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The A14-scale: development and evaluation of a questionnaire for assessment of adherence and individual barriers

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Abstract

Objective To develop a questionnaire (“A14”) for the description of adherence and individual barriers as basis for adherence-enhancing interventions in the clinical and pharmaceutical setting, and to compare it to the validated German MMAS (Morisky Medication Adherence Scale). Method Fourteen questions with a 5-item likert-scale from “never” (4) to “very often” (0) were given to 150 medical inpatients. According to their score, patients were classified into non-adherent (score <50) or adherent (score 50–56). On the dichotomous MMAS, “yes” is scored 0 and “no” 1 point, a total score of 4 indicating adherence. Patients with complete scales were compared with the remaining patients regarding socio-demographic factors. Descriptive statistics, Cronbach’s Alpha, Spearman correlation, and κ were computed. Results Eighty-three participants completed both scales. Patients with missing values differed significantly regarding age, education, and adherence according to MMAS. Cronbach’s Alpha for A14 was 0.861. MMAS and A14 median total scores were 4 and 52, respectively. About 39.5% of patients were non-adherent as per MMAS compared to 40% as per A14; κ was 0.262 (P = 0.016). The total scores correlated with a Rho-value of 0.43 (P < 0.001). Conclusion The A14-scale showed good internal consistency and a significant correlation with the MMAS suggesting that it merits further investigation.

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Acknowledgements

We would like to thank all patients taking part in the study and the ward staff of “Siebeck” for logistical support. Our gratitude goes to RN Barbara Williams and Prof. Ingeborg Walter-Sack for their assistance in the forward-backward-translation of the A14-scale.

Funding

This work was in part supported by the AOK Baden-Württemberg Health Insurance Company.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, Medizinische Klinik (Krehl-Klinik), University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Susanne Jank, Thilo Bertsche & Walter E. Haefeli

  2. Cooperation Unit Clinical Pharmacy, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Susanne Jank & Thilo Bertsche

  3. Department of Internal Medicine II, Psychosomatic and General Internal Medicine, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Dieter Schellberg & Wolfgang Herzog

Authors
  1. Susanne Jank
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  2. Thilo Bertsche
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  3. Dieter Schellberg
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  4. Wolfgang Herzog
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  5. Walter E. Haefeli
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Corresponding author

Correspondence to Walter E. Haefeli.

Appendix: German wording of the A14-scale used in the study

Appendix: German wording of the A14-scale used in the study

Persons wishing to use the scale are requested to formally contact Prof. Walter E. Haefeli at walter.emil.haefeli@med.uni-heidelberg.de.

  1. 1.

    Wenn ich Nebenwirkungen von einem Medikament bekomme, höre ich ganz auf, es zu nehmen.

  2. 2.

    Wenn ich Nebenwirkungen von einem Medikament bekomme, nehme ich es für eine Weile nicht (Tage oder Wochen).

  3. 3.

    Wenn meine Erkrankung sich verschlimmert hat, erhöhe ich selbst die Dosis des jeweiligen Medikaments.

  4. 4.

    Wenn ein Medikament nicht wirkt, höre ich ganz auf, es zu nehmen.

  5. 5.

    Wenn es die Umstände erfordern, nehme ich eine Extra-Dosis oder lasse eine Dosis aus (z.B. eine „Wassertablette“ auslassen wegen einer Reise).

  6. 6.

    Wenn meine Erkrankung sich gebessert hat, höre ich ganz auf, das jeweilige Medikament zu nehmen.

  7. 7.

    Wenn meine Erkrankung sich gebessert hat, nehme ich das jeweilige Medikament für eine Weile nicht (Tage oder Wochen).

  8. 8.

    Wenn es mir zu teuer wird, mein Medikament (bzw. die Zuzahlungen) zu bezahlen, höre ich ganz auf, es zu nehmen.

  9. 9.

    Damit die Packung länger reicht, nehme ich mein Medikament weniger häufig ein oder nehme es für eine Weile nicht.

  10. 10.

    Wenn ich nicht rechtzeitig dazu komme, ein neues Rezept vom Arzt zu holen, nehme ich mein Medikament für eine Weile nicht.

  11. 11.

    Ich nehme mein Medikament gar nicht ein, weil ich es nicht gut finde, jede Erkrankung mit Medikamenten zu behandeln.

  12. 12.

    Ab und zu setze ich mein Medikament für eine Weile aus, weil ich es nicht gut finde, ständig Medikamente zu nehmen.

  13. 13.

    Ich vergesse es, mein Medikament einzunehmen.

  14. 14.

    Aufgrund körperlicher Beschwerden kann ich mein Medikament nicht einnehmen (z.B. weil ich die Packung nicht öffnen oder die Tablette nicht schlucken kann).

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Jank, S., Bertsche, T., Schellberg, D. et al. The A14-scale: development and evaluation of a questionnaire for assessment of adherence and individual barriers. Pharm World Sci 31, 426–431 (2009). https://doi.org/10.1007/s11096-009-9296-x

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  • DOI: https://doi.org/10.1007/s11096-009-9296-x

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