The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review.
BACKGROUND
Nonadherence to immunosuppressive therapy is recognized as a key prognostic indicator for poor posttransplantation long-term outcomes. Several methods aiming to measure medication nonadherence have been suggested in the literature. Although combining measurement methods is regarded as the gold standard for measuring nonadherence, self-report is generally considered a central component of adherence assessment. However, no systematic review currently exists to determine which instrument(s) are most appropriate for use in transplant populations.


METHODS
The transplant360 Task Force first performed a survey of the self-report adherence instruments currently used in European centers. Next, a systematic literature review of self-report instruments assessing medication adherence in chronically ill patients was conducted. Self-report instruments were evaluated to assess those which were: (a) short and easy to score; (b) assessed both the taking and timing of medication intake; and (c) had established reliability and validity.


RESULTS
Fourteen instruments were identified from our survey of European centers, of which the Basel Assessment of Adherence Scale for Immunosuppressives met the aforementioned criteria. The systematic review found 20 self-report instruments, of which only two qualified for use in transplantation, that is, the Brief Antiretroviral Adherence Index and the Medication Adherence Self-Report Inventory.


CONCLUSIONS
The three selected self-report scales may assist transplant professionals in detecting nonadherence. However, these scales were only validated in patients with HIV. Although HIV shares similar characteristics with transplantation, including the importance of taking and timing of medication, further validation in transplant populations is required.
Department of Public Health, Katholieke Universiteit Leuven, Centre for Health Services and Nursing Research and Heart Transplantation Programme, Leuven, Belgium. fabienne.dobbels@med.kuleuven.be
Fabienne
F
Dobbels
Lut
L
Berben
Sabina
S
De Geest
Gerda
G
Drent
Annette
A
Lennerling
Clare
C
Whittaker
Christiane
C
Kugler
D000328:Adult; D006801:Humans; D007165:Immunosuppression Therapy / Q000523:psychology; D055118:Medication Adherence / Q000523:psychology*; D018579:Patient Selection; D011379:Prognosis; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment; D011795:Surveys and Questionnaires / Q000592:standards; D014180:Transplantation / Q000523:psychology*; D016896:Treatment Outcome; D016903:Drug Monitoring