Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ)
Main Article Content
Keywords
Asthma, Adherence to medication, Compliance, Questionnaire, Self-report, Scale, Survey
Abstract
Background: Adherence to medication is the cornerstone to achieve the best treatment outcome. Pharmacists are healthcare professionals found in a pivotal position to assess asthmatic patients’ adherence to medication. A brief, reliable, and valid measure of patients adherence to mediations is useful to enable the pharmacists to deliver that vital service. Objective: To develop a reliable and valid adherence assessment tool for asthmatic patients. Methods: The Adherence to Asthma Medication Questionnaire (AAMQ-13) was developed based on an extensive literature review, followed by applying the Delphi technique, and then it was pilot-tested by 55 patients. The final AAMQ-13 was completed by 213 patients. Psychometric evaluation was assessed including reliability, criterion validity, and construct validity. Results: The AAMQ-13 is a feasible 13-item questionnaire, as it can be completed within an average of two minutes. It has high reliability (Cronbach’s alpha= 0.87). Criterion-concurrent validity was established by comparing the AAMQ-13 to the Test of the Adherence to Inhaler (TAI) and the pharmacy refill records. Criterion-convergent validity was established by comparing the AAMQ-13 to the Asthma Control Test (ACT) questionnaire and the Positive Health Behaviors Scale (PHBS). Construct validity was established through AAMQ-13 factor analysis which revealed two factors explaining 51.76% of the total variance. Conclusion: The AAMQ-13 is a reliable and valid questionnaire with several desirable characteristics as it has high reliability, good criterion validity, and strong construct validity. The AAMQ-13 is a suitable questionnaire that can identify non-adherent patients and reveal the reasons behind their non-adherence
References
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25. Plaza V. Update on questionnaires for assessing adherence to inhaler devices in respiratory patients. Curr Opin Allergy Clin Immunol. 2017;18(1):44-50. https://doi.org/10.1097/ACI.0000000000000410
26. Kim MT, Hill MN, Bone LR, et al. Development and Testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.Prog Cardiovasc Nurs. 2000;15(3):90-96. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x
27. Plaza V, Fernandez-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2015;29(2):142-152. https://doi.org/10.1089/jamp.2015.1212
28. Svarstad BL, Chewing BA, Sleath BL, et al. The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-124. https://doi.org/10.1016/s0738-3991(98)00107-4
29. Culig J, Leppée M. From Morisky to Hill-Bon; Self-Reports Scales for Measuring Adherence to Medication. Coll Antropol.2014;38:55-62.
30. Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc.2011;51(1):90-94. https://doi.org/10.1331/JAPhA.2011.09154
31. Nguyen T, Caze A La, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br JClin Pharmacol. 1999;77(3):427-445. https://doi.org/10.1111/bcp.12194
32. Luckie K, Pharmacy BMHL, Pang TC, et al. Development and validation of an asthma first aid knowledge questionnaire. Res Soc Adm Pharm. 2018;14(5):459-463. https://doi.org/10.1016/j.sapharm.2017.05.014
33. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-1015.https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x
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39. Woynarowska-Sołdan M, Panczyk M, Iwanow L, et al. Validation of the positive health behaviours scale: a nationwide survey of nurses in Poland. Int J Occup Saf Ergon. 2019;25(1):76-85. https://doi.org/10.1080/10803548.2018.1436124
40. Andrade SE, Kahler KH, Frech F, et al. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565-574. https://doi.org/10.1002/pds.1230
41. Pallant J. SPSS Survival Manual. McGraw-Hill Education. Open University Press; 2016.
42. Schatz M, Zeiger RS, Yang S, et al. Development and preliminary validation of the adult asthma adherence questionnaireTM. JAllergy Clin Immunol Pract. 2013;1(3):280-288. https://doi.org/10.1016/j.jaip.2013.03.001
43. Mark TL, Johnson G, Fortner B, et al. The benefits and challenges of using computer-assisted symptom assessments in oncology clinics: Results of a qualitative assessment. Technol Cancer Res Treat. 2008;7(5):401-405. https://doi.org/10.1177/153303460800700508
44. Rolstad S, Adler J, Rydén A. Response Burden and Questionnaire Length: Is Shorter Better? A Review and Meta-analysis. Value Heal. 2011;14(8):1101-1108. https://doi.org/10.1016/j.jval.2011.06.003
45. Brown MT, Bussell JK. Medication Adherence: WHO Cares? Mayo Clin Proc. 2011;86(4):304-314. https://doi.org/10.4065/mcp.2010.0575
46. Readdean KC, Parrott JS, Heuer AJ. Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis. Res Soc Adm Pharm. 2018;14(4):321-331. https://doi.org/10.1016/j.sapharm.2017.05.008
47. Choi TN, Westermann H, Sayles W, et al. Beliefs About Asthma Medications: Patients Perceive. J Asthma. 2008;45(5):409-414.https://doi.org/10.1080/02770900801971834
48. Icek A. The Theory of Planned Behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211.
49. Plaza V. Update on questionnaires for assessing adherence to inhaler devices in respiratory patients. Curr Opin Allergy Clin Immunol. 2018;18(1):44-50. https://doi.org/10.1097/ACI.0000000000000410
50. Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983;13(1):177-183. https://doi.org/10.1017/s0033291700050182
51. Risser J, Jacobson TA, Kripalani S. Development and Psychometric Evaluation of the Self-Efficacy for AppropriateMedication Use Scale (SEAMS) in Low-Literacy Patients with Chronic Disease. J Nurs Meas. 2007;15(3):203-219. https://doi. org/10.1891/106137407783095757
2. Jabeen U, Zeeshan F, Bano I, et al. Adherence to asthma treatment and their association with asthma control in children.JPMA. 2018;68(5):725-728.
3. Larsson K, Kankaanranta H, Janson C, et al. Bringing asthma care into the twenty- first century. npj Prim Care Respir Med.2020;30(1):1-11. https://doi.org/10.1038/s41533-020-0182-2
4. Donner CF, Amaducci S, Bacci E, et al. Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD. Monaldi Arch Chest Dis. 2018;88(886):14-36. https://doi.org/10.4081/monaldi.2018.886
5. Taylor TE, Zigel Y, Looze C De, et al. Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery.Chest J. 2017;153(3):710-722. https://doi.org/10.1016/j.chest.2017.08.1162
6. Lee J, Tay TR, Radhakrishna N, et al. Non-adherence in the era of severe asthma biologics and thermoplasty. Eur Respir J.2018;51(4). https://doi.org/10.1183/13993003.01836-2017
7. De Geest S, Sabaté E. Adherence to long-term therapies: Evidence for action. 2003;2(4):323. https://doi.org/10.1016/S1474-5151(03)00091-4
8. Bae SG, Kam S, Park KS, et al. Factors related to intentional and unintentional medication nonadherence in elderly patients
with hypertension in rural community. Patient Prefer Adherence. 2016;10:1979-1989. https://doi.org/10.2147/PPA.S114529
9. Garfield S, Clifford S, Eliasson L, et al. Suitability of measures of self-reported medication adherence for routine clinical use: Asystematic review. BMC Med Res Methodol. 2011;11(149). https://doi.org/10.1186/1471-2288-11-149
10. Stirratt MJ, Dunbar-jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. TBM Pract PUBLIC Heal POLICIES. 2015;5(4):470-482. https://doi.org/10.1007/s13142-015-0315-2
11. Monnette A, Zhang Y, Shao H, et al. Concordance of Adherence Measurement Using Self-Reported Adherence Questionnaires and Medication Monitoring Devices : An Updated Review. Pharmacoeconomics. 2018;36(1):17-27. https://doi.org/10.1007/s40273-017-0570-9
12. Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983;13(1):177-183. https://doi.org/10.1017/s0033291700050182
13. Voruganti LNP, Awad AG. Personal evaluation of transitions in treatment (PETiT): a scale to measure subjective aspects of antipsychotic drug therapy in schizophrenia. Schizophr Res. 2002;56(1-2):37-46. https://doi.org/10.1016/s0920-9964(01)00161-x
14. Svarstad BL, Chewing BA, Sleath BL, et al. The brief medication questionnaire : A tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-124. https://doi.org/10.1016/s0738-3991(98)00107-4
15. Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42(3):241-247. https://doi.org/10.1016/s0920-9964(99)00130-9
16. Martinez CE, Sossa MP, Rand CS. Validation of a Questionnaire for Assessing Adherence to Metered-Dose Inhaler Use in Asthmatic Children. Pediatr Asthma Allergy Immunol. 2007;20(4):243-254. https://doi.org/10.1089/pai.2007.001
17. Byerly MJ, Nakonezny PA, Rush AJ. The Brief Adherence Rating Scale (BARS) validated against electronic monitoring in assessing the antipsychotic medication adherence of outpatients with schizophrenia and schizoaffective disorder. Schizophr Res. 2008;100(1-3). https://doi.org/10.1016/j.schres.2007.12.470
18. Kim MT, Hill MN, Bone LR, et al. Development and Testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Prog Cardiovasc Nurs. 2000;15(3):90-96. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x
19. Kripalani S, Risser J, Gatti ME, et al. Development and Evaluation of the Adherence to Refills and Medications Scale (ARMS)among Low-Literacy Patients with Chronic Disease. Value Heal. 2009;12(1):118-123. https://doi.org/10.1111/j.1524-4733.2008.00400.x
20. Risser J, Jacobson TA, Kripalani S. Development and Psychometric Evaluation of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) in Low-Literacy Patients With Chronic Disease. J Nurs Meas. 2007;15(3):203-219. https://doi.org/10.1891/106137407783095757
21. Cohen JL, Mann DM, Wisnivesky JP, et al. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma. Ann Allergy, Asthma Immunol. 2009;103(4):325-331. https://doi.org/10.1016/s1081-1206(10)60532-7
22. Miravitlles M, Soler-cataluña JJ, Alcázar B, et al. Factors affecting the selection of an inhaler device for COPD and the ideal device for different patient profiles. Results of EPOCA Delphi consensus. Pulm Pharmacol Ther. 2017;48:97-103. https://doi.org/10.1016/j.pupt.2017.10.006
23. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence.Med Care. 1986;24(1):67-74. https://doi.org/10.1097/00005650-198601000-00007
24. Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42(3):241-247. https://doi.org/10.1016/s0920-9964(99)00130-9
25. Plaza V. Update on questionnaires for assessing adherence to inhaler devices in respiratory patients. Curr Opin Allergy Clin Immunol. 2017;18(1):44-50. https://doi.org/10.1097/ACI.0000000000000410
26. Kim MT, Hill MN, Bone LR, et al. Development and Testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.Prog Cardiovasc Nurs. 2000;15(3):90-96. https://doi.org/10.1111/j.1751-7117.2000.tb00211.x
27. Plaza V, Fernandez-Rodríguez C, Melero C, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for asthma and COPD patients. J Aerosol Med Pulm Drug Deliv. 2015;29(2):142-152. https://doi.org/10.1089/jamp.2015.1212
28. Svarstad BL, Chewing BA, Sleath BL, et al. The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999;37(2):113-124. https://doi.org/10.1016/s0738-3991(98)00107-4
29. Culig J, Leppée M. From Morisky to Hill-Bon; Self-Reports Scales for Measuring Adherence to Medication. Coll Antropol.2014;38:55-62.
30. Lavsa SM, Holzworth A, Ansani NT. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc.2011;51(1):90-94. https://doi.org/10.1331/JAPhA.2011.09154
31. Nguyen T, Caze A La, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br JClin Pharmacol. 1999;77(3):427-445. https://doi.org/10.1111/bcp.12194
32. Luckie K, Pharmacy BMHL, Pang TC, et al. Development and validation of an asthma first aid knowledge questionnaire. Res Soc Adm Pharm. 2018;14(5):459-463. https://doi.org/10.1016/j.sapharm.2017.05.014
33. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008-1015.https://doi.org/10.1046/j.1365-2648.2000.t01-1-01567.x
34. Hsu C, Sandford BA. The Delphi Technique: Making Sense of Consensus. Pract Assessment, Res Eval. 2007;12(1). https://doi.org/10.7275/pdz9-th90
35. Sumsion T. The Delphi Technique: An Adaptive Research Tool. Br J Occup Ther. 1998;61(4):153-156.
36. Villiers MR De, Villiers PJT, Kent AP. The Delphi technique in health sciences education research. Med Teach. 2005;27(7):639-643. https://doi.org/10.1080/13611260500069947
37. ISPOR Task Force. Available from: https://www.ispor.org/member-groups/task-forces
38. Lababidi H, Hejjaoui A, Zarzour M. Validation of the Arabic version of the asthma control test. CHEST J. 2008;132(4):44-47.https://doi.org/10.4103/1817-1737.39635
39. Woynarowska-Sołdan M, Panczyk M, Iwanow L, et al. Validation of the positive health behaviours scale: a nationwide survey of nurses in Poland. Int J Occup Saf Ergon. 2019;25(1):76-85. https://doi.org/10.1080/10803548.2018.1436124
40. Andrade SE, Kahler KH, Frech F, et al. Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf. 2006;15(8):565-574. https://doi.org/10.1002/pds.1230
41. Pallant J. SPSS Survival Manual. McGraw-Hill Education. Open University Press; 2016.
42. Schatz M, Zeiger RS, Yang S, et al. Development and preliminary validation of the adult asthma adherence questionnaireTM. JAllergy Clin Immunol Pract. 2013;1(3):280-288. https://doi.org/10.1016/j.jaip.2013.03.001
43. Mark TL, Johnson G, Fortner B, et al. The benefits and challenges of using computer-assisted symptom assessments in oncology clinics: Results of a qualitative assessment. Technol Cancer Res Treat. 2008;7(5):401-405. https://doi.org/10.1177/153303460800700508
44. Rolstad S, Adler J, Rydén A. Response Burden and Questionnaire Length: Is Shorter Better? A Review and Meta-analysis. Value Heal. 2011;14(8):1101-1108. https://doi.org/10.1016/j.jval.2011.06.003
45. Brown MT, Bussell JK. Medication Adherence: WHO Cares? Mayo Clin Proc. 2011;86(4):304-314. https://doi.org/10.4065/mcp.2010.0575
46. Readdean KC, Parrott JS, Heuer AJ. Effect of pharmacist intervention on improving antidepressant medication adherence and depression symptomology: A systematic review and meta-analysis. Res Soc Adm Pharm. 2018;14(4):321-331. https://doi.org/10.1016/j.sapharm.2017.05.008
47. Choi TN, Westermann H, Sayles W, et al. Beliefs About Asthma Medications: Patients Perceive. J Asthma. 2008;45(5):409-414.https://doi.org/10.1080/02770900801971834
48. Icek A. The Theory of Planned Behavior. Organ Behav Hum Decis Process. 1991;50(2):179-211.
49. Plaza V. Update on questionnaires for assessing adherence to inhaler devices in respiratory patients. Curr Opin Allergy Clin Immunol. 2018;18(1):44-50. https://doi.org/10.1097/ACI.0000000000000410
50. Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983;13(1):177-183. https://doi.org/10.1017/s0033291700050182
51. Risser J, Jacobson TA, Kripalani S. Development and Psychometric Evaluation of the Self-Efficacy for AppropriateMedication Use Scale (SEAMS) in Low-Literacy Patients with Chronic Disease. J Nurs Meas. 2007;15(3):203-219. https://doi. org/10.1891/106137407783095757
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Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ). Pharm Pract (Granada) [Internet]. 2022 Jul. 4 [cited 2025 Jan. 14];20(2):2673. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2673
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Development and validation of the Adherence to Asthma Medication Questionnaire (AAMQ). Pharm Pract (Granada) [Internet]. 2022 Jul. 4 [cited 2025 Jan. 14];20(2):2673. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2673