A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients
Non-adherence to the therapeutic regimen is an increasingly growing problem especially among patients undergoing hemodial ysis. The aim of this study was to modify the Greek version of Simplified Medication Adherence Questionnaire (GR-SMAQ) for patients undergoing hemodialysis (GR-SMAQ-HD) and explore its validity and reliability. Between June 2016 and November 2016 a group of patients undergoing hemodialysis (N=107) com pleted the Greek version of SMAQ. The study was carried out in three Dialysis Units of Hospitals of Athens and Peloponnese region, Greece. The form of GR-SMAQ was modified specifically for renal patients while four additional items were added so as the tool study all aspects of adherence to hemodialysis regimen.Construct validity was checked through exploratory factor analy sis with principal Component Analysis with the Equamax method. Test-retest reliability and internal consistency were tested. Statistical analysis was performed using the IBM SPSS Statistics version 21. The significance level was set up at 5%. The Greek version of SMAQ for patients undergoing hemodialysis includes eight questions. Three factors emerged from factor analysis. Cronbach’s α coefficient was 0.742 for the whole scale and for each subscale was for Medication Adherence 0.75, for Attendance at hemodialysis session 0.856 and for Diet/Fluid restriction was 0.717. The total mean score was 6.29 (±1.82). GR-SMAQ-HD is a reliable and valuable tool that can be used by hemodialysis nurs es and students of nursing for detection of adherence levels in clin ical practice.
1. Achieng, L., Musangi, H., Billingsley, K., Onguit, S., Ombegoh, E., Bryant, L., ... Keiser, P. (2013). The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings. PLoS One, 8(12), e67259. doi: 10.1371/journal.pone.0067259
2. Albayrak Cosar, A., & Cinar Pakyuz, S. (2016). Scale development study: the fluid control in hemodialysis patients. Japanese Journal of Nursing Science, 13, 174-182.
3. Arenas, M.D., Malek, T., Álvarez-Ude, F., Gil, M.T., Moledous, A. & Reig-Ferrer, A. (2010a). Phosphorus binders: preferences of patients on haemodialysis and its impact on treatment compliance and phosphorus control. Nefrologia, 30, 522-530.
4. Arenas, M.D., Malek, T., Gil, M.T., Moledous, A., Alvarez-Ude, F. & Reig-Ferrer, A., (2010b). Challenge of phosphorus control in hemodialysis patients: a problem of adherence? Journal of Nephrology, 23, 525-534.
5. Barnes, T., Hancock, K. & Dainton, M. (2013).Training nurses to support greater patient engagement in haemodialysis. Journal of Renal Care, 39 Suppl 2:10-8.
6. Bellizzi V., Cupisti, A., Locatelli, F., Bolasco, P., Brunori, G., Cancarini, G., ... Conservative Treatment of CKD study group of the Italian Society of Nephrology (2016). Low-protein diets for chronic kidney disease patients: the Italian experience. BMC Nephrology, 17, 77.
7. Block, G.A., Klassen, P.S., Lazarus, J.M. Ofsthun, N., Lowrie, E.G. & Chertow, G.M. (2004). Mineral metabolism, mortality, and morbidity in maintenance hemodialysis. Journal of the American Society of Nephrology, 15, 2208-2218.
8. Cowperthwaite, J., Schutt-Aine, R., Herranen, M. & Sorribes, M.P. (2012). Introduction of a competency based haemodialysis education programme: 5 years experience. Journal of Renal Care, 38, 162-169.
9. Culig, J. & Leppée, M. (2014). From Morisky to Hill bone; self-reports scales for measuring adherence to medication. Collegium Antropologicum, 38, 55-62.
10. Davison, I. & Cooke, S. (2015). How nurses’ attitudes and actions can influence shared care. Journal of Renal Care, 41, 96-103.
11. Durose, C.L., Holdsworth, M., Watson, V. & Przygrodzka, F. (2004). Knowledge of dietary restrictions and the medical consequences of noncompliance by patients on hemodialysis are not predictive of dietary compliance. Journal of the American Dietetic Association, 104, 35-41.
12. Erlingmark, J., Hedström, M. & Lindberg, M. (2016). Nurse staffing and renal anaemia outcomes in haemodialysis care. Journal of Renal Care, 42, 185-189.
13. Estrella, M.M., Jaar, B.G., Cavanaugh, K.L., Fox, C.H., Perazella, M.A., Soman, S.S., ..., Choi, M.J. (2013). Perceptions and use of the national kidney foundation KDOQI guidelines: a survey of U.S. renal healthcare providers. BMC Nephrology, 14, 230. doi: 10.1186/1471-2369-14-230.
14. Ghimire, S., Castelino, R.L., Lioufas, N.M., Peterson, G.M. & Zaidi, S.T. (2015). Nonadherence to medication therapy in haemodialysis patients: A Systematic Review. PLoS One, 10(12), e0144119. doi: 10.1371/journal.pone.0144119
15. Goodman, W.G. (2002). Vascular calcification in end-stage renal disease. Journal of Nephrology, 15 suppl 6, S82-S85.
16. Ibrahim, S., Hossam, M. & Belal, D. (2015). Study of non-compliance among chronic hemodialysis patients and its impact on patients’ outcomes. Saudi Journal of Kidney Diseases and Transplantation, 26, 243-249.
17. Ikonomou, M., Skapinakis, P., Balafa, O., Eleftheroudi, M., Damigos, D. & Siamopoulos, K.C. (2015). The impact of socioeconomic factors on quality of life of patients with chronic kidney disease in Greece. Journal of Renal Care, 41, 239-246.
18. Jimmy, B. & Jose, J. (2011). Patient medication adherence: measures in daily practice. Oman Medical Journal, 26, 155-159.
19. Kammerer, J., Garry, G., Hartigan, M., Carter, B. & Erlich, L. (2007). Adherence in patients on dialysis: strategies for success. Nephrology Nursing Journal, 34, 479-486.
20. Karamanidou, C., Clatworthy, J., Weinman, J. & Horne, R. (2008). A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease. BMC Nephrology, 9:2. doi: 10.1186/1471-2369-9-2.
21. Kim, M., Hill, M., Bone, L., & Levine, D. (2000). Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Progress In Cardiovascular Nursing, 15, 90-96.
22. Kim, Y. & Evangelista, L.S. (2013). Development and cultural adaptation of the Spanish Version of the End Stage Renal Disease Adherence Questionnaire (SESRD-AQ). Nephrology Nursing Journal, 40, 493-507.
23. Kim, Y., Evangelista, L.S., Phillips, L.R., Pavlish, C. & Kopple, J.D. (2010). End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ): testing the psychometric properties in patients receiving in-center hemodialysis. Nephrology Nursing Journal, 37, 377-393.
24. Knobel, H., Alonso, J. Casado, J.L., Collazos, J., González, J., Ruiz, I., …, GEEMA Study Group (2002). Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS, 16, 605-613.
25. Krousel-Wood, M., Joyce, C., Holt, E., Levitan, E., Dornelles, A., Webber, L., & Muntner, P. (2013). Development and evaluation of a self-report tool to predict low pharmacy refill adherence in elderly patients with uncontrolled hypertension. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 33, 798-811.
26. Kutner, N.G., Zhang, R., & McClellan, W.M. (2002). Psychosocial predictors of non-compliance in haemodialysis and peritoneal dialysis patients. Nephrology Dialysis Transplantation, 17, 93-99.
27. Lam, W.Y. & Fresco, P. (2015). Medication adherence measures: an overview. BioMed Research International 217047. doi: 10.1155/2015/217047.
28. Lee, S.W. (2012). Sodium balance in maintenance hemodialysis. Electrolytes & Blood Pressure, 10, 1-6.
29. Leggat, J.E., Orzol, S.M., Hulbert-Shearon, T.E., Golper, T.A., Jones, C.A., Held, P.J. & Port, F.K. (1998). Noncompliance in hemodialysis: predictors and survival analysis. American Journal of Kidney Diseases, 32, 139-145.
30. López-Gómez, J.M., Villaverde, M., Jofre, R., Rodriguez-Benítez, P. & Pérez-García R. (2005). Interdialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodialysis patients. Kidney International, Suppl 93, S63-S68
31. Nguyen, T., Caze, A., & Cottrell, N. (2014). What are validated self-report adherence scales really measuring? A systematic review. British Journal of Clinical Pharmacology, 77, 427-445. http://dx.doi.org/10.1111/bcp.12194
32. Oberguggenberger, A.S., Sztankay, M., Beer, B., Schubert, B., Meraner, V., Oberacher H…, Hubalek, M. (2012). Adherence evaluation of endocrine treatment in breast cancer: methodological aspects. BMC Cancer, 12, 474. doi: 10.1186/1471-2407-12-474.
33. Poveda, V., Amado, L., Filgueiras, M., Teixeira, L., Miranda, V., Santos-Silva, A., …, Costa, E. (2016) End-stage renal disease adherence questionnaire: translation and validation to the Portuguese language, Renal Failure, 38(10), 1633-1638.
34. Rushe, H. & McGee, H.M. (1998). Assessing adherence to dietary recommendations for hemodialysis patients: the Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ). Journal of Psychosomatic Research, 45, 149-157.
35. Sandlin, K., Bennett P.N., Ockerby, C. & Corradini, AM. (2013). The impact of nurse-led education on haemodialysis patients’ phosphate binder medication adherence. Journal of Renal Care, 39, 12-18.
36. Segall, L., Nistor, I. & Covic, A. (2014). Heart failure in patients with chronic kidney disease: A systematic integrative review. BioMed Research International, 937398. http://doi.org/10.1155/2014/937398
37. Smyth, W., Hartig, V., Hayes, M. & Manickam, V. (2015). Patients’ adherence to aspects of haemodialysis regimens in tropical north Queensland, Australia. Journal of Renal Care, 41, 110-118.
38. Streiner, D.L. Norman, G.R. & Cairney, J. (2014). Health measurement scales: A practical guide to their development and use (5th ed.). New York: Oxford University Press Inc.
39. Svarstad, B.L., Chewning, B.A., Sleath, B.L. & Claesson, C. (1999). The Brief Medication Questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Education and Counseling, 37, 113-24.
40. Tan, X., Patel, I., Chang, J. (2014). Review of the four item Morisky Medication Adherence Scale (MMAS-4) and eight item Morisky Medication Adherence Scale (MMAS-8). University of Minnesota, College of Pharmacy. Retrieved from the University of Minnesota Digital Conservancy, http://hdl.handle.net/11299/171823.
41. Theofilou, P. (2012). Results from the translation and cultural adaptation of the Greek Simplified Medication Adherence Questionnaire (GR-SMAQ) in patients with lung cancer. Journal of Clinical Trials, 3, 2. http://dx.doi.org/10.4172/2167-0870.1000133
42. Thompson, K., Kulkarni, J. & Sergejew, A.A. (2000). Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research, 42, 241-247.
43. van der Meer, I.M., Ruggenenti, P. & Remuzzi, G., (2010). The diabetic CKD patient - a major cardiovascular challenge. Journal of Renal Care, 36 Suppl 1:34-46.
44. Vlaminck, H., Maes, B., Jacobs, A., Reyntjens, S. & Evers, G. (2001). The Dialysis Diet and Fluid Non-adherence Questionnaire: Validity testing of a self-report instrument for clinical practice. Journal of Clinical Nursing, 10, 707-715.
45. Zyga, S., Alikari, V., Sachlas, A., Fradelos, E.C., Stathoulis, J., Panoutsopoulos, G., …, Lavdaniti, M. (2015). Assessment of fatigue in end stage renal disease patients undergoing hemodialysis: prevalence and associated factors. Medical Archives, 69, 376-380.