Barriers to Medication Adherence in Chronic Dermatological Diseases: A Validation Study of the Arabic Version of the Adherence Barriers Questionnaire and a Cross-Sectional Survey
📖عربي Arabic version of the unique ABQ questionnaire available! In order to improve patients’ adherence to healthcare interventions such as long-term medication therapy in chronic diseases, there is one major challenge: Scientists as well as developers of adherence-promoting interventions and physicians need to know exactly WHY patients do not adhere with the interventions/prescriptions that were recommended to them.The ABQ is a unique and validated questionnaire to identify adherence barriers on a patient-level. It has now been validated in Arabic questionnaire.
Objective:Treatment non-adherence in chronic dermatological diseases is a persistent problem. Therefore, the use of a reliable and valid instrument to identify barriers to treatment adherence is essential. To date, no Arabic version of the Adherence Barriers Questionnaire (ABQ-A) has been available to identify barriers to treatment adherence among patients in Arab communities. Therefore, we conduct this study to validate an ABQ-A and then identify potential barriers to adherence in common chronic dermatological diseases.
Methods: The cross-section study was prospectively conducted in the Dermatology Department at Assiut University Hospital between March 2022 and August 2023. In total, 400 Egyptian patients with common chronic dermatological diseases (vitiligo, acne vulgaris, psoriasis vulgaris, and atopic dermatitis) were randomly recruited. Patient adherence to treatment was assessed using the Arabic versions of the Morisky Medication Adherence Scale and the Adherence to Refills and Medications Scale (ARMS). Adherence barriers were examined using the newly developed ABQ-A. Reliability and internal consistency of the ABQ-A were examined via Cronbach’s alpha coefficient (Cronbach’s α). Construct validity was evaluated through exploratory factor analysis. External validity was tested by calculating Spearman’s rho correlations between ABQ-A scores and ARMS scores.
Results:The mean age of the 400 patients was 32.6 years (standard deviation = 15.6), ranging from 18 to 69 years and 228 patients were females. Totally 293 patients (73.3%) exhibited low adherence. The mean ARMS score was 33.5 ± 4.6, and the mean ABQ-A score was 39.1 ± 3.9. The Cronbach’s α for the ABQ-A was 0.78, indicating acceptable internal consistency. Exploratory factor analysis revealed that the ABQ-A consisted of 3 factors (intentional, medication/healthcare system-related, and unintentional adherence barriers), supporting construct validity. Among the three factors, the medication/healthcare system-related barriers subscale had the highest mean ABQ-A score (15.2 ± 1.8), followed by the intentional (13.1 ± 1.8) and unintentional (10.8 ± 1.6) adherence barriers subscales. Items with mean ABQ-A scores exceeding 3 identified key barriers: financial burden (item 8), psychological distress (item 10), difficulty maintaining medication routines (item 11), perceived systemic obstacles to healthcare (item 12), and concerns about side effects, which prompted discussions with doctors (item 15a) or led to medication discontinuation (item 15b). External validity was confirmed by a significant positive correlation between ABQ-A and ARMS scores (r = 0.84, P < 0.001).