Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding

Nieuwkerk, Pythia T.; Kolk, Indrek; Prins, Jan M.; Locadia, Mirjam; Sprangers, Mirjam A. G.

doi:10.3851/imp1644

Cited by 46 publications

(37 citation statements)

References 11 publications

(19 reference statements)

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“…Self-report is most commonly used [22] because it is inexpensive, feasible in a wide variety of settings, and is clinically applicable. Yet it tends to overestimate adherence [23,24] because of recall bias or a desire to please the treatment provider and prevent criticism [25,26]. Aside from these problems associated with measurement, it is also not clear what individual-and structural-level factors are associated with greater levels of adherence.…”

Section: Introductionmentioning

confidence: 94%

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

et al. 2011

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This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.

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Section: Introductionmentioning

confidence: 94%

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

et al. 2011

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“…Determining the optimal recall period requires balancing shorter intervals (to improve recall/estimation) with longer intervals (to increase the representativeness of the sampled time period and capture cases of infrequent nonadherence). Studies comparing self-report measures with different recall time frames have determined that 30-day recall intervals reduce ceiling effects relative to shorter intervals [44,68,69,71]. A single-item rating of medication adherence over the last 30 days has been validated against viral load in large HIV patient samples and showed the smallest ceiling effect relative to other self-report measures [44,68,69].…”

Section: Recommendations For Optimizing the Validity Of Self-report Mmentioning

confidence: 99%

“…Nieuwkerk et al [71] used a social desirability scale to stratify a large sample of Dutch HIV patients into those reporting lower vs. higher social desirability concerns. The team found that the relationship between self-report medication adherence and viral load was statistically significant for patients indicating low social desirability concerns, but not for those indicating high social desirability concerns.…”

Section: Recommendations For Optimizing the Validity Of Self-report Mmentioning

confidence: 99%

“…Determining the optimal recall period requires balancing shorter intervals (to improve recall/estimation) with longer intervals (to increase the representativeness of the sampled time period and capture cases of infrequent nonadherence). Studies comparing self-report measures with different recall time frames have determined that 30-day recall intervals reduce ceiling effects relative to shorter intervals [44,68,69,71] Although these findings suggest that estimated adherence over 30-day periods may be optimal, this approach could present concerns when working with populations characterized by significant cognitive impairment or memory problems, such as persons with severe mental illness or dementia. Basic approaches to assist recall include use of medication lists and pill diagrams, as well as anchoring recall to salient events through a timeline follow-back method [5,9].…”

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confidence: 99%

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Self-report measures of medication adherence behavior: recommendations on optimal use

Stirratt

Dunbar‐Jacob

Crane

et al. 2015

Behav. Med. Pract. Policy Res.

594

528

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Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review selfreport medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care. KeywordsAdherence, Compliance, Self-management, Medication, Self-report Valid measurement of medication adherence plays a crucial role in healthcare and health research. When a patient is not benefiting from a medication regimen, clinicians need sound adherence information to determine whether the medication is ineffective or not being taken as prescribed. Assessing medication adherence during routine clinical care can further ensure that individuals in need of adherence support interventions receive them, ideally before deleterious outcomes occur. In the context of clinical research, proper interpretation of proof-of-concept trials testing new pharmacologic regimens requires valid adherence data, because any null findings may stem from poor adherence rather than a lack of drug efficacy. Research designed to understand and promote medication adherence also requires precise methods of adherence assessment.Among many approaches to assessing medication adherence, patient self-report measures remain the most common method [1][2][3][4][5][6]. These measures are defined by asking respondents to characterize their medication adherence behavior. Self-report measures of medication adherence range from simple singleitem questions regarding missed doses to complex multi-item assessments that incorporate reasons for nonadherence [7]. The widespread use of self-report adherence measures in clinical care and research reflects their low cost and ease of implementation across a large variety of medication regimens.There are two primary challenges related to selfreport measures of medication adherence. ImplicationsPractice: Routine assessment of medication...

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“…Social desirability bias (responding in a culturally appropriate and acceptable manner 7 ) is considered as a main contributor to false positive self-report of good adherence. 5, 8 Indeed, self-reported adherence has been found to be lower and a better predictor of treatment outcomes (HIV RNA copies/ml) among HIV infected patients with a low tendency than in those with a high tendency towards socially desirable responses. 8 Social desirability bias is more frequent among the elderly, women, minority, less educated individuals, 9, 10 and among those with low socio-economic status.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with false-positive self-reported adherence to antihypertensive drugs

Tedla

Bautista²

2016

J Hum Hypertens

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Self-reported medication adherence is known to overestimate true adherence. However, little is known about patient factors that may contribute to the upward bias in self-reported medication adherence. The Objective of this study is to examine whether demographic, behavioral, medication, and mood factors are associated with being a false positive self-reported adherer (FPA) to antihypertensive drug treatment. We studied 175 patients (mean age: 50 years; 57% men) from primary care clinics starting antihypertensive drug treatment. Self-reported adherence was measured with the medication adherence report scale (MARS) and by the number of drug doses missed in the previous week/month and compared to pill count adherence (PCAR) as gold standard. Data on adherence, demographic, behavioral, medication, and mood factors were collected at baseline and every three months up to 1 year. FPA was defined as being non-adherer by PCAR and adherer by self-report. Mixed effect logistic regression was used for the analysis. Twenty percent of participants were FPA. Anxiety increased (odds ratio -OR: 3.00; P=0.01), while smoking (OR: 0.40; P=0.03), and drug side effects (OR: 0.46, P=0.03) decreased the probability for FPA by MARS. An educational below completed high school increased the probability of being a FPA as measured by missing doses in the last month (OR: 1.66; P=0.04) and last week (OR: 1.88; P=0.02). The validity of self-reported adherence varies significantly according to drug side effects, behavioral factors, and patient’s mood. Careful consideration should be given to the use of self-reported measures of adherence among patients likely to be false-positive adherers.

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Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding

Cited by 46 publications

References 11 publications

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

Adherence to Highly Active Antiretroviral Therapy (HAART): A Meta-Analysis

Self-report measures of medication adherence behavior: recommendations on optimal use

Factors associated with false-positive self-reported adherence to antihypertensive drugs

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