DAI-10 is as good as DAI-30 in schizophrenia

Drug attitude inventory (DAI-30) is considered to be the best predictor of poor adherence in first-episode schizophrenia. We compared the short version (DAI-10) with DAI-30 in long-term schizophrenia, documented if DAI was associated with poor insight, PANSS and GAF and constructed DAI-10 percentiles. DAI-30 and DAI-10 were homogenous (r=0.82 and 0.72, respectively) with good test-retest reliability (0.79). The correlation between the DAI versions was high (0.94). Percentile scores of DAI-10 were computed. DAI is an easy-to-use self-report instrument seemingly assessing a unique clinical dimension relevant to non-adherence. DAI-10 might be preferred for its simplicity and good psychometric properties.     

Development of a patient satisfaction questionnaire for HIV/AIDS patients in Nigeria

Objective The aim of this study was to develop and validate a questionnaire for assessing HIV-infected patients?? satisfaction with pharmaceutical care received in Nigerian HIV clinics. Method Questionnaire??s items were selected based on similar published studies and designed on a 5- point Likert response scale. Face and content validity, feasibility, factorial validity, reliability, and construct validity were evaluated. The instrument??s feasibility was assessed in a secondary health care facility (St. Charles Borromeo Hospital Onitsha) and validated in a tertiary health care facility (University of Nigeria Teaching Hospital Enugu). Factor analysis used principal components and varimax rotation. Reliability was established using internal consistency with Cronbach??s alpha. Convergent and discriminant validity were determined using Spearman??s rho correlation. Results A self-administered 16-item questionnaire in 5-point Likert response scale format was developed. Questionnaire evaluated cumulative experience of patients with comprehensive pharmaceutical care practice in pharmacies of HIV clinics. Eighty questionnaires were collected for pilot test while four hundred questionnaires were retrieved for the validity test. Factor analysis resulted in four factors: ??Interpersonal/Professional relationship with pharmacist??, ??patient counseling??, ??drug information?? and ??managing therapy??, with a cumulative variance of 56.7%. Cronbach??s alpha for the whole questionnaire was 0.85, and 0.81, 0.66, 0.67 and 0.72 for the four factors, respectively. Four items used for convergent and discriminant validity showed convergence between the related items and variance between the unrelated items. Conclusion The questionnaire developed is a reliable and valid instrument for assessing patient satisfaction with pharmaceutical care in HIV clinics in Nigeria. Further research is needed to expand the instruments?? robustness.     

Validation of an Empathy Scale in Pharmacy and Nursing Students

Objective. To validate an empathy scale to measure empathy in pharmacy and nursing students.Methods. A 15-item instrument comprised of the cognitive and affective empathy domains, was created. Each item was rated using a 7-point Likert scale, ranging from strongly disagree to strongly agree. Concurrent validity was demonstrated with the Jefferson Scale of Empathy – Health Professional Students (JSE-HPS).Results. Reliability analysis of data from 216 students (pharmacy, N=158; nursing, N=58) showed that scores on the empathy scale were positively associated with JSE-HPS scores (p<0.001). Factor analysis confirmed that 14 of the 15 items were significantly associated with their respective domain, but the overall instrument had limited goodness of fit.Conclusions. Results of this study demonstrate the reliability and validity of a new scale for evaluating student empathy. Further testing of the scale at other universities is needed to establish validity.     

Development of clinical pharmacy services to improve drug adherence in psychiatric hospital patients

In the present study, we investigated whether the pharmacy services in our psychiatric hospital helped to improve the attitude of psychiatric patients to drugs. The subjects were 168 patients who received advice on medication at the hospital between August 2008 and December 2009. We found that anxiety about medication in 76% of these patients was relieved by the provision of clinical pharmacy services. This can be attributed to patients gaining an understanding of the importance of taking medication at a particular time, drug types, drug efficacy and drug-induced adverse events. Patient drug adherence scores using the 10-item version of the Drug Attitude Inventory (DAI-10) were significantly improved after pharmacy services were provided, indicating an improvement in drug adherence. There was a significant positive correlation between the DAI-10 score and understanding of the necessity for medication, but no correlation between the DAI-10 score and the amount of drug administered or number of doses taken per day. These results suggest that the clinical pharmacy services improve understanding of the importance of medication timing, drug type, drug efficacy and drug-induced adverse events, and also relieve medication anxiety, enhance understanding of the necessity of taking medication and improve patient attitude to a drug. We intend to further take comprehensive measures including educational, behavioral and emotional intervention.     

Evaluation of the symptoms, adherence and satisfaction after pharmaceutical care at asthma clinic for outpatient

In the present study, we investigated whether counseling at an outpatient asthma clinic improved asthma symptoms, adherence and patient satisfaction: The asthma control test (ACT) and asthma control questionnaire (ACQ) were used to assess subjective symptoms, 10-item version of the drug attitude inventory (DAI-10) was used to determine medication adherence, and 8-item Japanese version of the client satisfaction questionnaire (CSQ-8J) was used to ascertain patient satisfaction. All scores of inhalation technique, PEF (peak expiratory flow) value/predicted PEF value (%), ACT, ACQ and DAI-10 in 26 patients with asthma increased after counseling at the outpatient asthma clinic compared to those before counseling. The average CSQ-8J score of 28 points (highest possible score: 32 points) indicated that the patients were satisfied with services provided by this clinic. These results indicate that counseling provided by pharmacists at the outpatient clinic is a valuable way improving subjective symptoms, lung function and medication adherence. These results also indicate that counseling at the asthma clinic by pharmacists improves the quality of life of patients with asthma.     

Predicting treatment-seeking behavior: psychometric properties of a brief self-report scale

Development of a brief instrument to assess attitudes toward treatment and predict treatment-seeking behavior among out-of-treatment substance misusers is described. Exploratory factor analysis of an initial pool of 41 items identified four subscales: Perceived need for treatment: perceived drug problem severity; motivation to quit; and negative attitudes toward treatment. Psychometric analyses of data from 535 substance misusers participating in an outreach intervention project provided substantial support for the reliability and construct validity of the first three subscales, and marginal support for the fourth. Evidence of predictive validity was provided by further analyses indicating significant relationships between the three primary scales and both treatment admissions and treatment-seeking during a 3-month follow-up period. The final instrument, the Treatment Attitude Profile (TAP), contains 25 items in a self-report format suitable for use with limited literacy populations in field or office settings.     

Predicting Treatment-Seeking Behavior: Psychometric Properties of a Brief Self-Report Scale

Development of a brief instrument to assess attitudes toward treatment and predict treatment-seeking behavior among out-of-treatment substance misusers is described. Exploratory factor analysis of an initial pool of 41 items identified four subscales: Perceived need for treatment: perceived drug problem severity; motivation to quit; and negative attitudes toward treatment. Psychometric analyses of data from 535 substance misusers participating in an outreach intervention project provided substantial support for the reliability and construct validity of the first three subscales, and marginal support for the fourth. Evidence of predictive validity was provided by further analyses indicating significant relationships between the three primary scales and both treatment admissions and treatment-seeking during a 3-month follow-up period. The final instrument, the Treatment Attitude Profile (TAP), contains 25 items in a self-report format suitable for use with limited literacy populations in field or office settings.     

The drug abuse screening test

The Drug Abuse Screening Test (DAST) was designed to provide a brief instrument for clinical screening and treatment evaluation research. The 28 self-report items tap various consequences that are combined in a total DAST score to yield a quantitative index of problems related to drug misuse. Measurement properties of the DAST were evaluated using a clinical sample of 256 drug/alcohol abuse clients. The internal consistency reliability estimate was substantial at .92, and a factor analysis of item intercorrelations suggested an unidimensional scale. With respect to response style biases, the DAST was only moderately correlated with social desirability and denial. Concurrent validity was examined by correlating the DAST with background variables, frequency of drug use during the past 12 months, and indices of psychopathology. Although these findings support the usefulness of the DAST for quantifying the extent of drug involvement within a help-seeking population, further validation work is needed in other populations and settings.     

Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS®) in the Swedish COAST-study

The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS^®) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Non-adherence (MEMS^® adherence ≤0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p<0.001). At the most “optimal” cut-off of 4, one-third of the adherent would falsely be identified as non-adherent. A somewhat larger AUC (0.78, p<0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing.     

海洛因稽延性戒断症状评定量表的修订

对初步编制的评定量表进行修订 ,用于评定海洛因稽延性戒断症状。方法··:对国内有代表性的7个城市脱毒后未染毒的829例海洛因依赖者 ,使用修订后的10个项目的评定量表进行评定。结果··:修订后的评定量表具有很好的内部一致性 ,Cronbachα系数为0.9166(F=90.352,P<0.001) ,各项目分与剩余总分的相关系数大于0.684(P<0.001)。因子分析提取2个共性因子 :分别由睡眠障碍及其它项目组成。聚类分析显示 ,评定量表包括3个部分 :躯体症状、焦虑情绪和睡眠障碍。结论··:修订后的海洛因稽延性戒断症状评定量表具有很好的内部结构 ,适于调查海洛因依赖者脱毒后的稽延性戒断症状。     

Development of the ASK-20 Adherence Barrier Survey*

ABSTRACT

Objective: Poor medication adherence is widespread among patients with chronic conditions requiring long-term drug therapy. Medication adherence is determined by multiple patient-, context-, and therapy-dependent factors. This paper describes the development and initial validation of the ASK-20 survey, created to identify actionable risk factors for medication nonadherence and to improve communication about adherence.

Methods: A pool of 30 items was generated through comprehensive literature review. Items were refined and the item pool was expanded through an expert panel review and patient focus groups to yield 47 candidate items, each with five response options ranging from either Strongly Agree to Strongly Disagree or from In the Last Week to Never. The pool of 47 candidate items was administered to a web-based sample of 605 patients taking medications and reporting a diagnosis of asthma, diabetes, or depression for psychometric testing and item reduction.

Results: Eleven multi-item factor groupings with two additional unique items were identified on the basis of principal components analysis and interpretability. Twenty (20) items representing ten factor groupings were selected for the final instrument. Each of the final items was dichotomized as positive – indicating a barrier, or negative. Two summary scores – the sum of all positive barriers or Total Barrier Count (TBC) and the sum of raw item scores, the ASK-20 score – were calculated. Concurrent validity of the dichotomously scored individual items, the TBC and ASK-20 scores in relation to self-reported adherence was generally good. Cronbach's alpha coefficient was 0.77 for the TBC and 0.85 for the ASK-20 score.

Conclusions: ASK-20 consists of 20 clinically actionable items representing multiple factors that affect medication adherence. The ASK-20 survey demonstrated satisfactory validity and internal consistency and may be used to identify actionable barriers to adherence across a spectrum of chronic diseases. Future research using more objective measures of adherence is warranted to confirm the exploratory validity and reliability of ASK-20 reported in this study.     

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=−1.79; 95% CI: −3.13, −0.45; p-value = 0.009).ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.     

An Item Response Theory (IRT) analysis of the Short Inventory of Problems-Alcohol and Drugs (SIP-AD) among non-treatment seeking men-who-have-sex-with-men: Evidence for a shortened 10-item SIP-AD

The Short Inventory of Problems-Alcohol and Drugs (SIP-AD) is a 15-item measure that assesses concurrently negative consequences associated with alcohol and illicit drug use. Current psychometric evaluation has been limited to classical test theory (CTT) statistics, and it has not been validated among non-treatment seeking men-who-have-sex-with-men (MSM). Methods from Item Response Theory (IRT) can improve upon CTT by providing an in-depth analysis of how each item performs across the underlying latent trait that it is purported to measure. The present study examined the psychometric properties of the SIP-AD using methods from both IRT and CTT among a non-treatment seeking MSM sample (N = 469). Participants were recruited from the New York City area and were asked to participate in a series of studies examining club drug use. Results indicated that five items on the SIP-AD demonstrated poor item misfit or significant differential item functioning (DIF) across race/ethnicity and HIV status. These five items were dropped and two-parameter IRT analyses were conducted on the remaining 10 items, which indicated a restricted range of item location parameters (− .15 to − .99) plotted at the lower end of the latent negative consequences severity continuum, and reasonably high discrimination parameters (1.30 to 2.22). Additional CTT statistics were compared between the original 15-item SIP-AD and the refined 10-item SIP-AD and suggest that the differences were negligible with the refined 10-item SIP-AD indicating a high degree of reliability and validity. Findings suggest the SIP-AD can be shortened to 10 items and appears to be a non-biased reliable and valid measure among non-treatment seeking MSM.     

Dimensions and severity of marijuana consequences: development and validation of the Marijuana Consequences Questionnaire (MACQ)

The Marijuana Consequences Questionnaire (MACQ) is a 50-item self-report measure modeled after the Young Adult Alcohol Consequences Questionnaire (YAACQ). College students (n=315) completed questionnaires online. A confirmatory factor analysis supported the hypothesized 8-factor structure. The results indicate good convergent and discriminant validity of the MACQ. A brief, unidimensional, 21-item version (B-MACQ) was developed by a Rasch model. Comparison of item severity estimates of the B-MACQ items and the corresponding items from the YAACQ indicates that the severity of alcohol- and marijuana-problems is defined by a relatively unique pattern of consequences. The MACQ and B-MACQ provide promising new alternatives to assessing marijuana-related problems.     

An interventionist adherence scale for a specialized brief negotiation interview focused on treatment engagement for opioid use disorders

ABSTRACT

Background: No psychometrically validated instrument for evaluating the extent to which interventionists correctly implement brief interventions designed to motivate treatment engagement for opioid use disorders has been reported in the literature. The objective of this study was to develop and examine the psychometric properties of the Brief Negotiation Interview (BNI) Adherence Scale for Opioid Use Disorders (BAS-O). Methods: In the context of a randomized controlled trial evaluating the efficacy of 3 models of emergency department care for opioid use disorders, the authors developed and subsequently examined the psychometric properties of the BAS-O, a 38-item scale that required raters to answer whether or not (“Yes” or “No”) each of the critical actions of the BNI was correctly implemented by the research interventionist. BAS-O items pertained to the BNI's 4 steps: (1) Raise the Subject, (2) Provide Feedback, (3) Enhance Motivation, and (4) Negotiate and Advise. A total of 215 audio-recorded BNI and 88 control encounters were rated by 3 trained raters who were independent of the study team and blind to study hypotheses, treatment, and assignment. Results: The results indicated the BAS-O has fair to excellent psychometric properties, in terms of good internal consistency, excellent interrater reliability, discriminant validity, and construct validity, and fair predictive validity. A 13-item, 2-factor solution accounted for nearly 80% of the variance, where factor 1 addressed “Autonomy and Planning” (7 items) and factor 2 addressed “Motivation and Problems” (6 items). However, predictive validity was found for only one of the BAS-O factor items (i.e., Telling patients that treatment will address a range of issues related to their opioid use disorder). Conclusions: This study suggests that the BAS-O is a psychometrically valid measure of adherence to the specialized BNI for motivating treatment engagement in patients with opioid use disorders, thus providing a brief (13-item), objective method of evaluating BNI skill performance.     

Toward the psychometric detection of substance misuse in young men: the SAP scale

A 36-item MMPI-derived scale, devoid of circular items, was constructed by contrasting the item responses of a sample of young men alcohol offenders and a sample of young men in treatment for drug or alcohol misuse, with samples of similarly aged and sexed college students, ambulatory medical patients and psychiatric outpatients who were not substance misusers. Detection rates, which averaged approximately 85% for four standardization samples, suffered no validity shrinkage on cross-validation.     

Psychometric evaluation of a comprehensive medication management service experience instrument

BackgroundThe Health-Systems Alliance for Integrated Medication Management (HAIMM) instrument was developed to estimate patient experience following pharmacist-delivered comprehensive medication management (CMM).ObjectivesThe objective of this paper was to assess the psychometric properties and factor structure of the HAIMM instrument.MethodsData were collected from 5 members of the HAIMM collaborative. A one-factor confirmatory factor analysis (CFA) model was used to assess instrument dimensionality. A partial-credit item response theory model was used to assess the psychometric properties of the ten-item HAIMM patient experience instrument, consisting of tests for rating scale functioning, person and item fit, and content validity.ResultsAmong 516 respondents, there was a strong skew toward high satisfaction, including a strong ceiling effect. CFA results suggest a unidimensional construct. Item difficulty was spread across a low range and content redundancies were identified. The mean-square values for both infit and outfit all fell within the recommended range, whereas the z-standard fit was within the recommended range for most items. The 5-point Likert scale used in the HAIMM instrument did not distinguish between participants’ level of experience following the pharmacist-delivered CMM service.ConclusionThe psychometric analysis showed the HAIMM survey tool does not cover all of the content that should be assessed to fully evaluate CMM experiences. In its current form, the HAIMM instrument should not be used to make comparisons about the quality of CMM services provided, although it may be useful to monitor patient satisfaction for quality improvement purposes. Further research is required to develop an improved instrument that contains expanded content coverage, response options, and aspects of CMM to be useful by health care providers, health systems, and other decision makers.     

Use of the CAGE scale in a population survey of drinking.

This article examines the use of the CAGE scale, a 4-item self-report screening test designed to identify problem drinkers, among 703 drinkers aged 18 and over interviewed in a general population survey. The results showed that 10.9% of drinkers reported two or more items affirmatively, the suggested cut-off indicative of problem drinking. This rate is similar to the percentage of drinkers who consume four or more standard drinks daily, derived from aggregate per capita consumption estimates. Factor analysis of the items showed a unidimensional scale with good psychometric properties. Other cut-offs are also compared with other alcoholism estimates. In general, the results indicated some utility of the CAGE in general population surveys.