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Transl Behav Med. 2015 Dec;5(4):470-82. doi: 10.1007/s13142-015-0315-2. Epub 2015 Jul 9.

Self-report measures of medication adherence behavior: recommendations on optimal use.

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NIH/National Institute of Mental Health Division of AIDS Research, Bethesda, MD USA.
School of Nursing, University of Pittsburgh, Pittsburgh, PA USA.
Division of Infectious Diseases, University of Washington, Seattle, WA USA.
Department of Psychology, University of Washington, Seattle, WA USA.
NIH/National Heart, Lung and Blood Institute, Bethesda, MD USA.
Department of Pediatrics, Baylor College of Medicine, Houston, TX USA.
Department of Family Medicine, University of Michigan, Ann Arbor, MI USA.
NIH/National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD USA.
Health Science Center, University of Texas, San Antonio, TX USA.
NIH/National Institute on Drug Abuse, Bethesda, MD USA.
School of Medicine, New York University, New York, NY USA.
School of Medicine, Johns Hopkins University, Baltimore, MD USA.
NIH/National Eye Institute, Bethesda, MD USA.
National Science Foundation, Arlington, VA USA.


Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review self-report medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care.


Adherence; Compliance; Medication; Self-management; Self-report

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