Category: Health Psychology / Behavioral Medicine - Adult
It would be valuable to assess patients’ perspectives at times when they are under medical advice to follow specific treatment plans to treat their medical conditions. Do they believe they are adhering to their treatment plans? Do they appraise their treatment plans as likely to be effective? Do they appraise their treatment plans as burdens that reduce quality of life? Patient perspectives on treatment adherence, effectiveness, and burden could be important for predicting treatment outcomes. It would be especially useful to have a general-purpose questionnaire that could measure these types of perspectives across a range of different diagnostic categories and across different treatment plans. This would maximize questionnaire utility and allow for continuity across research regarding different medical conditions. As it stands, many existing assessment instruments in this area are highly specific. For example, a scale developed by Morisky et al. (2008) is intended for assessing only medication compliance and only in people with hypertension. At the other extreme, there are a few general-purpose scales intended for use in demographic research with medical patients, but these instruments generally contain such a wide range of items that they fail to produce concise scales with good psychometric properties measuring distinct and theoretically meaningful constructs. Thus, there is a need for a well-validated, general-purpose instrument that assesses theoretically distinct dimensions of patient perspective vis-à-vis medical treatment plans.
A new, 14-item questionnaire was developed for assessing three dimensions of patient responses to medical treatment plans: adherence, appraised benefit, and appraised burden. This instrument is unique in that respondents first identify the key components of their treatment plans (such as taking medication or exercising), and then answer questions in regards to those identified components. Items for the questionnaire were developed in a preliminary study that included 103 people reporting serious medical conditions (such as conditions requiring hospitalization). Participants were recruited via Qualtrics Panels, and they completed a questionnaire administered via the Internet. Results were used to identify good items and to make revisions by dropping bad items and writing new items. This resulted in a final instrument, called the Treatment Adherence and Appraisal Questionnaire (TAAQ), which was validated using another Internet sample that included 204 people reporting a current diagnosis of either diabetes (36%) or hypertension (64%). Participants completed the TAAQ, the Morisky medication compliance scale, and several criterion measures. All scales on the TAAQ had good reliability (alphas > .80), and all had small to moderate correlations with criterion variables regarding patient anxiety and patient satisfaction, whereas the Morisky scale had lower reliability (alpha = .49) and did not correlate with criterion variables. The appraised burden scale was unique in being negatively correlated with an index of treatment success based on self-reported blood pressure or A1C levels. In a confirmatory factor analysis, the three scales on the TAAQ demonstrated a good fit.
Keith Sanford– Associate Professor, Baylor University, Waco, Texas