  • Paul R. Skolnik
    • 3
  • William H. Rogers
    • 1
  • William Coady
    • 1
  • Helene Hardy
    • 3
  • Ira B. Wilson
    • 1
  1. 1.Institute for Clinical Research and Health Policy Studies, Department of MedicineTufts-New England Medical CenterBostonUSA
  2. 2.Department of PsychologyMassachusetts General Hospital, Harvard Medical School, Fenway Community Health CenterBostonUSA
  3. 3.Center for HIV/AIDS Care and ResearchBoston University Medical CenterBostonUSA

Personalised recommendations