TY - JOUR
T1 - Assessing the validity of self-reported medication adherence among inner-city asthmatic adults
T2 - the Medication Adherence Report Scale for Asthma
AU - Cohen, Jessica L.
AU - Mann, Devin M.
AU - Wisnivesky, Juan P.
AU - Horne, Robert
AU - Leventhal, Howard
AU - Musumeci-Szabó, Tamara J.
AU - Halm, Ethan A.
N1 - Funding Information:
Funding Sources: This study was funded by the National Institute on Aging and Center for Study of Health Beliefs and Behaviors ( RO1 HS09973 ) and Agency for Healthcare Research and Quality ( K08 HS013312 ). Ms Cohen was additionally supported by the Doris Duke Charitable Foundation for Clinical Research fellows.
PY - 2009/10
Y1 - 2009/10
N2 - Background: A validated tool to assess adherence with inhaled corticosteroids (ICS) could help physicians and researchers determine whether poor asthma control is due to poor adherence or severe intrinsic asthma. Objective: To assess the performance of the Medication Adherence Report Scale for Asthma (MARS-A), a 10-item, self-reported measure of adherence with ICS. Methods: We interviewed 318 asthmatic adults receiving care at 2 inner-city clinics. Self-reported adherence with ICS was measured by MARS-A at baseline and 1 and 3 months. ICS adherence was measured electronically in 53 patients. Electronic adherence was the percentage of days patients used ICS. Patients with a mean MARS-A score of 4.5 or higher or with electronic adherence of more than 70% were defined as good adherers. We assessed internal validity (Cronbach α, test-retest correlations), criterion validity (associations between self-reported adherence and electronic adherence), and construct validity (correlating self-reported adherence with ICS beliefs). Results: The mean patient age was 47 years; 40% of patients were Hispanic, 40% were black, and 18% were white; 53% had prior asthma hospitalizations; and 70% had prior oral steroid use. Electronic substudy patients were similar to the rest of the cohort in age, sex, race, and asthma severity. MARS-A had good interitem correlation in English and Spanish (Cronbach α = 0.85 and 0.86, respectively) and good test-retest reliability(r = 0.65, P<.001). According to electronic measurements, patients used ICS 52% of days. Continuous MARS-A scores correlated with continuous electronic adherence (r = 0.42, P<.001), and dichotomized high self-reported adherence predicted high electronic adherence (odds ratio, 10.6; 95% confidence interval, 2.5-44.5; P < .001). Construct validity was good, with self-reported adherence higher in those saying daily ICS use was important and ICS were controller medications (P =.04). Conclusions: MARS-A demonstrated good psychometric performance as a self-reported measure of adherence with ICS among English- and Spanish-speaking, low-income, minority patients with asthma.
AB - Background: A validated tool to assess adherence with inhaled corticosteroids (ICS) could help physicians and researchers determine whether poor asthma control is due to poor adherence or severe intrinsic asthma. Objective: To assess the performance of the Medication Adherence Report Scale for Asthma (MARS-A), a 10-item, self-reported measure of adherence with ICS. Methods: We interviewed 318 asthmatic adults receiving care at 2 inner-city clinics. Self-reported adherence with ICS was measured by MARS-A at baseline and 1 and 3 months. ICS adherence was measured electronically in 53 patients. Electronic adherence was the percentage of days patients used ICS. Patients with a mean MARS-A score of 4.5 or higher or with electronic adherence of more than 70% were defined as good adherers. We assessed internal validity (Cronbach α, test-retest correlations), criterion validity (associations between self-reported adherence and electronic adherence), and construct validity (correlating self-reported adherence with ICS beliefs). Results: The mean patient age was 47 years; 40% of patients were Hispanic, 40% were black, and 18% were white; 53% had prior asthma hospitalizations; and 70% had prior oral steroid use. Electronic substudy patients were similar to the rest of the cohort in age, sex, race, and asthma severity. MARS-A had good interitem correlation in English and Spanish (Cronbach α = 0.85 and 0.86, respectively) and good test-retest reliability(r = 0.65, P<.001). According to electronic measurements, patients used ICS 52% of days. Continuous MARS-A scores correlated with continuous electronic adherence (r = 0.42, P<.001), and dichotomized high self-reported adherence predicted high electronic adherence (odds ratio, 10.6; 95% confidence interval, 2.5-44.5; P < .001). Construct validity was good, with self-reported adherence higher in those saying daily ICS use was important and ICS were controller medications (P =.04). Conclusions: MARS-A demonstrated good psychometric performance as a self-reported measure of adherence with ICS among English- and Spanish-speaking, low-income, minority patients with asthma.
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U2 - 10.1016/S1081-1206(10)60532-7
DO - 10.1016/S1081-1206(10)60532-7
M3 - Article
C2 - 19852197
AN - SCOPUS:76149126638
SN - 1081-1206
VL - 103
SP - 325
EP - 331
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
IS - 4
ER -