Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study

Abstract

Background Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020–2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ. Methods HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach’s coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation (r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ. Results All participants were female with a mean age of 33; median: 34 years; range 18–45 years. Cronbach’s alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups. Conclusions Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.

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“…Agala et al. reported SMAQ to be measurement invariant across different intervention groups and time points [ 27 ]. We have also collected information using patient log and pill count to verify the accuracy of the self-reported items of SMAQ.…”

“…There is no gold standard for measuring medication adherence as each method has its advantages and limitations [25]. The primary outcome of adherence was defined using self-reported adherence via SMAQ, which is a valid and reliable instrument [18,26,27]. Agala et al reported SMAQ to be measurement invariant across different intervention groups and time points [27].…”

“…The primary outcome of adherence was defined using self-reported adherence via SMAQ, which is a valid and reliable instrument [18,26,27]. Agala et al reported SMAQ to be measurement invariant across different intervention groups and time points [27]. We have also collected information using patient log and pill count to verify the accuracy of the self-reported items of SMAQ.…”

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“…It is analogous to the scale's precision. (Agala et al, 2020). This means that if the students take the test twice, both students' results and the relationship among their results should be similar across the tests.…”

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“…or certain artifactual categorizations (e.g. experimental vs. treatment group [60,61]; pre-vs. post-measurement [62,63]; internet-based test vs. paper-and-pencil test [64]).…”