Send to

Choose Destination
Curr Med Res Opin. 2008 Nov;24(11):3197-206. doi: 10.1185/03007990802463642 . Epub 2008 Oct 14.

Further testing of the reliability and validity of the ASK-20 adherence barrier questionnaire in a medical center outpatient population .

Author information

Center for Health Outcomes Research, United BioSource Corporation,Bethesda, MD, USA.



This study examined the psychometric properties of the ASK-20 questionnaire, which was developed to assess barriers to medication adherence.


Patients with asthma, diabetes, and congestive heart failure were recruited from a university medical center. Participants in this convenience sample completed the ASK-20 questionnaire and other questionnaires. Approximately one-third of participants were randomized to a 2-week retest administration. Analyses examined the reliability and validity of the ASK-20.


A total of 112 patients participated (75.9% female; mean age = 46.7 years). The ASK-20 had good internal consistency reliability (Cronbach's alpha = 0.76) and test-retest reliability (0.80). Concurrent validity was demonstrated through significant correlations with the Morisky Medication Adherence Scale (r = -0.61, p < 0.001), condition-specific measures, and the SF-12 Mental Component Summary score (r = -0.40, p < 0.001). The correlation of the ASK-20 with proportion of days covered by filled medication prescriptions in the past 6 months (based on pharmacy claims) was relatively weak (r = -0.13), but in the expected direction. The ASK-20 total score significantly discriminated among groups of patients who differed in self-reported indicators including the Morisky score; missing a medication dose in the past week; number of days medication was not taken as directed; and treatment satisfaction.


The ASK-20 demonstrated adequate reliability and validity, and it may be a useful measure of barriers to treatment adherence across a spectrum of chronic diseases. Limitations related to scale construction, lack of longitudinal data, and item characteristics are discussed.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Taylor & Francis
Loading ...
Support Center