Design and development of a non-adherence survey for the elderly with chronic diseases: a mixed method study

Abstract

Title: Design and development of a non-adherence survey for the elderly with chronic diseases: a mixed method study Introduction and purpose: worldwide population transition and aging is one of the crucial challenges of countries in the 21st century. By being aware of the obstacles and problems facing this age group, it is possible to implement the necessary policies and programs to solve the obstacles and increase the quality of elders’ life. Since policies and programs must be designed and implemented based on the needs, culture and value system of the society in which a person lives. The present study uses a combined approach to explain the obstacles of non-adherence to medication and design a non-adherence measurement tool. Follow-up of drug use was done in Iranian elderly. Materials and methods: The present study was conducted with the combined research approach of exploratory sequential mixed method and with the participation of the elderly (people over 60 years old) covered by health care centers in Tabriz city in 1400. The methodology consists of two phases, in the first phase of the study, the qualitative type, using the opinions of 15 selected elderly through a semi-structured interview, the reasons for non-compliance with medication were investigated. Also, for a deeper understanding of the issues at this stage, interviews with experts as well as review of similar articles also used. In the second phase of the study, which is a cross-sectional descriptive study, a tool for measuring non-adherence to medication use was designed based on the findings of the qualitative research conducted in the first phase, then psychometrically, includes face validity, content validity, validity structure and reliability, and finally, after reviewing and analyzing the findings, the designed questionnaire was introduced as a tool compatible with Iranian elderly. Result: Based on the results of the qualitative section, obstacles to medication compliance included 81 primary items. At the end of the qualitative part, the designed tool with 21 items entered the psychometric stage of the tool. After checking the validity (content and form), the instrument with 18 items entered the construct validity phase. The expressed variance was determined in the range of 45% to 74%. The internal consistency for all expressions was equal to 0.915 and the reliability of the tool was equal to (ICC=0.852 (0.783-0.941)). Conclusion: The issue of non-adherence to medication needs attention at different levels, and interventions should be designed and implemented according to each level. By using the measurement tool designed in the present study, better planning is possible to be applied to reduce the reasons for non-compliance and increase the compliance rate of medication use in the elderly in the programs and policies of the country.