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Validity Of The Self-Reported Domains Of Subjective Extent Of Nonadherence (DOSE-Nonadherence) Scale In Comparison With Electronically Monitored Adherence To Cardiovascular Medications

Authors Cornelius T, Voils CI, Umland RC, Kronish IM

Received 8 August 2019

Accepted for publication 13 September 2019

Published 3 October 2019 Volume 2019:13 Pages 1677—1684


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Talea Cornelius,1 Corrine I Voils,2,3 Redeana C Umland,1 Ian M Kronish1

1Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; 2William S Middleton Veterans Memorial Hospital, Madison, WI 53705, USA; 3Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI 53792, USA

Correspondence: Talea Cornelius
Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street PH9-319, New York, NY 10032, USA
Tel +1212-304-5215

Background: Self-report measures are important tools for assessing adherence to medication. Many of these scales, however, combine the extent of and reasons for nonadherence in one instrument, and have limited reliability and validity. The present study was the first to assess the convergent validity of the self-reported Domains of Subjective Extent of Nonadherence (DOSE-Nonadherence) scale with electronically measured adherence to a single cardiovascular medication.
Methods: English- and Spanish-speaking patients evaluated for acute coronary syndrome (N=165; n=68 and n= 97, respectively) were recruited from an urban academic emergency department. Post-hospital discharge, participants were mailed a medication bottle with an electronic cap (eCAP) that recorded bottle openings. At 1 month, participants completed the 3-item DOSE-Nonadherence scale, which assessed the extent to which patients missed, skipped, or did not take the eCAP-monitored medication over the past 7 days. Correlations, sensitivity, and specificity were calculated using eCAP-monitored correct dosing adherence over the same 7-day time period as the reference standard.
Results: The most commonly assessed medication was aspirin (70.91%). Correlations between self-reported and electronically monitored adherence were low-to-moderate: English-speaking participants (n=68), r=0.24, p=0.046; Spanish-speaking participants (n=97), r=0.18, p=0.071. Sensitivity was low (0.47 English, 0.28 Spanish) and specificity was moderate (0.77 English, 0.88 Spanish).
Conclusions: The DOSE-Nonadherence scale was associated with electronically monitored adherence to a single daily cardiovascular medication in English-speaking participants, but had weak diagnostic properties when using electronic adherence as the reference standard.

Keywords: medication adherence, self-report, nonadherence, validity, electronic monitoring

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