한국노년학

The Korean Gerontological Society (한국노년학회)
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Development of medication adherence scale for the elderly with chronic disease

만성질환 노인의 약물이행 측정도구 개발

  • Received : 2020.12.17
  • Accepted : 2021.01.04
  • Published : 2021.02.28
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Abstract

This study was to develop the Medication Adherence Scale in Elderly (MAS-E) with chronic disease and verify its reliability and validity. The MAS-E was developed in 5 steps: Configuration of conceptual frame by content analysis, preliminary items, pilot study, reliability and validity test, and development of final MAS-E with chronic disease. The questionnaires were collected from 345 adults with one-to-one interviews. Verification of its reliability and validity was divided into two phases. Reliability was tested using Cronbach's alpha, split-halves reliability, and test-retest. For validity tests, item analysis, factor analysis, total score-factor score correlation analysis, and criterion related validity were used. The developed scale consisted of 18 items and 4 factors - remember of taking medication (2 items), expectations for drug effects (5 items), practice taking medication according to instructions (8 items), communicating with health professionals (3 items), and explained 69.7% of total variance. The scale had significantly positive correlation (r = .72, p <.001) with the Morisky Medication Adherence Scale (MMAS-8). Cronbach's alpha was .91, Guttman split half coefficient was .80, and test-retest reliability was .912. Finding suggest that the MAS-E is a suitable scale to assess the status of medication adherence in elderly with chronic disease.

본 연구는 만성질환 노인의 약물이행을 측정하기 위한 도구(Medication Adherence Scale in Elderly, MAS-E)를 개발하고 신뢰도와 타당도를 검증하는 방법론적 연구이다. MAS-E는 혼종모형을 이용한 내용 분석에 의해 개념적 기틀을 구성하고 이를 기반으로 문항을 구성하고 내용타당도를 검증하여 예비문항을 구성하였고 문항을 검토한 후 예비 조사를 실시하여 총 26문항을 최종 확정하여 본 조사를 실시하였다. 설문조사 자료는 일대일 인터뷰를 통해 지역사회에 거주하는 만성질환 노인 345 명으로부터 수집되었다. 도구평가를 위해 신뢰도와 타당도를 검증하고 검증결과를 기반으로 최종 문항을 확정하여 만성질환 노인의 약물이행 도구(MAS-E)를 개발하였다. 타당도 검증에서 문항분석, 요인분석, 총점-요인 간 상관관계를 통해 4개 요인과 18문항이 도출되었으며-약물사용 기억하기(2문항), 약물효과에 대한 기대(5문항), 처방과 지시에 따른 약물사용 실천(8문항), 의료인과의 소통(3문항), 전체 18문항은 분산의 69.7 %를 설명하는 것으로 나타났다. 최종 도구의 총점-요인 간 상관관계는 모두 유의한 상관관계를 나타냈다. 준거타당도 검증 결과, 개발된 도구는 Morisky Medication Adherence Scale (MMAS-8)과 유의하게 양의 상관관계(r = .72, p <.001)를 나타냈다. 신뢰도 검증에서 문항내적 일관성 신뢰도 Cronbach'α는 .906, Guttman 반분검사 신뢰도는 .804, 검사-재검사 신뢰도는 .912로 나타나 개발된 도구는 안정적이고 일관성을 확보하였다. 본 연구를 통해 개발된 MAS-E는 타당도와 신뢰도가 모두 검증된 도구로서 만성질환 노인의 약물이행 정도를 평가하고 약물이행 개선을 위한 중재연구의 효과 평가에 활용될 수 있을 것이다

Keywords

References

  1. 대한노인병학회. (2005). 노인병학. 서울: 의학출판사.
  2. 민신홍, 김종임. (2012). 만성질환을 가진 노인의 약물복용이행 설명모형 구축. 기본간호학회지, 19(4), 463-473. doi.org/10.7739/jkafn.2012.19.4.463
  3. 배상근, 전혜지, 양현수, 김보경, 박기수. (2015). 지역사회 노인 고혈압 환자들의 약물 순응도와 관련요인. 대한임상건강증진학회지, 15(3), 121-128. doi.org/10.15384/kjhp.2015.15.3.121
  4. 보건복지부. (2017). 2017년 노인실태조사보고서. 세종: 보건복지부.
  5. 성태제. (2010). 문항제작 및 분석의 이론과 실제. 서울: 학지사.
  6. 안선영, 송미순. (1999). 퇴원 노인의 처방 약물 이행도에 관한 연구. 노인간호학회지, 1(1), 16-28.
  7. 유승희, 강정희. (2015). 약물이행과 관련된 국내 선행연구 고찰. 한국보건간호학회지, 29(2), 285-297. doi.org/10.5932/JKPHN.2015.29.2.285
  8. 이은옥, 임난영, 박현애. (2009). 간호의료연구와 통계분석. 서울: 수문사.
  9. 이희정. (2002). 고혈압 환자의 약물요법이행에 영향을 미치는 요인. 단국대학교 석사학위논문, 서울.
  10. 장진구, 노대영, 김찬영. (2015). 한국판 약물 순응척도의 표준화 연구. 대한정신약물학회지, 26(2), 43-49.
  11. 한국사례관리연구회. (2007). 복약순응도 높이기. 서울: 현문사.
  12. 허준. (2014). 허준의 쉽게 따라하는 Amos 구조방정식 모형. 서울: 한나래출판사.
  13. Abebe, S. M., Berhane, Y., & Worku, A. (2014). Barriers to diabetes medication adherence in North West Ethiopia. Springerplus, 3, 195. doi.org/10.1186/2193-1801-3-195
  14. Banning, M. (2008). Older people and adherence with medication: a review of the literature. International Journal of Nursing Studies, 45, 1550-1561. doi.org/10.1016/j.ijnurstu.2008.02.009
  15. Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares? Mayo Clinic Proceedings, 86(4), 304-314. doi.org/10.4065/mccp.2010.0575
  16. Chen, C. H., Wu, J. R., Yen, M., & Chen, Z. C. (2007). A model of medication-taking behavior in elderly individuals with chronic disease. The Journal of Cardiovascular Nursing, 22(5), 359-365. https://doi.org/10.1097/01.JCN.0000287029.87746.58
  17. DeVellis, R. F. (2012). Scale development: theory and applications(3nd ed.) Sage.
  18. Doggrell, S. A. (2010). Adherence to medications in the older-aged with chronic conditions. Drugs Aging, 27(3), 239-254. doi.org/10.2165/11532870-000000000-00000
  19. Giardini, A., Martin, M. T., Cahir, C., Lehane, E., Menditto, E., Strano, M., et al. (2015). Toward appropriate criteria in medication adherence assessment in older persons: Position Paper. Aging Clinical and Experimental Research, 28(3), 371-381. doi.org/10.1007/s4050-015-0435-z
  20. Guzman, A. B. (2013). Developing a model of medication adherence among Filipino elderly. Educational Gerontology, 39, 298-313. doi.org/10.1080/03601277.2012.661336
  21. Kaiser, H. F. (1974). An index of factorial simplicity. Psychometrika, 38(1), 31-36. https://doi.org/10.1007/BF02291575
  22. Kim, H. S., Cho, J. H., & Yoon, K. H. (2015). New directions in chronic disease management. Endocrinology and Metabolism, 30, 159-166. doi.org/10.3803/EnM.2015.30.2.159
  23. Laba, T. L., Lehnbom, E., Brien, J. A., & Jan, S. (2015). Understanding if, how and why non-adherent decisions are made in an Australian community sample: a key to sustaining medication adherence in chronic disease? Research in Social & Administrative Pharmacy, 11(2), 154-162. doi.org/10.1016/j.sapharm.2014.06.006
  24. Lavsa, S. M., Holzworth, A., & Ansani, N. T. (2011). Selection of a validated scale for measuring medication adherence. Journal of American Pharmacists Association, 51(1), 90-94. doi.org/10.1331/JAPhA.2011.09154
  25. McHorney, C. A., & Spain, C. V. (2011). Frequency of and reasons for medication non-fulfillment and non-persistence among American adults with chronic disease in 2008. Health Expect, 14(3), 307-320. doi.org/10.1111/j.1369-7625.2010.00619.x
  26. McHorney, C. A. (2009). The adherence esimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease. Current Medical Research and Opinion, 25(1), 215-238. https://doi.org/10.1185/03007990802619425
  27. Mosby's Medical Dictionary, 8th edition. (2009). Retrieved January 19 2017 from http://medical-dictionary.thefreedictionary.com/chronic+disease
  28. Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24(1), 67-74. https://doi.org/10.1097/00005650-198601000-00007
  29. Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. Journal of Clinical Hypertension, 10(5), 348-354. https://doi.org/10.1111/j.1751-7176.2008.07572.x
  30. Murray, M. D., Morrow, D. G., Weiner, M., Clark, D. O., Tu, W., Deer, M. M., et al. (2004). A conceptual framework to study medication adherence in older adults. The American Journal of Geriatric Pharmacotherapy, 2(1), 36-43. doi.org/10.1016/S1543-5946(04)90005-0
  31. Nunnally, J. C. (1978). Psychometric theory(2nd ed.). New York: McGraw-Hill.
  32. Oyekan, E., Nimalasuriya, A., Martin, J., Scott, R., Dudl, R. J., & Green K. (2009). The B-SMART appropriate medication-use process: a guide for clinicians to help patients-part 1: barriers, solutions, and motivation. The Permanente Journal, 13(1), 62-69. https://doi.org/10.7812/TPP/07-057
  33. Reynolds, K., Viswanathan, H. N., Muntner, P., Harrison, T. N., Cheetham, T. C., Hsu, J. W., et al. (2014). Validation of the osteoporosis-specific morisky medication adherence scale in long-term users of bisphosphonates. Quality of Life Research, 23(7), 109-120. doi.org/10.1007/s11136-014-0662-3
  34. Rodgers, B. L., & Kn afl, K. A. (2000). Concept development in nursing : Foundations, techniques, and applications. Sanders. pp. 129-159.
  35. Rose, L., Kim, M., Dennison, C., & Hill, M. (2000). The contexts of adherence for African Americans with high blood pressure. Journal of Advanced Nursing, 32(3), 587-594. doi.org/10.1046/j.1365-2648.2000.01538.x
  36. Schwartz-Barcott, D., & Kim, H. S. (2000). An expansion and elaboration of the hybrid model of concept development. In: B. L. Rodgers, & K. A. Knafl, editors. Concept Development in Nursing: Foundations, Techniques, and Applications. Philadelphia: W. B. Saunders Co. p. 129-159.
  37. Sencan, N. M., Wertheimer, A., & Levine, C. B. (2011). What determines the duration of patient medication compliance in patients with chronic disease: are we looking in the wrong place? Southern Med Review, 4(2), 97-101. doi.org/10.5655/smr.v4i2.10
  38. Svarstad, B. L., Chewning, B. A., Sleath, B. L., & Claesson, C. (1999). The brief medication questionnaire: a tool for screening patient adherence and barriers to adherence. Patient Education and Counseling, 37(2), 113-124. https://doi.org/10.1016/S0738-3991(98)00107-4
  39. Thompson, K., Kulkarni, J., & Sergejew, A. A. (2000). Reliability and validity of a new medication adherence rating scale(MARS) for the psychoses. Schizophrenia Research, 42(3), 241-247. doi.org/10.1016/S09209964(99)00130-9
  40. Tourkmani, A. M., Al Khashan, H. I., Albabtain, M. A., Al Harbi, T. J., Al Qahatani, H. B., & Bakhiet, A. H. (2012). Medication adherence among patients in a chronic disease clinic. Saudi Med J, 33(12), 1278-1284.
  41. Vejux, j., Galery, K., Bin jamin , S., Ghali, A, De Decker, L., & Berrut, G. (2014). Evaluation tools of drug adherence for elderly subjects: towards a new pattern of scale. Geriatri Psychol Neuropsychiatr Vieil, 12(2), 139-154. doi.org/10.1684/pnv.2014.0470