AIDS and Behavior

, Volume 17, Issue 1, pp 307–318 | Cite as

Evaluation of the Single-Item Self-Rating Adherence Scale for Use in Routine Clinical Care of People Living with HIV

  • B. J. Feldman
  • R. J. Fredericksen
  • P. K. Crane
  • S. A. Safren
  • M. J. Mugavero
  • James H. Willig
  • J. M. Simoni
  • I. B. Wilson
  • M. S. Saag
  • M. M. Kitahata
  • H. M. Crane
Original Paper


The self-rating scale item (SRSI) is a single-item self-report adherence measure that uses adjectives in a 5-point Likert scale, from “very poor” to “excellent,” to describe medication adherence over the past 4 weeks. This study investigated the SRSI in 2,399 HIV-infected patients in routine care at two outpatient primary HIV clinics. Correlations between the SRSI and four commonly used adherence items ranged from 0.37 to 0.64. Correlations of adherence barriers, such as depression and substance use, were comparable across all adherence items. General estimating equations suggested the SRSI is as good as or better than other adherence items (p’s <0.001 vs. <0.001–0.99) at predicting adherence-related clinical outcomes, such as HIV viral load and CD4+ cell count. These results and the SRSI’s low patient burden suggest its routine use could be helpful for assessing adherence in clinical care and should be more widespread, particularly where more complex instruments may be impractical.


HIV Adherence Self-report Visual analogue scale 


El elemento de la escala de autoevaluación (SRSI, por sus siglas en inglés), es una medición del cumplimiento en un autoinforme de un solo elemento, que usa términos descriptivos en una escala de Likert de 5 puntos, que va desde “muy malo” a “excelente”, para describir el cumplimiento con respecto a los medicamentos durante las últimas 4 semanas. Este estudio investigó el SRSI en 2.399 pacientes infectados por VIH, que reciben atención clínica de rutina en dos clínicas ambulatorias de atención primaria para VIH. La correlación entre el SRSI y cuatro elementos de cumplimiento usados generalmente, oscilaba entre 0,37 y 0,64. La correlación de las barreras de cumplimiento, como la depresión y el consumo de drogas, con el SRSI fue similar a la observada en los otros elementos de cumplimiento. Las ecuaciones generales de cálculo sugieren que el SRSI es tan válido como los otros elementos de cumplimiento (p’s <0,001 comparado con <0,001–0,99), en la predicción de resultados clínicos sobre cumplimiento, como la carga viral de VIH y el recuento de células CD4+. Estos resultados, además de la carga baja de pacientes y la fácil administración del SRSI, sugieren que su uso rutinario podría ser útil para evaluar el cumplimiento en la atención clínica y se debería extender, especialmente en los lugares en donde no se pueden utilizar instrumentos más complejos.



We thank the patients of the University of Washington Madison HIV clinic and the University of Alabama, Birmingham 1917 HIV Clinic. This study was supported by Grants from the NIH NIMH RO1 Grant (RO1 MH084759), NIH PROMIS Roadmap (U01 AR057954-S1), the University of Washington Center for AIDS Research NIAID Grant (P30 AI027757), the University of Alabama Birmingham Center for AIDS Research NIAID Grant (P30 AI27767), and the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) Grant (R24 AI067039).


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • B. J. Feldman
    • 1
  • R. J. Fredericksen
    • 1
  • P. K. Crane
    • 1
  • S. A. Safren
    • 2
  • M. J. Mugavero
    • 3
  • James H. Willig
    • 3
  • J. M. Simoni
    • 4
  • I. B. Wilson
    • 5
  • M. S. Saag
    • 3
  • M. M. Kitahata
    • 1
  • H. M. Crane
    • 1
  1. 1.Department of Medicine, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA
  3. 3.Department of MedicineUniversity of Alabama, BirminghamBirminghamUSA
  4. 4.Department of PsychologyUniversity of WashingtonSeattleUSA
  5. 5.Department of Health Services, Policy & PracticeBrown UniversityProvidenceUSA

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