Identifying Dimensions and Items for a Questionnaire to Assess Medication Adherence in Men and Women with Ischemic Heart Disease: Insights from the GENADHECAR Study

Álvaro Carbonell-Soliva,1,2,* Rauf Nouni-García,2– 5,* Jose A Quesada,1,2,4 Francisco González-Llopis,6 Alberto Cordero,7– 9 Vicente Bertomeu-González,10 Domingo Orozco-Beltrán,1,2,4 José Verdú-Soriano,11 Andreu Nolasco,12 Virtudes Pérez-Jover,13 Jose Joaquín Mira,13,14 Adriana López-Pineda,1,2,4 Silvia Guillén-García,15 Pablo Martínez-Pérez,16 Concepción Carratalá-Munuera,1,2,4,* Vicente F Gil-Guillén,1,2,4,* CollaboratorsLeticia Fernández Friera, Julio Osende Olea, Avelino Pereira Expósito, Eduardo Paya Mora, Joaquina Díaz Torres On behalf of GENADHECAR GroupCardiology Section, HM Sanchinarro Hospital, 28050 Madrid, Spain.; Cardiology Section, HM Sanchinarro Hospital, 28050 Madrid, Spain.; General University Hospital of Elda, 03600 Elda, Alicante, Spain; General University Hospital of Elda, 03600 Elda, Alicante, Spain; General University Hospital of Elda, 03600 Elda, Alicante, Spain; 1Clinical Medicine Department, Miguel Hernández University of Elche, San Juan de Alicante, 03550, Spain; 2Primary Care Research Center, Miguel Hernández University of Elche, San Juan de Alicante, 03550, Spain; 3Pathology and Surgery Department, Miguel Hernández University of Elche, San Juan de Alicante, 03550, Spain; 4Network for Research on Chronicity, Miguel Hernández University of Elche, San Juan de Alicante, 03550, Spain; 5Diagnostic Center, Institute of Health and Biomedical Research of Alicante, General University Hospital of Alicante, Alicante, 03110, Spain; 6General University Hospital of Elda, Elda, 03600, Spain; 7Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, 28029, Spain; 8Cardiology Department, IMED Hospital, Elche, 03203, Spain; 9Cardiology Research Unit, Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO), Valencia, 46020, Spain; 10Hospital Clinica Benidorm, Benidorm, 03501, Spain; 11Community Nursing, Preventive Medicine, Public Health and History of Science Department, University of Alicante, San Vicente Del Raspeig, 03690, Spain; 12Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, University of Alicante, San Vicente del Raspeig, 03690, Spain; 13Department of Health Psychology, Miguel Hernández University of Elche, Elche, 03202, Spain; 14Centro de Salud Hospital Plá, Alicante, 03013, Spain; 15Cardiology Section, General University Hospital of Elda, Elda, 03600, Spain; 16Department of Clinical Medicine, Miguel Hernández University of Elche, San Juan de Alicante, 03550, Spain*These authors contributed equally to this workCorrespondence: Adriana López-Pineda, Clinical Medicine Department, School of Medicine, University of Miguel Hernández de Elche, San Juan de Alicante, 03550, Spain, Tel +34 96 591 9309, Email [email protected]: The objective of this study was to identify dimensions and items for a future questionnaire aimed at measuring medication nonadherence in people with ischemic heart disease, considering gender differences and incorporating the views of healthcare professionals, researchers, and patients.Patients and Methods: We conducted a mixed-method cross-sectional study at San Juan de Alicante University Hospital and Miguel Hernández University (Spain). The methods used to identify dimensions included a consensus group of healthcare and scientific professionals, an open-response survey for community pharmacists, a closed-response patient survey, and patient focus groups. When drafting the item list, we followed international recommendations related to the number and wording of items. Our study also included a qualitative review of the item list and response scales by psychologists.Results: The resulting item list includes 41 potential items grouped into 26 dimensions and five domains: “patient”, “treatment”, “disease”, “health professional-patient relationship” and “healthcare system”. It covers aspects such as personal beliefs, mood, polypharmacy, disease symptoms, patient-healthcare professional interaction and healthcare system factors. Response options are presented on a 5-point Likert scale, including agreement-level responses and frequency-level responses.Conclusion: With the collaboration of patients, researchers, and healthcare providers, we potentially identified five domains, 26 dimensions, and 41 items with 5-point Likert scale response options. These will be considered in the subsequent development and validation of a questionnaire to measure medication adherence in patients with ischemic heart disease. Keywords: cardiovascular disease, medication nonadherence, item development, mixed-methods research, gender perspective