title: Self-report measures of medication adherence behavior: recommendations on optimal use.
abstract: Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review self-report medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care.
authors.affiliation: NIH/National Institute of Mental Health Division of AIDS Research, Bethesda, MD USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stirratt
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Dunbar-Jacob
authors.affiliation: Division of Infectious Diseases, University of Washington, Seattle, WA USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Department of Psychology, University of Washington, Seattle, WA USA.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: NIH/National Heart, Lung and Blood Institute, Bethesda, MD USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Czajkowski
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, TX USA.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Hilliard
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Aikens
authors.affiliation: NIH/National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Hunter
authors.affiliation: Health Science Center, University of Texas, San Antonio, TX USA.
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
authors.affiliation: NIH/National Institute on Drug Abuse, Bethesda, MD USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Huntley
authors.affiliation: School of Medicine, New York University, New York, NY USA.
authors.forename: Gbenga
authors.initials: G
authors.lastname: Ogedegbe
authors.affiliation: School of Medicine, Johns Hopkins University, Baltimore, MD USA.
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Rand
authors.affiliation: NIH/National Eye Institute, Bethesda, MD USA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Schron
authors.affiliation: National Science Foundation, Arlington, VA USA.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Nilsen
keywords: Adherence; Compliance; Medication; Self-management; Self-report