Medications Non-adherence Reasoning Scale (MedNARS): Development and psychometric properties appraisal

Hamid Allahverdipour; Majid Badri; Abdolreza Shaghaghi; Hassan Mahmoodi; Haleh Heizomi; Shayesteh Shirzadi; Mohammad Asghari-Jafarabadi

doi:10.34172/hpp.2023.26

Medications Non-adherence Reasoning Scale (MedNARS): Development and psychometric properties appraisal

Health Promot Perspect. 2023 Sep 11;13(3):212-218. doi: 10.34172/hpp.2023.26. eCollection 2023.

Authors

Hamid Allahverdipour^{1

2}, Majid Badri², Abdolreza Shaghaghi², Hassan Mahmoodi³, Haleh Heizomi², Shayesteh Shirzadi⁴, Mohammad Asghari-Jafarabadi^{5

6

7

8}

Affiliations

¹ Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
² Health Education & Promotion Department, Tabriz University of Medical Sciences, Tabriz, Iran.
³ Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
⁴ Department of Public Health, Neyshabur University of Medical Sciences, Neyshabur, Iran.
⁵ Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
⁶ School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, 3004, Australia.
⁷ Department of Psychiatry, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, 3168, Australia.
⁸ Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main aim of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings.

Methods: A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses.

Results: A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach's alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: χ² /df=1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA)=(0.07), comparative fit index (CFI)=0.95, Tucker-Lewis index (TLI)=0.93 and standardized root mean squared residual (SRMSR)=(0.05).

Conclusion: The study findings were indicative of MedNARS's applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.

Keywords: Aged; MedNARS; Medication nonadherence; Psychometrics; Surveys and questionnaires.