Conference Contribution Details
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Lehane, E, McCarthy, G.
The Royal College of Nursing 2012 International Nursing Research Conference
The ‘reasoning and regulating’ medication adherence instrument - development and psychometric testing
Oral Presentation
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Background: Medication adherence is a significant
healthcare issue given that pharmacotherapy
is fundamental to disease management. Many
patients experience difficulty taking medications
resulting in sub-optimal adherence. Ambiguity
surrounding adherence issues for patients with
a chronic illness has been exacerbated by a lack
of measurement instruments which address
adherence in a patient-centred, medication-specific
and theoretically-integrative manner. This
ambiguity has led to difficulty for practitioners
not only in relation to ascertaining key adherence
influencing factors but also in determining strategies
that can effectively help patients with medication-
Aim: To develop and psychometrically test a new
instrument which measures factors that influence
adherence in patients prescribed pharmacotherapy
for coronary disease.
The study was conducted in 2 phases. Phase
1 involved the development of the instrument
structure and content. Constructs to be measured
were defined through an analysis of adherence
literature and qualitative interviews with patients.
Phase 2 established the psychometric properties
of the instrument with a convenience sample of
404 patients through factor analyses, reliability
and validity estimations.
Results: Exploratory factor analyses revealed
a logically coherent, 16-item, 3 factor solution,
which explained 49% variance. The factors were
labelled: ‘Medication Planning Strategies’, ‘Health
Risk’ and ‘Health Protection’. Internal consistency
reliability met acceptable standards (α = 0.700
to α=0.785). Fair to excellent intra-class correlations
for temporal stability were demonstrated
(0.498: 0.882). Preliminary construct validity
was supported by promising findings in relation
to content validity results and factor structure
Discussion & Conclusion: The main outcome of
this research is a new adherence instrument which
is patient-focused, underpinned by a medicationspecific,
theoretical framework and has proven
preliminary psychometric properties. It is hoped
that this measure will be useful in identifying
factors that impede or facilitate adherent behavior
and contribute to advancing the science of instrument
development within adherence research.
Recommended reading:
Horne, R., Weinman, J., Barber, N., Elliot, R.,
Morgan, M. (2005). Concordance, adherence and
compliance in medicine taking. United Kingdom:
Balkrishnan, R., Jayawant, S.S. (2007). Medication
adherence research in populations. Clinical
Therapy, 29, pp 1180-1183.
Albert, N.M. (2008). Improving medication
adherence in chronic cardiovascular disease.
Critical Care Nurse, 28, 54-64.