Development and psychometric validation of a barrier assessment tool for adherence to prescribed medication regimens in post-PCI patients

BACKGROUND: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, affecting approximately 197 million people and causing over 9 million deaths annually. Although percutaneous coronary intervention (PCI) improves survival, medication non-adherence affects more than one-quarter of patients after myocardial infarction. Validated instruments assessing multidimensional adherence barriers in post-PCI patients remain limited. This study developed and validated the Post-PCI Barrier Scale for Adherence to Prescribed Medication Regimens (PCI-BSAR). METHODS: = 50), exploratory factor analysis, reliability testing, and measurement model assessment were performed in 253 post-PCI patients. RESULTS: The final 23-item PCI-BSAR demonstrated excellent content validity (S-CVI/Ave = 0.92). Exploratory factor analysis identified four domains: patient- and clinical-related, treatment and healthcare interaction-related, socioeconomic, and healthcare access and system-related barriers, explaining 69.6% of the variance. The questionnaire showed high internal consistency (Cronbach's α = 0.909), composite reliability (0.848-0.938), AVE >0.50, and HTMT <0.85. CONCLUSION: PCI-BSAR is a reliable and valid instrument for identifying multidimensional medication adherence barriers in post-PCI patients and may support individualized adherence assessment during routine outpatient follow-up.