34 hours ago · These measures are defined by asking respondents to characterize their medication adherence behavior. Self-report measures of medication adherence range from simple single-item questions regarding missed doses to complex multi-item assessments that … >> Go To The Portal
Self-reported PT/PP at a given point in time is not necessarily representative of medication adherence over time. Among chronically ill patients, 3-4 days recall of PT/PP yield adherence estimates, which are practically as reliable and valid as longer intervals and which predict functional outcomes. Publication types
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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.
Self-report measures that can indicate reasons for nonadherence such as the Morisky adherence measure [ 42, 63] may be administered at baseline and during selected visits to ascertain adherence barriers to inform interventions to address and improve these challenges.
10. Research publications should include clear descriptions of any self-report adherence measure, its administration method, and descriptive data resulting from the measure (e.g., mean, median, standard deviation) to help further the science. 1.
Use a self-report adherence measure that specifies a recall period for adherence behavior. A recall period of the last 30 days may reduce ceiling effects relative to shorter intervals. Populations characterized by cognitive impairment may require other approaches (e.g., daily text message or interactive voice response surveys). 8.
Disadvantages of Self-Report Data Self-reports are subject to these biases and limitations: Honesty: Subjects may make the more socially acceptable answer rather than being truthful. Introspective ability: The subjects may not be able to assess themselves accurately.
Self-report studies have validity problems. Patients may exaggerate symptoms in order to make their situation seem worse, or they may under-report the severity or frequency of symptoms in order to minimize their problems. Patients might also simply be mistaken or misremember the material covered by the survey.
The main advantage of self-report is that it is a relatively simple way to collect data from many people quickly and at low cost. ... There are several disadvantages of self-report that threaten the reliability and validity of measurement. ... The situation and location of interviews may also influence self-report measures.More items...
The barriers to medication adherence included four concepts, namely, lifestyle challenges, patient incompatibility, forgetting of medicine use, and nonexpert advice. These concepts are always present in the disease process and reduce the patients' efforts to achieve normal living and adhere to the medication.
The main disadvantage of self-report questionnaires might be the possibility of providing invalid answers. While responding to the items, respondents may not answer truthfully, especially on sensitive questions.
What is a significant limitation of self-report measures of personality? If a person is unaware of the psychological processes that underlie her or his motivations, behaviors, or feelings, those motivations, behaviors, and feelings can't accurately be reported.
A drawback of self-report surveys is the level of accuracy.
However, it appears that self-report is not a valid measure of pattern of SB, which might preclude large scale studies of the impact of pattern of SB and effect of “breaks” using self-report measures.
Researchers have found that self-reported data are accurate when individuals understand the questions and when there is a strong sense of anonymity and little fear of reprisal.” “These results are very similar to those found in other surveys as well as results gathered historically.
This list of potential barriers included:Demographic factors such as age, ethnicity, gender, education, marriage status.Psychosocial factors: beliefs, motivation, attitude.Patient-prescriber relationship.Health literacy.Patient knowledge.Physical difficulties.Tobacco or alcohol intake.Forgetfulness.More items...•
poor patient understanding of the home medication regimen (worse in low literacy or vulnerable populations) lack of experience or expertise by junior providers in eliciting a medication history. inadequate or fragmented health information systems. errors in history taking.
Consequences of nonadherence include worsening condition, increased comorbid diseases, increased health care costs, and death.
Failure to use standardized and validated self-report measures is a common problem in much of health research and clinical practice [ 1, 35 ]. A review of 41 studies of the agreement between adherence self-report measures and EDM devices identified 19 publications that failed to name or describe the particular self-report measure used in the study; these studies showed significantly lower correspondence between self-report and electronically monitored adherence when compared with studies that used named, standardized self-report measures [ 55 ]. With many validated self-report scales available for clinical or research use, there are sound options from which to choose (see Appendix ). It is recommended that researchers and clinicians select a self-report measure that has prior validation data within the relevant chronic illness area and preferably one that has demonstrated both concurrent and criterion validity [ 35 ]. To help improve available information on measures, adherence-related publications should include a clear description of any self-report measure and its administration method, along with descriptive data resulting from the measure (e.g., mean, median, standard deviation) [ 9, 35 ].
Self-report measures may be disadvantageous when used as the primary outcome in clinical trials testing counseling and behavioral interventions to improve medication adherence, because intervention participants may be disproportionately influenced to self-report faithful adherence relative to comparison arm participants. The evidence for this is mixed, however. A study combining data from multiple randomized trials of HIV treatment adherence interventions found no moderation by arm of the association between self-report medication adherence and other estimates of the intervention’s effects, including biological outcomes and EDM data [ 100 ]. Further research is needed to determine whether self-report can be a valid indicator of adherence intervention effects. Until then, randomized controlled trials of adherence interventions would benefit from a more objective method of adherence assessment as the primary study outcome (e.g., EDM devices, prescription refill measures, or multiple measures with complementary properties, such as self-report and adherence biomarkers). Use of multiple measures in adherence research can triangulate intervention effects [ 34, 72] and advance measurement science through comparisons with one another.
Self-report measures that ask participants to make global estimates of their adherence behavior instead of reporting doses missed or doses taken may therefore be helpful. A series of HIV studies [ 44, 68 – 70] have determined that self-report measures with rating scales as response options (e.g., “In the last 30 days, how good a job did you do at taking HIV medicines in the way you were supposed to? Never, rarely, sometimes, usually, almost always, always”) yield greater variability and reduced ceiling effects (i.e., reports of perfect adherence) than measures asking about a specific number of missed doses. Similar findings have emerged in hypertension studies, although Gonzales and colleagues [ 53] found the best performance when asking for an estimate of the percentage of doses taken, rather than rating adherence on a Likert-type scale. This evidence suggests that self-report measures that ask for global estimates of adherence may be preferable.
Key advantages include low-cost, noninvasiveness, minimal patient burden, ease of administration, and flexibility in timing and mode of administration . Self-report medication adherence measures are almost certainly the most practical method of measuring adherence in the context of clinical care and can provide information to providers about nonadherence prior to development of adverse clinical outcomes [ 1, 10, 36 – 39 ]. 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 ].
The large number of patients and complex protocols used in many clinical trials create a need for low-cost, low-burden adherence measures. Adherence assessment may be needed at several junctures during clinical trials. At screening, measures may be needed to assess risk of nonadherence prior to randomization to allow exclusion of participants likely to have problems adhering to the protocol. At baseline, adherence assessment will allow early identification of potential problems so that study resources can be devoted to improving adherence and retention for those likely to have problems adhering. Throughout any trial, monitoring adherence can aid in determining proper drug dosages and identifying low adherence so that staff can intervene to address problems as they develop.
Computer technology has the potential to improve accuracy of self-report by reducing biases caused by social desirability, interviewer characteristics, and questionnaire structure. Studies in many domains have demonstrated that computer administration of sensitive questions has been shown to increase reporting levels of sensitive behaviors, particularly in comparison with interviewer-based administration [ 73, 74] as patients prefer and are more willing to disclose sensitive information to a computer rather than an interviewer [ 74 – 87 ]. Direct computer entry further enhances the quality of data by not allowing double or ambiguous answers [ 88 ], and it is often associated with a lower rate of unanswered questions than paper forms [ 80, 82, 85, 88, 89] because patients must provide a valid response to a question and/or press the “next” button to move on.
Medication adherence has been defined as “the extent to which patients take medications as prescribed by their health care providers” [ 10 ]. A scientific consensus group described the primary components of medication adherence as initiation (i.e., starting a recommended medication regimen), implementation (i.e., executing the prescribed dosage schedule), and persistence (i.e., length of time on regimen before discontinuation) [ 11 ]. Regimen implementation has been the focus of much research and is commonly defined as the percentage of prescribed medication doses taken over a specific time interval [ 10 ].
Self-report questionnaires are used to measure medication adherence, often times both clinically and for research purposes. Despite the presence of several published tools, some may have prohibitive licensure and fee requirements, which researchers should be aware of prior to using them.
Medication non-adherence is one of the well-recognized and persistent challenges in routine clinical practice, particularly in the management of chronic diseases. Medication non-adherence can lead to poor clinical outcomes and increased healthcare costs.
The existence of several questionnaires to measure medication adherence presents researchers with alternative tools to use in people with different health conditions—most of these tools have demonstrated good correlations with certain clinical outcomes, indicating they can be effectively used to understand the relationship between medication non-adherence and various health outcomes.
Data sharing is not applicable to this article as no new data were created or analysed in this study.
Failure to use standardized and validated self-report measures is a common problem in much of health research and clinical practice [ 1, 35 ]. A review of 41 studies of the agreement between adherence self-report measures and EDM devices identified 19 publications that failed to name or describe the particular self-report measure used in the study; these studies showed significantly lower correspondence between self-report and electronically monitored adherence when compared with studies that used named, standardized self-report measures [ 55 ]. With many validated self-report scales available for clinical or research use, there are sound options from which to choose (see Appendix ). It is recommended that researchers and clinicians select a self-report measure that has prior validation data within the relevant chronic illness area and preferably one that has demonstrated both concurrent and criterion validity [ 35 ]. To help improve available information on measures, adherence-related publications should include a clear description of any self-report measure and its administration method, along with descriptive data resulting from the measure (e.g., mean, median, standard deviation) [ 9, 35 ].
Self-report measures may be disadvantageous when used as the primary outcome in clinical trials testing counseling and behavioral interventions to improve medication adherence, because intervention participants may be disproportionately influenced to self-report faithful adherence relative to comparison arm participants. The evidence for this is mixed, however. A study combining data from multiple randomized trials of HIV treatment adherence interventions found no moderation by arm of the association between self-report medication adherence and other estimates of the intervention's effects, including biological outcomes and EDM data [ 100 ]. Further research is needed to determine whether self-report can be a valid indicator of adherence intervention effects. Until then, randomized controlled trials of adherence interventions would benefit from a more objective method of adherence assessment as the primary study outcome (e.g., EDM devices, prescription refill measures, or multiple measures with complementary properties, such as self-report and adherence biomarkers). Use of multiple measures in adherence research can triangulate intervention effects [ 34, 72] and advance measurement science through comparisons with one another.
Self-report measures that ask participants to make global estimates of their adherence behavior instead of reporting doses missed or doses taken may therefore be helpful. A series of HIV studies [ 44, 68 – 70] have determined that self-report measures with rating scales as response options (e.g., “In the last 30 days, how good a job did you do at taking HIV medicines in the way you were supposed to? Never, rarely, sometimes, usually, almost always, always”) yield greater variability and reduced ceiling effects (i.e., reports of perfect adherence) than measures asking about a specific number of missed doses. Similar findings have emerged in hypertension studies, although Gonzales and colleagues [ 53] found the best performance when asking for an estimate of the percentage of doses taken, rather than rating adherence on a Likert-type scale. This evidence suggests that self-report measures that ask for global estimates of adherence may be preferable.
Key advantages include low-cost, noninvasiveness, minimal patient burden, ease of administration, and flexibility in timing and mode of administration . Self-report medication adherence measures are almost certainly the most practical method of measuring adherence in the context of clinical care and can provide information to providers about nonadherence prior to development of adverse clinical outcomes [ 1, 10, 36 – 39 ]. 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 ].
The large number of patients and complex protocols used in many clinical trials create a need for low-cost, low-burden adherence measures. Adherence assessment may be needed at several junctures during clinical trials. At screening, measures may be needed to assess risk of nonadherence prior to randomization to allow exclusion of participants likely to have problems adhering to the protocol. At baseline, adherence assessment will allow early identification of potential problems so that study resources can be devoted to improving adherence and retention for those likely to have problems adhering. Throughout any trial, monitoring adherence can aid in determining proper drug dosages and identifying low adherence so that staff can intervene to address problems as they develop.
Medication adherence has been defined as “the extent to which patients take medications as prescribed by their health care providers” [ 10 ]. A scientific consensus group described the primary components of medication adherence as initiation (i.e., starting a recommended medication regimen), implementation (i.e., executing the prescribed dosage schedule), and persistence (i.e., length of time on regimen before discontinuation) [ 11 ]. Regimen implementation has been the focus of much research and is commonly defined as the percentage of prescribed medication doses taken over a specific time interval [ 10 ].
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 self-report 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.