Identification of validated questionnaires to measure adherence to pharmacological antihypertensive treatments

Figures & data

Figure 1 Flow of information through the different phases of the systematic review.

Abbreviations: EMBASE, Excerpta Medica Database; LILACS, Literatura Latino Americana e do Caribe em Ciências da Saúde (Latin American and Caribbean Health Sciences Literature).

Table 1 Characteristics of the articles included

Author, year of publication	Questionnaire	Mean age (SD)	Sex % female, (n)	Language	Setting	Sample (n)	Items
Morisky et al^Citation21 1986	MGL	54a	70.00 (–)	English	Hospital (outpatient clinics)	290	4
Ben et al^Citation27 2012	BMQ vs MGL	66.60 (13.20)	64.60 (133)	Portuguese Portuguese	Primary health care unit	206	11 4
Kim et al^Citation28 2000	HB Comp Scale	41.30 (5.30) 59.20 (13.10)	0.00 (0) 69.20 (236)	English	Outpatient clinic	Study 1: 139 Study 2: 341	14
Krousel-Wood et al^Citation7 2005	HB Comp Scale (elderly)	69.00 (–)	49.00 (121)	English	Elderly community-dwelling	239	14
Lambert et al^Citation29 2006	Xhosa HB Comp Scale Xhosa Adapted HB Comp Scale	52.00 (7.60)	51.00 (50)	Xhosa	Community health centers	79 82	14 10
Song et al^Citation30 2011	HBMA-K	52.54 (5.40) 70.88 (5.40)	56.80 (88) 70.50 (261)	Korean	Baltimore- Washington metropolitan area	Study 1: 155 Study 2: 370	8
Morisky et al^Citation32 2008	MMAS-8	52.50 (12.20)	59.20 (809)	English	Hospital	1,367	8
Korb-Savoldelli et al^Citation31 2012	MMAS-8	55.70 (14.60)	42.70 (85)	French	Hospital, day care unit	199	8
Saleem et al^Citation33 2012	MMAS-8	39.50 (6.93)	28.20 (31)	Urdu	Hospital	110	8
Ma et al^Citation34 2012	TAQPH	59.68 (10.69)	58.30 (162)	Chinese	Hospital	278	28
Martín Alfonso et al^Citation35 2008	MBG	–	–	Spanish	Polyclinic	114	12
Martínez et al^Citation36 2011	MBG	Not indicatedb	81.00 (115)	Spanish	Health care center	142	12

Notes:

a Median.

b Range 37–90 years.

Abbreviations: BMQ, Brief Medication Questionnaire; HB Comp Scale, Hill-Bone Compliance to High Blood Pressure Therapy Scale; HBMA-K, Hill-Bone Medication Adherence – Korean version scale; MBG, Martín–Bayarre–Grau; MGL, Morisky–Green–Levine; MMAS-8, Morisky Medication Adherence Scale; SD, standard deviation; TAQPH, Treatment Adherence Questionnaire for Patients with Hypertension.

Table 2 Validity and reliability assessment

Questionnaire	Construct validity	Criterion validity	Stability (test–retest)	Homogeneity (internal consistency)
				Item–total correlations	Cronbach’s α
MGL^Citation21	PCFA: one factor	Comparative test: BP control. Concurrent validity: r=0.43 (6 months) Predictive validity: r=0.58 (42 months) – Student’s t-test=6.43, P<0.01 – Medication intake vs BP control: R^2=0.33, P<0.01 S =81.00% SP =44.00% PPV =75.00% NPV =52.00%	–	0.479–0.561	0.61
BMQ^Citation27	–	–	BMQ: r=0.83, P<0.001 Screen 1: r=0.84, P=0.010 Screen 2: r=0.86, P=0.004 Screen 3: r=0.94, P=0.120	–	BMQ: 0.67 (95% CI; 0.60–0.73) Screen 1: 0.67 (95% CI; 0.60–0.73) Screen 2: 0.84 (95% CI; 0.80–0.87) Screen 3: 0.76 (95% CI; 0.70–0.81)
MGL^Citation27	–	–	MGL: r=0.70, P=0.020	–	0.73 (95% CI; 0.67–0.79)
HB Comp Scale^Citation28
Study 1	Factor analysis variance (%): 27.00, one factor	Comparative test: BP control. Predictive validity: r=0.21, P=0.030	–	Range: −0.02 to 0.60 Mean: 0.34 (SD 0.17)	0.74
Study 2	Factor analysis variance (%): 35.00, one factor	Comparative test: BP control. Predictive validity: r=0.16, P<0.001	–	Range: 0.01–0.64 Mean: 0.46 (SD 0.16)	0.84
HB Comp Scale^Citation7 (elderly)	Factor analysis two factors	–	Not availablea	Range: 0.13–0.59b	Full questionnaire: 0.43 – Medication compliance subscale: 0.68 – Salt intake subscale: 0.49
Xhosa HB Comp Scale^Citation29	–	Comparative test: BP control. Predictive validity: questionnaire vs – Mean SBP: ρ=0.17, P=0.140 – Mean DBP: ρ=0.18, P=0.130	–	Range: 0.10–0.64 Mean: 0.38 (SD: 0.18) Subscale I (salt intake): 0.27 Subscale II (appointment-keeping): no resultc Subscale III (medication compliance): 0.46	Full questionnaire: 0.77 Subscale I (salt intake): 0.41 Subscale II (appointment-keeping): no resultc Subscale III (medication compliance): 0.76
Xhosa Adapted	–	Comparative test: BP control.	–	Range: 0.31–0.64	0.79
HB Comp Scale^Citation29		Predictive validity: questionnaire vs – Mean SBP: ρ=0.19, P=0.080 – Mean DBP: ρ=0.21, P=0.050		Mean: 0.45 (SD 0.11)
HBMA-K^Citation30	Factor analysis variance (%): 35.40, one factor	Comparative test: questionnaire vs – HBP knowledge with 26 item test – Beliefs about HBP – BP control Concurrent validity, comparative test: questionnaire vs – HBP knowledge (r=−0.13, P<0.01) – HBP belief (r=−0.18) – BP outcomes (SBP: r=0.18, P<0.01; and DBP: r=0.24, P<0.01)	–	Range: 0.37–0.63	0.80
MMAS-8^Citation32 (English)	Factor analysis CFA: one factor	Comparative test: −Concurrent validity: questionnaire vs MGL r=0.64, P<0.05 S =93.00% SP =53.00% Predictive validity: questionnaire vs – BP control (χ^2=6.6, P<0.05) – knowledge,^Citation37 attitude,^Citation38 social support,^Citation39 stress coping,^Citation40 medication complexity, and patient satisfaction with clinic visits^Citation41,Citation42 (P<0.05 for all, except for attitude)	–	Range: 0.3038–0.5896	0.83
MMAS-8^Citation31 (French)	Factor analysis PCFA variance (%): 27.50, one factor CFA: one factor	–	ICC =0.68 (95% CI; 0.63–0.72)	Range: −0.05 to 0.43	0.54 (95% CI; 0.44–0.63)
MMAS-8^Citation33 (Urdu)	Convergent validity, comparative test: questionnaire vs MGL ρ=0.765, P<0.001 Known group validity vs BP control χ^2=19.996, P<0.001	S =46.20% SP =60.00% PPV =45.00% NPV =61.10%	ICC meaningful (P<0.001)	Range: 0.30–0.48	0.701
TAQPH^Citation34	EFA variance (%): 62.50, six factors CFA: six factors	Concurrent validity, comparative test: questionnaire vs MMAS-8; GSES^Citation43 MMAS-8→ r=0.76, P<0.01 GSES→ r=0.69, P<0.01	ICC =0.82	Range: 0.31–0.66	Full questionnaire: 0.86; dimension I: 0.94; dimension II: 0.88; dimension III: 0.92; dimension IV: 0.76; dimension V: 0.83; dimension VI: 0.72
MBG^Citation35	PCFA variance (%): 68.70, three factors	−	–	Range: 0.28–0.70	0.889
MBG^Citation36	PCFA variance (%): 63.40, five factors	−	–	–	0.694

Notes:

a Longitudinal data to assess test–retest reliability were not available.

b The appointment-keeping subscale of the scale consists of only two items and was not included in this analysis.

c The appointment-keeping subscale did not provide an interpretable result, probably as a result of the South African public health system, in which reappointments are standard procedure.

Abbreviations: BMQ, Brief Medication Questionnaire; BP, blood pressure; CFA, confirmatory factorial analysis; CI, confidence interval; DBP, diastolic blood pressure; EFA, exploratory factorial analysis; GSES, General Self-Efficacy Scale; HB Comp Scale, Hill-Bone Compliance to High Blood Pressure Therapy Scale; HBMA-K, Hill-Bone Medication Adherence – Korean version (scale); HBP, high blood pressure; ICC, intraclass correlation coefficient; MBG, Martín–Bayarre– Grau (scale); MGL, Morisky–Green–Levine (scale); MMAS-8, Morisky Medication Adherence Scale; NPV, negative predictive value; PCFA, principal components factorial analysis; PPV, positive predictive value; S, sensitivity; SBP, systolic blood pressure; SD, standard deviation; SP, specificity; TAQPH, Treatment Adherence Questionnaire for Patients with Hypertension.

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