Department of Clinical Pharmacy, Faculty of Pharmacy, Marmara University, Istanbul, Turkey.
Department of Public Health, School of Medicine, Marmara University, Istanbul, Turkey.
J Clin Pharm Ther. 2022 Oct;47(10):1636-1643. doi: 10.1111/jcpt.13714. Epub 2022 Jun 23.
There are no validated self-report measures to assess extent of and reasons for medication nonadherence in the Turkish language. The aim of this study is to evaluate validity and reliability of the Domains of Subjective Extent of Nonadherence Scale, which assesses extent of and reasons for nonadherence in Turkish patients with hypertension, diabetes mellitus and/or dyslipidaemia in community pharmacy settings.
The Turkish version of the DOSE-Nonadherence scale was developed through translation and cultural adaption. Psychometric properties of the scale were evaluated in a cross-sectional study among 203 patients who visited six community pharmacies located in Istanbul, Turkey between November 2020 and March 2021. For the extent of nonadherence domain, reliability was estimated through Cronbach's alpha, and convergent validity was evaluated with Spearman's rank correlation with the validated Turkish version of the Medication Adherence Report Scale (MARS). Reasons for nonadherence were characterized among participants reporting nonadherence to the extent of nonadherence items. The measure was administered at baseline and 2 weeks later to 30 patients to estimate stability of extent scores using the Wilcoxon test and intraclass correlation coefficient. p < 0.05 was set as the level of statistical significance.
Among the 203 participants (65 male), the median (25th-75th percentiles) age was 59.0 years [51.0-67.0]. Cronbach's alpha for the extent of nonadherence scale was 0.86. A moderate negative correlation (r = -0.58; p < 0.001) was found between the extent of nonadherence scores and MARS, supporting convergent validity. The most common reasons for medication nonadherence were forgetfulness (22.5%) and mismatch between the patients' daily routine and medication taking (17.5%). The intraclass correlation coefficient was 0.97 for extent of nonadherence scores at baseline and 2 weeks (p < 0.001).
The DOSE-Nonadherence Scale could be used to identify nonadherent patients and their reasons for nonadherence in Turkish patients with chronic cardiometabolic conditions. This scale can be used to evaluate clinical pharmacist-led services to reduce medication nonadherence. Nonadherence could be recorded longitudinally in electronic health records to provide a more accurate picture of medication use. Pharmacists or other providers could administer interventions tailored to patients' reasons for nonadherence.
目前，在土耳其语中，没有经过验证的自我报告措施来评估药物治疗不依从的程度和原因。本研究的目的是评估在土耳其社区药房环境中评估高血压、糖尿病和/或血脂异常患者药物治疗不依从程度和原因的主观不依从程度量表的信度和效度。
通过翻译和文化适应，开发了土耳其语版的 DOSE 不依从量表。该量表的心理测量特性在 2020 年 11 月至 2021 年 3 月期间在土耳其伊斯坦布尔的六家社区药房就诊的 203 名患者的横断面研究中进行了评估。对于不依从程度域，通过 Cronbach's alpha 估计信度，通过与经过验证的土耳其版药物依从性报告量表（MARS）的 Spearman 秩相关评估聚合效度。在报告不依从程度项目的不依从的参与者中，描述了不依从的原因。在 30 名患者中，在基线和 2 周后测量该措施，使用 Wilcoxon 检验和组内相关系数估计程度评分的稳定性。p<0.05 为统计学显著性水平。
在 203 名参与者（65 名男性）中，中位（25 至 75 百分位数）年龄为 59.0 岁[51.0-67.0]。不依从程度量表的 Cronbach's alpha 为 0.86。不依从程度评分与 MARS 之间存在中度负相关（r=-0.58；p<0.001），支持聚合效度。药物治疗不依从的最常见原因是健忘（22.5%）和患者日常生活与服药时间不匹配（17.5%）。不依从程度评分的组内相关系数为 0.97，基线和 2 周时分别为 0.97（p<0.001）。
DOSE 不依从量表可用于识别土耳其慢性心脏代谢疾病患者中的不依从患者及其不依从原因。该量表可用于评估临床药师主导的服务，以减少药物治疗不依从。可以在电子健康记录中纵向记录不依从情况，以更准确地了解药物使用情况。药剂师或其他提供者可以根据患者不依从的原因进行量身定制的干预措施。
