Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
PLoS One. 2020 Nov 11;15(11):e0242051. doi: 10.1371/journal.pone.0242051. eCollection 2020.
To date, several medication adherence instruments have been developed and validated worldwide. However, most instruments have only assessed medication adherence from the patient's perspective. The aim was to develop and validate the PATIENT-Medication Adherence Instrument (P-MAI) and the HEALTHCARE PROFESSIONAL-Medication Adherence Instrument (H-MAI) to assess medication adherence from the patient's and healthcare professional (HCP)'s perspectives. The P-MAI-12 and H-MAI-12 were developed using the nominal group technique. The face and content validity was determined by an expert panel and piloted. The initial version of these instruments consisted of 12 items were validated from October-December 2018 at a primary care clinic in Malaysia. Included were patients aged ≥21 years, diagnosed with diabetes mellitus, taking at least one oral hypoglycaemic agent and who could understand English. The HCPs recruited were family medicine specialists or trainees. To assess validity, exploratory factor analysis (EFA) and concurrent validity were performed; internal consistency and test-retest were performed to assess its reliability. A total of 120/158 patients (response rate = 75.9%) and 30/33 HCPs (response rate = 90.9%) agreed to participate. EFA found three problematic items in both instruments, which was then removed. The final version of the P-MAI-9 and the HMAI-9 had 9 items each with two domains (adherence = 2 items and knowledge/belief = 7 items). For concurrent validity, the total score of the P-MAI-9 and the H-MAI-9 were not significantly different (p = 0.091), indicating that medication adherence assessed from both the patient's and HCP's perspectives were similar. Both instruments achieved acceptable internal consistency (Cronbach's α: P-MAI-9 = 0.722; H-MAI-9 = 0.895). For the P-MAI-9, 7/9 items showed no significant difference between test and retest whereas 8/9 items in the H-MAI-9 showed significant difference at test and retest (p>0.05). In conclusion, the P-MAI-9 and H-MAI-9 had low sensitivity and high specificity suggesting that both instruments can be used for identifying patients more likely to be non-adherent to their medications.
迄今为止，全球已经开发并验证了几种药物依从性工具。然而，大多数工具仅从患者角度评估药物依从性。本研究旨在开发并验证患者-药物依从性工具（P-MAI）和医疗保健专业人员-药物依从性工具（H-MAI），以从患者和医疗保健专业人员（HCP）的角度评估药物依从性。P-MAI-12 和 H-MAI-12 使用名义群体技术开发。通过专家小组确定其表面效度和内容效度，并进行预试验。这些工具的初始版本由 12 个项目组成，于 2018 年 10 月至 12 月在马来西亚的一家初级保健诊所进行验证。纳入标准为年龄≥21 岁、诊断为糖尿病、至少服用一种口服降糖药且能理解英语的患者。招募的 HCP 为家庭医学专家或受训人员。为评估有效性，进行了探索性因子分析（EFA）和同时效性；进行内部一致性和重测以评估其可靠性。共有 120/158 名患者（应答率=75.9%）和 30/33 名 HCP（应答率=90.9%）同意参与。EFA 发现两个工具中都有三个有问题的项目，然后将其删除。最终的 P-MAI-9 和 H-MAI-9 各有 9 个项目，分为两个领域（依从性=2 个项目和知识/信念=7 个项目）。对于同时效性，P-MAI-9 和 H-MAI-9 的总分没有显著差异（p=0.091），表明从患者和 HCP 角度评估的药物依从性相似。两个工具都具有可接受的内部一致性（Cronbach's α：P-MAI-9=0.722；H-MAI-9=0.895）。对于 P-MAI-9，7/9 个项目在测试和重测之间没有显著差异，而 H-MAI-9 中有 8/9 个项目在测试和重测之间有显著差异（p>0.05）。总之，P-MAI-9 和 H-MAI-9 的敏感性低而特异性高，表明这两个工具都可用于识别更可能不依从药物的患者。
