Development and validation of a medication adherence tool for people with bipolar disorder to identify non-adherent behaviour and diagnose an individual’s determinants of adherence

Prajapati, Asta (2022) Development and validation of a medication adherence tool for people with bipolar disorder to identify non-adherent behaviour and diagnose an individual’s determinants of adherence. Doctoral thesis, University of East Anglia.

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Abstract

Background
Around 40% of patients with bipolar disorder are non-adherent due to a wide range of determinants. Adherence support strategies are not tailored to individual’s determinants. This thesis aimed to develop and evaluate a medication adherence tool (‘C-MABQ’) to guide identifying adherence determinants.

Methods
Theoretical Domains Framework (TDF) underpinned the research programme comprising five empirical studies: 1) a systematic review of modifiable adherence determinants, 2) focus groups and interviews with patients and their families and friends to explore these determinants, 3) development of C-MABQ in collaboration with experts in the area, 4) consultation with healthcare professionals and patients to check face and content validity, and 5) psychometric evaluation of C-MABQ with patients.

Results
Literature identified determinants were mapped to 11 TDF domains; patients and their families and friends prioritised nine domains. A 50-item C-MABQ, developed from the prioritised determinants, had good face and content validity. The C-MABQ was completed by 325 patients for psychometric evaluation. Fifteen items representing six TDF domains, ‘Emotion’, ‘Social Influence’, ‘Memory, attention and decision processes’, ‘Intention’, ‘Goal’, ‘Social/professional role and identity’, fulfilled the Mokken Scale double monotonicity model criteria and demonstrated construct validity. The 15-item C-MABQ showed criterion validity with medication adherence report scale (ρ=0.32, P <0.001) but not with blood Lithium level. It showed good model fit (CFI=0.997, TLI=0.996, RMSEA=0.059), good internal consistency (α =0.91, 95% CI=0.89 to 0.93) and good test-retest reliability (ICC=0.74, 95% CI=0.61 to 0.82, P<0.001).

Conclusion
The 15-item C-MABQ identifies individual’s prominent adherence determinants. Their mapping to the TDF enables C-MABQ items to be linked to behaviour change techniques, thus guiding patients and healthcare professionals to select adherence support strategies tailored to the prioritised adherence determinant. Blood Lithium levels may not present accurate and reliable measure of adherence. Thus, a feasibility study to establish an appropriate adherence measure for a definitive trial is required.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Science > School of Pharmacy
Depositing User:	Chris White
Date Deposited:	27 Sep 2023 09:49
Last Modified:	27 Sep 2023 09:49
URI:	https://ueaeprints.uea.ac.uk/id/eprint/93112
DOI:

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