Rodrigues Malvina Thaís Pacheco, Moreira Thereza Maria Magalhães, Andrade Dalton Francisco de
Colégio Técnico de Teresina, Universidade Federal do Piauí, Teresina, PI, Brasil.
Universidade Estadual do Ceará, Fortaleza, CE, Brasil.
Rev Saude Publica. 2014 Apr;48(2):232-40. doi: 10.1590/s0034-8910.2014048005044.
To elaborate and validate an instrument of adherence to treatment for systemic arterial hypertension, based on Item Response Theory.
The process of developing this instrument involved theoretical, empirical and analytical procedures. The theoretical procedures included defining the construct of adherence to systemic arterial hypertension treatment, identifying areas involved and preparing the instrument. The instrument underwent semantic and conceptual analysis by experts. The empirical procedure involved the application of the instrument to 1,000 users with systemic arterial hypertension treated at a referral center in Fortaleza, CE, Northeastern Brazil, in 2012.. The analytical phase validated the instrument through psychometric analysis and statistical procedures. The Item Response Theory model used in the analysis was the Samejima Gradual Response model.
Twelve of the 23 items of the original instrument were calibrated and remained in the final version. Cronbach's alpha coefficient (α) was 0.81. Items related to the use of medication when presenting symptoms and the use of fat showed good performance as they were more capable of discriminating individuals who adhered to treatment. To ever stop taking the medication and the consumption of white meat showed less power of discrimination. Items related to physical exercise and routinely following the non-pharmacological treatment had most difficulty to respond. The instrument was more suitable for measuring low adherence to hypertension treatment than high.
The instrument proved to be an adequate tool to assess adherence to treatment for systemic arterial hypertension since it manages to differentiate individuals with high from those with low adherence. Its use could facilitate the identification and verification of compliance to prescribed therapy, besides allowing the establishment of goals to be achieved.
基于项目反应理论，阐述并验证一种用于系统性动脉高血压治疗依从性的工具。
开发该工具的过程涉及理论、实证和分析程序。理论程序包括定义系统性动脉高血压治疗依从性的结构、确定所涉及的领域并准备该工具。该工具由专家进行语义和概念分析。实证程序涉及2012年在巴西东北部塞阿拉州福塔莱萨的一个转诊中心，将该工具应用于1000名接受系统性动脉高血压治疗的患者。分析阶段通过心理测量分析和统计程序对该工具进行验证。分析中使用的项目反应理论模型是Samejima渐进反应模型。
原始工具的23个项目中有12个经过校准并保留在最终版本中。克朗巴赫α系数（α）为0.81。与出现症状时使用药物和脂肪摄入相关的项目表现良好，因为它们更能区分坚持治疗的个体。曾经停止服药和白肉消费的区分能力较弱。与体育锻炼和常规遵循非药物治疗相关的项目最难做出反应。该工具更适合测量高血压治疗的低依从性而非高依从性。
该工具被证明是评估系统性动脉高血压治疗依从性的合适工具，因为它能够区分高依从性个体和低依从性个体。它的使用除了有助于确定目标外，还可以促进对规定治疗依从性的识别和核查。
