Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension

Figures & data

Table 1 Demographic and Clinical Characteristics of Subjects

	n=120 n(%)
Age, years	81.9±5.2
<80	32 (27%)
≥80	88 (73%)
Sex
Female	67 (56%)
Male	53 (44%)
Marital status
Single/widow	112 (93%%)
Married	8 (7%)
Education level
Elementary school	52 (43%)
High school	24 (20%)
College or above	44 (37%)
Monthly medication expense (Chinese RMB)
<200	58 (48%)
<500	40 (33%)
≥500	22 (18%)
Type of medical payment
Totally reimbursed	11 (9%)
Partially reimbursed	92 (77%)
Totally self-paid	17 (14%)
Years taking antihypertensive medication
<10	35 (29%)
10–20	39 (33%)
≥20	46 (38%)
Current types of medication per day
<5	43 (36%)
5–10	52 (43%)
≥10	25 (21%)
Adverse drug events
Yes	14 (12%)
No	106 (83%)

Table 2 Reliability Analysis for ARMS-10 Items in the Study Group (n=120)

Question	Scale Mean if Item Deleted	Scale Variance if Item Deleted	Item-Total Correlation	Cronbach’s α if Item Removed
1. How often do you forget to take your medicine?	22.3	19.5	0.801	0.866
2. How often do you decide not to take your medicine?	22.3	21.7	0.534	0.885
3. How often do you forget to get prescriptions for your medicine?	22.4	21.1	0.607	0.880
5. How often do you skip a dose of your medicine before you go to the doctor?	22.3	21.8	0.515	0.886
6. How often do you miss taking your medicine when you feel better?	22.2	21.8	0.505	0.887
7. How often do you miss taking your medicine when you feel worse?	22.4	20.4	0.699	0.874
8. How often do you miss taking your medicine when you are careless?	22.3	20.0	0.701	0.873
9. How often do you change the dose of your medicine to suit your needs?	22.1	21.5	0.576	0.882
10. How often do you forget to take your medicine when you are supposed to take it more than once a day?	22.3	19.8	0.749	0.870
*12. How often do you plan ahead and refill your medicines before they run out?	22.4	21.0	0.567	0.883

Notes: Questions reduced with permission from Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–123. Copyright Emory University. *This item was reverse-coded, ie, 1 = always, 2 = most of the time, 3 = sometimes, 4 = never.

Abbreviation: ARMS, Adherence to Refills and Medications Scale.

Table 3 Factor Analysis (Varimax-Rotated Component Matrix) for ARMS in the Study Group (n=120)

Questions	Factor 1	Factor 2
1. How often do you forget to take your medicine?	0.800
2. How often do you decide not to take your medicine?		0.707
3. How often do you forget to get prescriptions for your medicine?	0.662
5. How often do you skip a dose of your medicine before you go to the doctor?		0.573
6. How often do you miss taking your medicine when you feel better?		0.733
7. How often do you miss taking your medicine when you feel worse?	0.855
8. How often do you miss taking your medicine when you are careless?	0.824
9. How often do you change the dose of your medicine to suit your needs?		0.752
10. How often do you forget to take your medicine when you are supposed to take it more than once a day?	0.834
*12. How often do you plan ahead and refill your medicines before they run out?		0.624
Eigenvalue	1.908	1.305
Variance explained	37.593%	25.723%

Notes: Questions reduced with permission from Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–123. Copyright Emory University. *This item was reverse-coded, ie, 1 = always, 2 = most of the time, 3 = sometimes, 4 = never.

Abbreviation: ARMS, Adherence to Refills and Medications Scale.

Table 4 Binary Logistic Regression Analysis Identifying Factors for ARMS Score

	ARMS-10 Score <20, n=17	ARMS-10 Score ≥20, n=103	OR	95% CI	p
Age, years			1.00	0.90–1.12	0.99
Sex
Female	12 (21%)	44 (79%)	1
Male	5 (12%)	37 (88%)	2.55	0.77–8.42	0.13
Education level
Elementary school or less	7 (19%)	30 (81%)	1
High school	4 (18%)	18 (82%)	0.25	0.06–1.05	0.06
College or above	6 (15%)	33 (85%)	0.57	0.15–2.19	0.41
Duration, years
<10	5 (20%)	20 (80%)	1
10–20	5 (14%)	30 (86%)	0.89	0.19–4.20	0.89
≥20	7 (18%)	31 (82%)	0.77	0.11–5.15	0.78
Number of medications
<5	8 (22%)	28 (78%)	1
5–10	3 (7%)	38 (93%)	4.43	0.89–22.11	0.07
≥10	6 (29%)	15 (71%)	0.81	0.13–4.91	0.82

Notes: χ²=11.80, df=8, n=120, p=0.58; R²=0.17.

Abbreviations: BP, blood pressure; ARMS, Adherence to Refills and Medications Scale.

Table 5 Binary Logistic Regression Analysis Identifying Factors for BP Control

	Controlled, n=40	Uncontrolled, n=80	OR	95% CI	p
Age, years			0.91	0.83–1.00	0.05*
Sex
Female	28 (42%)	39 (58%)	1
Male	12 (23%)	41 (77%)	1.95	0.77–4.96	0.16
Education level
Elementary or less	16 (32%)	34 (68%)	1
High school	8 (31%)	18 (69%)	2.25	0.62–8.17	0.22
College or above	16 (36%)	28 (64%)	1.45	0.50–4.23	0.49
Years taking antihypertensive medication
<10	15 (43%)	20 (57%)	1
10–20	12 (31%)	27 (69%)	1.86	0.53–6.56	0.34
≥20	13 (28%)	33 (72%)	1.26	0.27–5.85	0.77
Number of medications
<5	19 (36%)	34 (64%)	1
5–10	15 (29%)	37 (71%)	1.16	0.36–3.76	0.81
≥10	6 (24%)	19 (76%)	4.42	0.77–25.54	0.10
ARMS score
<20	12 (71%)	5 (29%)	1
20–30	27 (33%)	54 (67%)	6.60	1.74–25.08	0.006*
≥30	1 (5%)	21 (95%)	115.06	9.01–1,470.13	0*

Notes: χ²=34.23, df=10, n=120, p<0.001; R²=0.35. *Statistically significant.

Abbreviations: BP, blood pressure; ARMS, Adherence to Refills and Medications Scale.