Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin

Boas, Lilian Cristiane Gomes-Villas; Lima, Maria Luisa Soares Almeida Pedroso de; Pace, Ana Emilia

doi:10.1590/0104-1169.3155.2386

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Original Articles • Rev. Latino-Am. Enfermagem 22 (01) • Jan-Feb 2014 • https://doi.org/10.1590/0104-1169.3155.2386 copy

Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin¹ 1 Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), process # 2011/08937-6 and by Pró-Reitoria de Cultura e Extensão Universitária at Universidade de São Paulo.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

to verify the face validity, criterion-related validity and the reliability of two distinct forms of presentation of the instrument Measurement of Adherence to Treatment, one being for ascertaining the adherence to the use of oral antidiabetics and the other for adherence to the use of insulin, as well as to assess differences in adherence between these two modes of drug therapy.

METHOD:

a methodological study undertaken with 90 adults with Type 2 Diabetes Mellitus. The criterion-related validity was verified using the Receiver Operating Characteristic curves; and for the reliability, the researchers calculated the Cronbach alpha coefficient, the item-total correlation, and the Pearson correlation coefficient.

RESULTS:

the oral antidiabetics and the other showed sensitivity of 0.84, specificity of 0.35 and a Cronbach correlation coefficient of 0.84. For the adherence to the use of insulin, the values found were, respectively, 0.60, 0.21 and 0.68. A statistically significant difference was found between the final scores of the two forms of the instrument, indicating greater adherence to the use of insulin than to oral antidiabetics.

CONCLUSION:

it is concluded that the two forms of the Measurement of Adherence to Treatment instrument are reliable and should be used to evaluate adherence to drug treatment among people with diabetes mellitus.

Nursing Care; Diabetes Mellitus; Patient Compliance; Validation Studies

Items of the forms of Measurement of Adherence to Treatment (N = 90)

1-Have you ever forgotten to take the tablets/ administer the insulin for the diabetes?	0.67	0.81	0.45	0.63
2-Have you ever been careless with the time for taking the tablets/administering the insulin for the diabetes?	0.53	0.83	0.41	0.65
3-Have you ever not taken the tablets/administered the insulin for the diabetes because of feeling better?	0.65	0.81	0.46	0.63
4-Have you ever not taken the tablets/administered the insulin for the diabetes, on your own initiative, because of feeling worse?	0.49	0.84	0.53	0.60
5-Have you ever taken one or more tablets/administered one or more units of insulin for the diabetes, on your own initiative, because of feeling worse?	0.38	0.85	0.38	0.65
6-Have you ever interrupted the treatment for diabetes because you had let the tablets/insulin run out?	0.76	0.80	0.20	0.69
7-Have you ever not taken the tablets/administered the insulin for the diabetes, for any reason apart from being so instructed by the doctor?	0.77	0.79	0.40	0.66

Items from the forms of Measurement of Adherence to Treatment	r* (p-value)
Items 1	0.43 (0.000)^†
Items 2	0.25 (0.002)^†
Items 3	0.44 (0.000)^†
Items 4	0.53 (0.000)^†
Items 5	0.25 (0.020)^†
Items 6	0.28 (0.000)^†
Items 7	0.56 (0.000)^†
Total of the Scales	0.77 (0.000)^†

Items	Forms of the Instrument
	MAT OADs (N=90)		MAT insulin (N=90)
	Mean (SD)	Median (interval)	Mean (SD)	Median (interval)
1	5.06 (1.27)	6.00 (1.00-6.00)	5.50 (0.77)	6.00 (4.00-6.00)
2	4.87 (1.37)	5.00 (1.00-6.00)	5.04 (1.04)	5.00 (2.00-6.00)
3	5.62 (1.02)	6.00 (1.00-6.00)	5.71 (0.71)	6.00 (2.00-6.00)
4	5.27 (1.44)	6.00 (1.00-6.00)	5.71 (0.77)	6.00 (1.00-6.00)
5	5.71 (0.92)	6.00 (1.00-6.00)	5.57 (0.89)	6.00 (1.00-6.00)
6	5.56 (1.03)	6.00 (1.00-6.00)	5.80 (0.66)	6.00 (1.00-6.00)
7	5.61 (1.08)	6.00 (1.00-6.00)	5.89 (0.41)	6.00 (4.00-6.00)
Total of the scale	5.39 (0.84)	5.71 (1.71-6.00)	5.60 (0.45)	5.71 (4.00-6.00)

Items	Forms of the Instrument		Statistical value*	p-value
Items	MAT OADs (N=90)Mean (SD)	MAT insulin (N=90)Mean (SD)	Statistical value*	p-value
1	5.06 (1.27)	5.50 (0.77)	3.628	0.000^†
2	4.87 (1.37)	5.04 (1.04)	1.127	0.263
3	5.62 (1.02)	5.71 (0.71)	0.882	0.380
4	5.27 (1.44)	5.71 (0.77)	3.459	0.000^†
5	5.71 (0.92)	5.57 (0.89)	-1.238	0.219
6	5.56 (1.03)	5.80 (0.66)	2.203	0.030^†
7	5.61 (1.08)	5.89 (0.41)	2.889	0.005^†
Total of the scale	5.39 (0.84)	5.60 (0.45)	3.578	0.001^†

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Ana Emilia Pace Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto Departamento de Enfermagem Geral e Especializada Av. Bandeirantes, 3900 Bairro: Monte Alegre CEP: 14040-902, Ribeirão Preto, SP, Brasil E-mail: aepace@eerp.usp.br