title: Development and reliability of a correction factor for parent-reported adherence to pediatric antiepileptic drug therapy.
abstract: OBJECTIVE
  Study aims were (1) to document and examine associations between parent-report and electronic monitoring (EM) of pediatric antiepileptic drug (AED) adherence, (2) to determine the sensitivity and specificity of parent-reported adherence, and (3) to develop a correction factor for parent-reported adherence.
  
  
  METHODS
  Participants included 111 consecutive children with new-onset epilepsy (M(age) = 7.2 ± 2.0; 61.3% male; 75.8% Caucasian) and their primary caregivers. AED adherence was electronically monitored for 3 months prior to the 4-month clinic follow-up visit. Parent-reported adherence captured adherence 1-week prior to the clinic visit. For specificity/sensitivity analyses of parent-reported adherence, cut points of 50%, 80%, and 90% were used with electronically monitored adherence calculated 1-week prior to the clinic visit as the reference criterion.
  
  
  RESULTS
  Electronically monitored adherence (80.3%) was significantly lower than parent-reported adherence (96.5%; p < 0.0001) 1-week prior to the clinic visit, but both were significantly correlated (rho = 0.46, p < 0.001). The 90% parent-reported adherence cut point demonstrated the most sensitivity and specificity to electronically monitored adherence; however, specificity was still only 28%. A correction factor of 0.83 was identified as a reliable adjustment for parent-reported adherence when compared to electronically monitored adherence.
  
  
  CONCLUSIONS
  Although EM is the gold standard of adherence measurement for pediatric epilepsy, it is often not clinically feasible to integrate it into routine clinical care. Therefore, use of a correction factor for interpreting parent-reported adherence holds promise as a reliable clinical tool. With reliable adherence measurement, clinicians can provide adherence interventions with the hope of optimizing health outcomes for children with epilepsy.
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. avani.modi@cchmc.org
authors.forename: Avani C
authors.initials: AC
authors.lastname: Modi
authors.forename: Shanna M
authors.initials: SM
authors.lastname: Guilfoyle
authors.forename: Diego A
authors.initials: DA
authors.lastname: Morita
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Glauser
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D004569:Electroencephalography; D004827:Epilepsy / Q000145:classification / Q000188:drug therapy*; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010290:Parents; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012640:Seizures / Q000145:classification / Q000188:drug therapy; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000927:Anticonvulsants