The Psychometric Properties and Practicability of Self-Report Instruments to Identify Medication Nonadherence in Adult Transplant Patients: A Systematic Review

Dobbels, Fabienne; Berben, Lut; Geest, Sabina De; Drent, Gerda; Lennerling, Annette; Whittaker, Clare; Kugler, Christiane

doi:10.1097/tp.0b013e3181e346cd

Cited by 203 publications

(244 citation statements)

References 44 publications

(30 reference statements)

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Section: Advantages and Disadvantages Of Self-report Adherence Measuresmentioning

confidence: 99%

“…In addition to providing estimates of medication dose-taking behavior, self-reports can uniquely provide information about adherence determinants such as understanding of the medication regimen, reasons for nonadherence, attitudes and beliefs toward medicines, and other psychosocial factors. In clinical research settings, self-reports are frequently one component of triangulation strategies that combine multiple forms of adherence measurement [40], such as using self-report adherence measures to refine adherence data from electronic drug monitors (EDM) [32].Self-report measures of adherence have several potential disadvantages as well. These include the contestable assumptions that medication adherence behavior can be accurately recalled or reported without deference to social desirability concerns that encourage overreporting (for a review, see [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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Section: Advantages and Disadvantages Of Self-report Adherence Measuresmentioning

confidence: 99%

mentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…32,33 Moreover, BAASIS is the only instrument that has been validated for use among Brazilian Portuguese-speaking transplantation patients. 31 In addition, living donor recipients predominated in our sample.…”

Section: Discussionmentioning

confidence: 99%

“…12 As previously mentioned, to evaluate adherence to immunosuppressive drugs, we applied BAASIS, [32][33][34] as validated for use in Portuguese. 31 BAASIS assesses relevant dimensions of immunosuppressive drug use (i.e.…”

Section: Adherencementioning

confidence: 99%

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

et al. 2015

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CONTEXT AND OBJECTIVE: Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING:We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS: Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS: The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION: Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence. RESUMO

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“…Há alguns instrumentos que avaliam o uso de imunossupressores por meio de pontuações, as quais resultam em um escore que define adesão ou não adesão [16]. Dois instrumentos são muito utilizados para avaliação da adesão à terapia imunossupressora por autorrelato: o Immunosuppressant Therapy Adherence Instrument (ITAS), o qual mensura a adesão nos últimos três meses; e a Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS), que mensura a adesão no último mês [17][18][19]. A BAASIS já foi validada para o Português, em estudo que identificou que 34% dos pacientes transplantados renais não eram aderentes ao tratamento imunossupressor [18].…”

Section: Introductionunclassified

Avaliação da adesão à terapia imunossupressora por autorrelato de pacientes submetidos ao transplante renal

Rocha

Figueiredo

Canabarro

et al. 2017

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. ABSTRACT AIMS: To evaluate the characteristics and risk factors related to the adherence to immunosuppressive treatment of renal transplant patients using the self-report method by means of the Basel Assessment of Adherence Scale for Immunosuppressives (BAASIS). METHODS: A prospective cohort study with a quantitative approach was performed at the Nephrology and Transplantation Service of São Lucas Hospital of the Pontifical Catholic University of Rio Grande do Sul, with patients older than 18 years, transplanted from kidneys from deceased or living donors, with a minimum transplant time of three months and a maximum of 12 months. The BAASIS instrument was applied to evaluate adhesion. For statistical analysis, Fisher exact test (Monte Carlo simulation) was used to verify the association between the categorical variables, Student t test for independent sample means and Mann Whitney test in the variables without normality. A p<0.05 was adopted for the results to be considered significant. RESULTS: The sample consisted of 59 patients, 57.6% of whom were male, 79.7% were white, the mean age was 45.8 years, 57.6% had elementary school and 72.9% were catholic. Hemodialysis was the most used method, in 86.4% of patients before transplantation, and the mean time in the waiting list was 19.5 months. After transplantation, the mean time of hospitalization was 17.2 days. The assessment of adherence by BAASIS characterized 83% of patients as non-adherent. The main fact considered as non-adherence was to take the immunosuppressive drugs with more than two hours difference from the prescribed time, at least once a week, in the last four weeks. There was no significant difference when the statistical analysis was performed to compare the adhesion rate among the various categories of the demographic and clinical variables of the patients. CONCLUSIONS: A high rate of patients not adherent to the immunosuppressive treatment was identified, and the change in the schedule of immunosuppressants was the main fact that characterized this behavior. A shorter waiting time in the transplant queue was associated with non-adherence. The other variables, demographic and clinical, were not associated to the classification of adherent or non-adherent.

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The Psychometric Properties and Practicability of Self-Report Instruments to Identify Medication Nonadherence in Adult Transplant Patients: A Systematic Review

Cited by 203 publications

References 44 publications

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

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

Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

Avaliação da adesão à terapia imunossupressora por autorrelato de pacientes submetidos ao transplante renal

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