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Open Access Highly Accessed Research article

Performance of two questionnaires to measure treatment adherence in patients with Type-2 Diabetes

Carlos A Prado-Aguilar14*, Yolanda V Martínez1, Yolanda Segovia-Bernal2, Rosendo Reyes-Martínez3 and Raul Arias-Ulloa4

Author Affiliations

1 Unidad de Investigación Epidemiológica y en Servicios de Salud, Hospital General de Zona N° 1, Instituto Mexicano del Seguro Social, Aguascalientes, Ags., México

2 Unidad de Medicina Ambulatoria, Instituto Mexicano del Seguro Social, Aguascalientes, Ags., México

3 Unidad de Medicina Familiar, Instituto Mexicano del Seguro Social, Aguascalientes, Ags, México

4 Depto. de Salud Publica, Universidad Autónoma de Aguascalientes, Aguascalientes, Ags, México

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BMC Public Health 2009, 9:38  doi:10.1186/1471-2458-9-38

Published: 26 January 2009

Abstract

Background

Most valid methods to measure treatment adherence require time and resources, and they are not easily applied in highly demanding Primary Health Care Clinics (PHCC). The objective of this study was to determine sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities of two novel questionnaires as proxy measurements of treatment adherence in Type-2 diabetic patients.

Methods

Two questionnaires were developed by a group of experts to identify the patient's medical prescription knowledge (knowledge) and their attitudes toward treatment adherence (attitudes) as proxy measurements of adherence. The questionnaires were completed by patients receiving care in PHCC pertaining to the Mexican Institute of Social Security in Aguascalientes (Mexico). Pill count was used as gold standard. Participants were selected randomly, and their oral hypoglycemic prescriptions were studied. The main outcome measures for each questionnaire were sensitivity, specificity, predictive values, likelihood ratios, and post-test probabilities, all as an independent questionnaire test and in a serial analysis.

Results

Adherence prevalence was 27.0% using pill count. Knowledge questionnaire showed the highest sensitivity (68.1%) and negative predictive value (82.2%), the lowest negative likelihood ratio (0.58) and post-test probability for a negative result (0.16). Serial analysis showed the highest specificity (77.4%) and positive predictive value (40.1%) as well as the highest positive likelihood ratio (1.8) and post-test probability for a positive result (0.39).

Conclusion

Medical Prescription Knowledge questionnaire showed the best performance as proxy measurement to identify non-adherence in type 2 diabetic patients regarding negative predictive value, negative likelihood ratio, and post-test probability for a negative result. However, Medical Prescription Knowledge questionnaire performance may change in contexts with higher adherence prevalence. Therefore, more research is needed before using this method in other contexts.