Contributo para a validação concorrente de uma medida de adesão aos tratamentos

Artur Barata Delgado & Maria Luísa Lima¹

Departamento de Psicologia Social e das Organizações, ISCTE – Lisboa, Portugal PRAXIS XXI / BD / 21473 / 99

Resumo: Apesar da não adesão aos tratamentos ser provavelmente a principal causa de insucesso das terapêuticas, não se encontram suficientemente desenvolvidas medidas validadas de detecção do nível de adesão. Neste estudo desenvolveu-se, a partir da medida de adesão apresentada por Morisky, Green e Levine (1986), uma versão com 7 itens. Analisou-se, em diversas condições de resposta, a consistência interna da Medida de Adesão aos Tratamentos (MAT) e a sua validade concorrente através do critério contagem de medicamentos. A MAT apresentou uma boa consistência interna na condição de resposta na forma de escala de Likert. Em termos de validade concorrente, a medida de adesão apresentou correlações elevadas em qualquer condição de resposta. A resposta em forma de escala de Likert revelou maior sensibilidade e especificidade a captar os diversos comportamentos de adesão.

Palavras-chave: Adesão, Consistência interna e validade concorrente, Medida.

Contribution to concurrent validity of treatment adherence

Abstract: Non-adherence to medical regimens is likely the major cause of therapeutic failure. Besides that health professionals face difficulties on the assessment of rates of adherence. Based on Morisky, Green e Levine (1986)’s measure of medication adherence, a version with 7 items was developed. It was analysed, in diverse conditions of response, the internal consistency of the 7 items Measure Treatment Adherence (MTA) and its concurrent validity, through the pill count criterion. The MTA presented a good internal consistency in the condition of Likert scale response, and raised correlations in any condition of response. The response in form of Likert scale disclosed to greater sensitivity and specificity to detect the diverse behaviours of adherence.

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Referências

Asplund, J., Danelson, M., & Ohman, P. (1984). Patients compliance in hypertension. The importance of number of tablets. British Journal of Clinical Pharmacology, 17, 547-552.         [ Links ]

Bond, W.S., & Hussar, D.A. (1991). Detection methods and strategies for improving medication compliance. American Journal of Hospital Pharmacy, 48, 1978-1988.

Brooks, C.M., Richards, J.M., Kohler, C.L., Soong, S., Martin, B., Windson, R.A., & Bailey, W.C. (1994). Assessing adherence to asthma medication and inhaler regimens: A psychometric analysis of adult self-report scales. Medical Care, 32, 298-307.

Chesney, M.A., Morin, M., & Sherr, L. (2000). Adherence to HIV combination therapy. Social Science & Medicine, 50, 1599-1605.

Conrad, P. (1985). The meaning of medications: Another look at compliance. Social Science & Medicine, 20, 29-37.

Cramer, J.A., Mattson, R.H., Prevey, M.L., Scheyer, R.D., & Ouelltte, V.L. (1989). The Journal of the American Medical Associaton, 261, 3273-3277.

Cruz, M.M. (1998). Adesão do utente à prescrição do seu médico. Revista Portuguesa de Clínica Geral, 15, 16-21.

Enlund, H., & Poston, J.W. (1987). Impact of patient noncompliance on drug costs. Journal of Social and Administrative Pharmacy, 4, 105-111.

Eraker, S.A., Kirscht, J.P., & Becker, M.H. (1984). Understanding and improving patient compliance. Annals of Internal Medicine, 100, 258-268.

Freund, A., Johnson, S.B., Silverstein, J., & Thomas, J. (1991). Asseaaing daily management of childhood diabetes using 24-hour recall interviews: Reliability and stability. Health Psychology, 10, 200-208.

Gallagher, E.J., Viscoli, C.M., & Horwitz, R.I. (1993). The relationship of treatment adherence to the risk of death after myocardial infarction in women. The Journal of the American Medical Associaton, 270, 742-744.

Grégoire, J., Guibert, E., Archambault, A., & Contandriopoulos, A. (1992). Medication compliance in a family practice. Canadian Family Physician, 38, 2333-2337.

Inui, T.S., Carter, W.B., & Pecorado, R.E. (1981). Screening for noncompliance among patients with hypertension: Is self-report the best available measure? Medical Care, 19, 1061-1064.

Johnston, M., Wright, S., & Weinman, J. (Eds.). (1995). Measures in health psychology: a user´s portfolio. A guide to measurement in health psychology. Windsor: NFER-NELSON.

Johnson, S.B., Silverstein, J., Rosenbloom, A., & Cunningham, W. (1986). Assessing daily management in childhood diabetes. Health Psychology, 5, 545-564.

Johnson, S.B., Tomer, A., Cunningham, W., & Henretta, J.C. (1990). Adherence in childhood diabetes: Results of a confirmatory factor analyses. Health Psychology, 9, 493-501.

Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of compliance. Patient Education and Counseling, 10, 117-138.

McCombs, J.S., Nichol, M.B., Newman, C.M., & Sclar, D.A. (1994). The costs of interrupting antihypertensive drug therapy in a medicaid population. Medical Care, 32, 214-226.

Meichenbaum, D., & Turk, D.C. (1987). Facilitating treatment adherence. New York: Plenum Press.

Morisky, D., Green L., & Levine, D. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67-74.

Nilsson, J.G. (2001). Concordance in practice. Common objectives for doctors, nurses and pharmacists in Sweden to improve adherence to prescribed medicines. Journal of Social and Administrative Pharmacy, 18, 81-82.

Ramalhinho, I. (1994). Adesão à terapêutica anti-hipertensiva. Contributo para o seu estudo. Manuscrito não publicado, Faculdade de Farmácia da Universidade de Lisboa, Lisboa.

Shea, S., Misra, D., Ehrlich, M.H., Field, L., & Francis, C. K.(1992). Correlates of nonadherence to hypertension treatment in an inner-city minority population. American Journal of Public Health, 12, 1607-1612.

Stanton, A.L. (1987). Determinants of adherence to medical regimens by hipertensite patients. Journal of Behavioral Medicine, 10, 377-394.

Steele, D.J., Jackson, T.C., & Gutmann, M. (1990). Have you been taking your pill? The adherence-monitoring sequence in the medical interview. The Journal of Family Practice, 30, 294-299.

Taylor, S.E. (1986). Health Psychology. New York: Random House.

Wright, E.C. (1993). Non-compliance – Or how many aunts has Matilda? The Lancet, 342, 909-013.

¹ Contactar para E-mail: lpl@iscte.pt