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Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication Cover

Measurement Tools and Utility of Hair Analysis for Screening Adherence to Antihypertensive Medication

Global Heart
Volume 18 (2023): Issue 1
By: Jyoti R. Sharma,  Phiwayinkosi V. Dludla,  Girish Dwivedi and  Rabia Johnson  
Open Access
|Mar 2023
Figures & tables

Figures & Tables

Figure 1

Flow chart of literature search.

Table 1

Descriptive information of different questionnaires for the assessment of medication adherence.

QUESTIONNAIREBRIEF DESCRIPTION AND FUNCTIONRELIABILITYLIMITATIONSREFERENCES
Morisky, Green, Levine (MGL) scale

  • Four-item Morisky scale

  • Short and concise

  • Assesses frequency of missing medicine because of forgetfulness

  • Barriers to treatment adherence

  • Symptom severity

  • Validated assessment tool for nonadherence to medication

  • Cronbach’s α = 0.61

  • Sensitivity and specificity value 81% and 44%, respectively

Overestimation[33, 37, 64]
Morisky Medication Adherence Scale (MMAS-8)

  • Eight-item Morisky modified adherence scale

  • Assesses nonadherence due to feelings of pressure or reasons other than forgetfulness

  • Better psychometric problems assessment

  • More popular than the four-item Morisky scale

  • Cronbach’s α = 0.68

  • Has been used in clinical settings

  • Translated and validated in various countries

  • Sensitivity and specificity values of 93% and 53%, respectively

Recall bias
Does not comprehensively assess the predictors of nonadherence
Moderate performance in the identification of patients without medication adherence problems		[46, 51, 65, 66]
The Hill-Bone Compliance to High Blood Pressure Scale (HBCHTS)Assesses patient behaviors for three important aspects:

  • Decreased sodium intake

  • Adherence to the appointment

  • Taking of medication

  • Validated for clinical settings in South Africa

  • Validated focusing on cultural sensitivity and appropriateness for low literacy

  • More detailed info on compliance behavior

  • Cronbach’s α = 0.43–0.84

Does not provide a cutoff point for optimal or poor adherence
Limited clinical outcome correlation with adherence		[38, 67, 68, 69, 70]
Turkish HBTS

  • Used in primary settings in Turkey

  • Considers unintentional and intentional medication nonadherence

  • Prevents patient’s boredom and loss of attention

Good construct validity and reliability
Validated for clinical settings
Validated for primary settings in Turkey
Cronbach’s α = 0.83 for medication compliance, 0.62 for salt intake items, and 0.72 for whole scale of HBTS		Limited to primary settings in Turkey[60]
Brief Medication Questionnaire (BMQ)

  • Self-report tool for screening adherence and barriers to adherence

  • Based on a 5-item regimen scale

  • Focuses on a drug regimen

  • Measures barriers to adherence

  • Sensitivity level of 80% and specificity level of 100%

  • Cronbach’s α = 0.6

Needs clinical studies to validate the utility in primary care settings[41, 68]
Adherence self-report questionnaire

  • Based on six descriptions associated with six levels of adherence

  • Able to assess adherence to medication

  • Sensitivity values of 1442%

  • High specificity values (90%–93%)

  • Less ability to detect true nonadherence

  • Possible role of Hawthrone effect (change in patient’s behavior due to being monitoried) cannot be ignored

  • Needs to validate the findings in patients with low adherence to medication

  • Short monitoring period (33 days)

[39, 71]
Stages of change (SOC) for adherence measure

  • Predicts behavior changes in patients

  • Two-item measure of SOC for adherence to medication regimens

Construct validity confirmed with the association of SOC with previously measured levels of adherence

  • Needs to be validated in clinical settings

  • Generic stage-tailored approach

  • Chances of social desirability bias

[40]
Table 2

Methods of measuring medication adherence in the management of hypertension.

METHODSIN USE GLOBALLYUTILIZED IN AFRICAADVANTAGESDISADVANTAGESREFERENCES
INDIRECT METHODS
Patient interviewsYesYes

  • Easy

  • Cheapest

  • Greatly biased

  • Often provides limited and irrelevant information

  • Overestimation of adherence

[25, 26, 27, 43]
[28, 29, 30]
QuestionnairesYesYes

  • Easy

  • Inexpensive

  • Ability to provide reasonable information

  • Provides overestimated information about adherence

  • Recall bias

  • Can be challenging and time-consuming for illiterate patients

[36, 44, 45, 46, 48, 49, 50, 54, 72]
Pill countingYesYes

  • Cost-effective

  • Simplest

  • Can be used in various formulations

  • Cumbersome for patient and assessor

  • Time-consuming

  • Does not ascertain time, consumption, dose, or frequency of medication

  • Inaccurate

  • Underestimation due to early refill

[73, 74, 75, 76, 77, 78, 79, 80, 81]
Electronic monitoringYesYes

  • Highly accurate

  • Identifies medication pattern

  • Real-time monitoring

  • Identifies partial adherence

  • Expansive

  • Technical support required

  • Inconvenient for the patient

  • Overestimation with improper use

  • Pressure on patients

[81, 82, 83, 84, 85, 86, 87, 88]
DIRECT METHODS
Direct observed therapyYesNo

  • Easy to apply

  • Secure medication intake

  • Results available in a short period

  • Possible hiding of tablets in mouth

  • Ethical issues

  • Cannot provide info about degree of nonadherence

  • Mostly utilized in conditions when medication is taken over a specified period

  • Potentially expensive in long-term perspective

[89, 90, 91, 92, 93]
Therapeutic drug monitoring using plasma and urine samplesYesYes

  • High sensitivity

  • High specificity

  • Expansive and intrusive

  • Provides information about total and partial screening

  • Single-point evaluation of adherence

  • Needs expertise

  • Subject to white coat adherence

[88, 94, 95, 96, 97, 98, 99, 100, 101]
Therapeutic drug monitoring with dry blood spotYesNo

  • Convenient

  • Accurate

  • Easy and quick

  • Susceptible to abuse

  • Single-point assessment of adherence

  • Individualized variations in metabolism

  • Occurrence of white cost-effect

  • Various other contributing factors to nonadherence

  • No pattern of adherence

  • Need technicians and professionals

  • Not suitable for multidrug regimens

[90, 93]
DOI: https://doi.org/10.5334/gh.1191 | Journal eISSN: 2211-8179
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Language: English
Submitted on: Aug 12, 2022
Accepted on: Feb 16, 2023
Published on: Mar 22, 2023
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
hypertension,
drug/treatment adherence,
compliance,
antihypertensive medication

© 2023 Jyoti R. Sharma, Phiwayinkosi V. Dludla, Girish Dwivedi, Rabia Johnson, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2023): Issue 1
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