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      Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study

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          Abstract

          Background

          Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020–2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ.

          Methods

          HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach’s coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation ( r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ.

          Results

          All participants were female with a mean age of 33; median: 34 years; range 18–45 years. Cronbach’s alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups.

          Conclusions

          Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.

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          Most cited references44

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          A Meta-Analysis of Cronbach's Coefficient Alpha

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            Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.

            A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode = 7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.
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              What are validated self-report adherence scales really measuring?: a systematic review.

              Medication non-adherence is a significant health problem. There are numerous methods for measuring adherence, but no single method performs well on all criteria. The purpose of this systematic review is to (i) identify self-report medication adherence scales that have been correlated with comparison measures of medication-taking behaviour, (ii) assess how these scales measure adherence and (iii) explore how these adherence scales have been validated.
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                Author and article information

                Contributors
                abckris@gmail.com
                bruce_fried@unc.edu
                jim.thomas@unc.edu
                heidi_reynolds@unc.edu
                klich@unc.edu
                katewhetten@gmail.com
                crzimmer@email.unc.edu
                morrisse@email.unc.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                28 April 2020
                28 April 2020
                2020
                : 20
                : 567
                Affiliations
                [1 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, School of Medicine, , University of North Carolina, ; Chapel Hill, North Carolina United States of America
                [2 ]GRID grid.10698.36, ISNI 0000000122483208, Health Policy & Management, , UNC Gillings School of Global Public Health, ; Chapel Hill, North Carolina United States of America
                [3 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, MEASURE Evaluation and Epidemiology Department, , University of North Carolina, ; Chapel Hill, North Carolina United States of America
                [4 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, MEASURE Evaluation, , University of North Carolina, ; Chapel Hill, North Carolina United States of America
                [5 ]GRID grid.26009.3d, ISNI 0000 0004 1936 7961, Health Policy and Inequalities Research, , Duke Global Health Institute, Duke University, ; Durham, North Carolina United States of America
                [6 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, Odum Institute for Research in Social Science, , University of North Carolina, ; Chapel Hill, North Carolina United States of America
                [7 ]GRID grid.410711.2, ISNI 0000 0001 1034 1720, Sheps Center for Health Services Research, , University of North Carolina, ; Chapel Hill, North Carolina United States of America
                Article
                8585
                10.1186/s12889-020-08585-w
                7189687
                32345253
                907d2aa8-9ba6-4998-a5b5-8f30725f98f3
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 25 July 2019
                : 25 March 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000200, United States Agency for International Development;
                Award ID: GHA-A-00-08-00003-00
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                hiv/aids care,antiretroviral therapy,adherence,patient reported outcomes,measurement invariance,ethiopia,sub-saharan africa,smaq,simplified medication adherence questionnaire

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