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J Eval Clin Pract. 2017 Dec;23(6):1252-1257. doi: 10.1111/jep.12773. Epub 2017 Jul 17.

Influence of the mode of administration on the results of medication adherence questionnaires.

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Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
Cognitive and Behavioural Center for Research and Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
Pharmacology and Pharmaceutical Care Laboratory, Institute for Biomedical Imaging and life Sciences, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
Institute for Medicines Research (iMed. Ulisboa), Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal.



Adherence to medication regimen is commonly assessed through questionnaires, some of which are validated via self-administration. The inadequate health literacy of elderly people pushes researchers to the use of interviews as a method of administration. The aims of this study were to compare the results obtained with an interviewer-administered and a self-administered medication adherence questionnaire and to evaluate the consequences of the adherence status classification of individuals.


A cross-sectional study was performed in which the Medida de Adesão aos Tratamentos adherence questionnaire was administered to adult patients who were taking at least 1 antihypertensive drug. The data were collected in 7 community pharmacies in central Portugal between March 2014 and September 2015 in 2 different phases: in the first phase, the questionnaire was applied during a healthcare professional interview, and the second phase involved a self-report administration. A confirmatory factor analysis was conducted, and the measurement and structural invariances across the application methods were examined.


A sample of 425 patients with a mean age of 68.21 ± 10.56 years participated in the study. The confirmatory factor analysis revealed that both the interview and self-report had a good fit with the original model, although the self-report results exhibited a better fit. In the interview administration, we obtained lower values for skewness and higher levels of kurtosis. The patients subjected to the interview administration presented with a 9.7% higher tendency to answer "never" when compared with the self-administered application, which overestimated adherence.


The interview administration method induced bias that led to a higher percentage of "never" answers and a subsequent overestimation of adherence levels. Self-report administration should be preferred in the application of medication adherence questionnaires.


bias (epidemiology); medication adherence; patient outcome assessment; patient preference; reproducibility of results; surveys and questionnaires

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