Abstract
Few self-report measures of medication adherence have been rigorously developed and validated against electronic drug monitoring (EDM). Assess the validity of the 3-item self-report scale by comparing it with a contemporaneous EDM measure. We conducted an observational study in which adherence assessments were done monthly for up to 4 months for 81 patients with HIV who were taking antiretroviral medications. We report results for both HIV antiretroviral medications, and also for other, non-HIV-related medications. Raw and calibrated self-report adherence measures, electronic drug monitoring adherence measures, and sociodemographic variables. The mean age of patients was 46 years, 37 % were female, 49 % had some education beyond high school, 22 % were Black, and 22 % were Hispanic. Cronbach’s alphas for the 3-item scale for HIV and non-HIV medications were 0.83 and 0.87, respectively. The mean differences (raw/uncalibrated self-report scale minus EDM) for HIV and non-HIV medications were 7.5 and 5.2 points on a 100-point scale (p < 0.05 for both). Pearson correlation coefficients between the calibrated 3-item scale and the EDM for HIV and non-HIV medications were 0.47 and 0.59, respectively. The c-statistics for the ROC curves for the calibrated scale, using cut-offs of 0.8 and 0.9 for the EDM gold standard measure to define non-adherence, were between 0.74 and 0.76 for HIV and non-HIV medications. This 3-item adherence self-report scale showed good psychometric characteristics and good construct validity when compared with an EDM standard, for both HIV and non-HIV medications. In clinical care it can be a useful first-stage screener for non-adherence. In clinical research and quality improvement settings it can be a useful tool when more complex and expensive methods such as EDM or pharmacy claims are impractical or unavailable.
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Funding
This work was supported by the National Institute of Mental Health at the National Institutes of Health (Grant No. RO1 MH 092238). Dr. Wilson was also supported by a K24 Grant (2K24MH092242).
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The authors declare that they have no conflict of interest.
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This work was presented in abstract form at the Pittsburgh Conference on the Science of Medication Adherence, Pittsburgh, PA. June 2, 2015.
Appendices
Appendix 1
In the last 30 days, on how many days did you miss at least one dose of any of your [drug name]?
Write in number of days: ____ (0–30)
In the last 30 days, how good a job did you do at taking your [drug name] in the way you were supposed to?
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□ Very poor
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□ Poor
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□ Fair
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□ Good
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□ Very good
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□ Excellent
In the last 30 days, how often did you take your [drug name] in the way you were supposed to?
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□ Never
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□ Rarely
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□ Sometimes
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□ Usually
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□ Almost always
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□ Always
Appendix 2
See Table 3.
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Wilson, I.B., Lee, Y., Michaud, J. et al. Validation of a New Three-Item Self-Report Measure for Medication Adherence. AIDS Behav 20, 2700–2708 (2016). https://doi.org/10.1007/s10461-016-1406-x
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DOI: https://doi.org/10.1007/s10461-016-1406-x