Development of a questionnaire to identify the levers of adhesion to patients’ medication: QUILAM

Abstract

Introduction: Health outcomes in chronic disease are largely dependent on treatment adherence. Thus, developing a questionnaire to identify the barriers and the levers to medication adherence is needed to adapt the educational monitoring in order to help the patients with chronic diseases to take their treatment as the doctor prescribed it. Methodology: Firstly, we carried a thematic analysis of semi-structured interviews with 30 patients with diabetes mellitus type II, chronic obstructive pulmonary disease and heart failure and 5 healthcare providers. Secondly, we realised a review of the literature related to the validated medication adherence scales. Thirdly, with an expert committee, we gathered 62 items related to the 5 dimensions of the WHO (disease, treatment, patient and one’s relatives, sociodemographic factors and health care system). Fourthly, 116 patients with the 3 targeted pathologies filled out the questionnaires. Findings: An exploratory factor analysis with maximum likelihood and Oblimin rotation was run to reduce the scale. We obtained a 14-item scale with 4 dimensions: general beliefs, specific beliefs, management of the treatment and relation between the patient and the health care system. The final scale QUILAM showed Cronbach’s Alphas of .6 minimum for the dimensions. Discussion: The scale showed satisfactory psychometric properties. The next stage will be to analyse the factorial structure of the questionnaire with the convergent and predictive validities among 330 patients with chronic conditions. In future, this scale will enable to classify the patients in function of one’s score of each dimension and propose a tailored intervention.