title: Developing a conceptual framework and a tool for measuring access to, and use of, medicines at household level (HH-ATM tool).
abstract: OBJECTIVE
  To develop a valid and reliable tool to evaluate access to, and use of, medicines at household level (HH-ATM tool).
  
  
  METHODS
  The Behavioral Model of Health Services Use was adapted and used as the conceptual framework for developing the HH-ATM tool. Questionnaires were designed (individual and household) based on the conceptual framework and existing tools, including items that captured the characteristics of predisposing, enabling and need factors; health care behaviours; outcomes and impacts.
  
  
  METHODS
  Face validity, content validity and test-retest reliability were assessed using inter-rater agreement, item and scale content validity indices, comprehensiveness indices, and intra-class correlation, kappa and weighted-kappa coefficients.
  
  
  RESULTS
  The household and individual questionnaires demonstrated appropriate validity and reliability. The content validity of household questionnaire was favourable, with inter-rater agreement of 86% and 91% for relevance and clarity, respectively. Scale content validity indices for relevance and clarity were 89% and 91%, respectively, and comprehensiveness was scored at 100%. These indices were also favourable for the individual questionnaire, all scoring 94% or higher.
  
  
  CONCLUSIONS
  The questionnaires showed excellent validity and reliability for use in Iran. The HH-ATM tool can be implemented to evaluate access to, and use of, medicines in Farsi-speaking communities, and may be useful in other communities if adapted appropriately.
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Yaghoubifard
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: arashidian@tums.ac.ir.
authors.forename: A
authors.initials: A
authors.lastname: Rashidian
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Kebriaeezadeh
authors.affiliation: Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: R
authors.initials: R
authors.lastname: Majdzadeh
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: S A
authors.initials: SA
authors.lastname: Hosseini
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Management, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Knowledge Utilization Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Akbari Sari
authors.affiliation: Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: J
authors.initials: J
authors.lastname: Salamzadeh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations
keywords: Access to medicines; Household survey; Iran; Middle income country; Questionnaire development; Rational use of medicines