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Coronery Artery Disease

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The Reasoning and Regulating Medication Adherence Instrument for Patients With Coronary Artery Disease: Development and Psychometric Evaluation

Ava-Gaye Shaw Reed
Northeastern Hospital School Of Nursing

Introduction The adherence with taking medications was found to be at a rate much lower than where the researchers had initially believed. Adherence with taking medications by patients with chronic illnesses was found to be even worse due to the lack of patient-centered, medication-specific and theoretically integrative measurement instruments. The researchers decided to work towards developing a tool that would not only be reliable but also a valid instrument that would measure the various factors that have an effect on the patients and the compliance with taking their medication. This study focused specifically on patients with coronary artery disease. This instrument was developed in two phases. Phase 1 consisted of developing the structure and content of the tool. This was defined by analyzing literature pertaining to medication adherence and interviews with patients. Phase 2 consisted of establishing the psychometric properties of the tool. Exploratory factor analyses, reliability and validity estimations were performed with a sample size of 404 patients from 3 tertiary cardiology referral centers. This phase resulted in a 16-item, three factor solution; Medication Planning Strategies, Health Risk and Health Protection. This helped to create an adherence instrument for patients on pharmacotherapy for coronary artery disease and initial psychometric properties to be established.
Assumption
The primary assumption of this article is that due to the disease trends in health care with illnesses transitioning from acute to chronic adherence with taking medication will continue to be a major issue. This issue will continue to exist due to current tools not being patient-centered, medication-specific or theoretically integrative especially with coronary artery disease patients.
Study
This study was the result of the researchers observing the poor adherence to taking medication in patients with chronic illnesses especially in patients with coronary artery disease. They looked at a variety of instruments that focused on the reasons why the noncompliance occurred and they realized that these same tools lacked key components. The researchers realized that these tools were not centered on the patients; they were not medication specific and lacked theoretically integrative measurement instruments. So they began their work to create a tool which included these keys areas. Their research was done in two phases. The first phase consisted of the development of the instrument content. The items for the tool were created from three sources. These sources were a qualitative study with patients taking medication for CAD, a review of theoretical and empirical adherence literature and an appraisal of existing medication adherence measures. The process resulted in 120 items which were reduced to a pool of 53, which would be used within the instrument. This then allowed them to begin the second phase. In phase 2 the researchers established the psychometric properties of the instrument. They looked at factor analysis, reliability and validity estimations with a patient sample size of 404 (n=404). The study was given to 420 eligible patients, which 408 completed the instrument. Four of the patients who had 25% or more missing data were excluded from the data analysis giving the total client size of 404. These participants had to meet specified criteria. These criteria included a primary diagnosis of CAD, currently prescribed medication for greater than 6 months, self-caring to medication management, can read and understand English and did not have a terminal illness or major comorbid condition that would impact the medication management of their cardiac condition. This resulted in a 16 item three-factor solution. The reliability was sufficient, meeting the standard. It was validated due to the preliminary findings, which was supported by findings in relation to content validity results and factor structure stability.
Discussion
This study described the process in which the developers went through to establish a new tool to determine factors as to why patients with CAD were noncompliant with taking their medication. The study proved that the instrument that was created in reliable and valid in determining these factors. This instrument proved to be more effective than previous tools that had been created to look at similar issues. This was confirmed through satisfactory internal consistency (a = .72) and temporal stability estimates (r = .82). The findings in relation to excellent content validity estimates (CVI = 0.90) and adequate stability of the final EFA solution. This presented solid evidence for construct validity of the newly developed instrument. This study gives researchers an alternate tool which is representative of the influential cognitive-motivational and volitional self-regulatory processes which contribute to intentional and unintentional adherence to taking medication. Despite these findings further research is still needed due to the infancy of the instrument. This tool will need to be compared to other comparable tools to solidify its reliability and validity. This lack of tool comparison is one of the study’s limitations. To do this, the study would have to be cross-validated through a second sample. There are other limiting factors to this study as well. This study consisted of a sample size which was predominately males. The sample size was also predominately of Irish decent. These two factors are key limitations which could bring into question the validity and reliability of the tool which was created. In order for this study to avoid such limitations the research need to extend to various populations and various demographics. This study needs to include more women as well as a larger variety of ethnic backgrounds. The study would also benefit from being used in various socioeconomic backgrounds. I feel that once the study has been extended to these areas then the true reliability and validity of the study will be seen.

References
Lehane, E., McCarthy, G., Collender, V., Deasy, A. & O’Sullivan, K. (2013). The Reasoning and Regulating Medication Adherence Instrument for Patients With Coronary Artery Disease: Development and Psychometric Evaluation. Journal of Nursing Measurement, 21.1, 64-79.

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