title: Development and validation of a tuberculosis medication adherence scale.
abstract: BACKGROUND
  Medication adherence is critical in Tuberculosis (TB) treatment success, but existing tools are inadequate in identifying non-adherents, reasons for non-adherence or interventions to improve adherence. This study intended to fill the gap by developing and validating a TB medication adherence scale (TBMAS).
  
  
  METHODS
  An initial 41-item TBMAS was designed through review of literature, consultation from an 8-member clinical expert panel and a 15-patient focus group, and pilot-testing in 25 TB patients. The questionnaire was validated in 438 patients who visited 23 community health centers for TB treatment in Wuhan from September 1, 2010, to August 31, 2011, using pharmacy refill records in a 15-week period as external criteria for medication adherence. After removing redundant and cross-loading items, the internal consistency, reliability and validity of TBMAS in identifying non-adherents were examined.
  
  
  RESULTS
  The final TBMAS included 30 items scored on a 5-point Likert scale, and these items were loaded in nine distinct factors that explained 65% of cumulative variance among respondents. Cronbach's alpha, test-retest reliability and split-half reliability were 0.87, 0.83, and 0.85, respectively. Convergent validity was supported by statistically significant associations between TBMAS scores and adherence measured by pharmacy refill records. Receiver Operating Characteristics curve analysis suggested a cut-off point at 113, with which TBMAS showed a positive predictive value of 65.5% and sensitivity of 82.9% in identifying non-adherents.
  
  
  CONCLUSIONS
  TBMAS demonstrated satisfactory internal consistency, reliability and validity in identifying TB patients with poor adherence and potential causes for non-adherence.
authors.affiliation: School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.forename: Xiaochen
authors.initials: X
authors.lastname: Tu
authors.forename: Yeqing
authors.initials: Y
authors.lastname: Tong
authors.forename: Rui
authors.initials: R
authors.lastname: Yang
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Wang
authors.forename: Shiyi
authors.initials: S
authors.lastname: Cao
authors.forename: Hong
authors.initials: H
authors.lastname: Fan
authors.forename: Feng
authors.initials: F
authors.lastname: Wang
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Gong
authors.forename: Ping
authors.initials: P
authors.lastname: Yin
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*