Interviews and a questionnaire were used to evaluate the face validity of the SMAT, an instrument that incorporates evidence-based components to determine functional, cognitive, and recall capabilities, as well as self-reported adherence and purposeful nonadherence. The study presented here is the first phase of a larger project, the second phase of which involved determining the psychometric properties of the SMAT in a patient cohort (manuscript in preparation). For the second phase of the project, the researchers modified the tool according to several of the recommendations arising from the current study.
Discussions during the group and individual interviews focused on evaluations of the different sections of the tool, and in some cases participants made specific suggestions for modifying the tool. For the section on functional ability, a common concern was the use of 10-point type on one of the labels. Several participants felt that this font size was quite small, but they were unsure of the font sizes used in community pharmacies. The investigators subsequently determined that prescription bottles used in community practice often carry type that is smaller than 10-point, and the original labels used in the SMAT were retained.
Few comments were made about the colours used in the colour-identification task, other than inquiries about how the tablets would be packaged. The lack of comments for this task was unexpected, because colour perception is important to medication adherence, and we anticipated that participants would identify concerns in this area. Colour vision changes with advancing age, and cognition may also play a role in an individual’s ability to recognize colours. The inability to perceive certain colours may present a barrier to self-medication and should be considered when recommending adherence aids. Therefore, in the modified version of the SMAT, the importance of colour recognition was increased, with patients being tested on their ability to recognize the colour of 10 tablets (with the selection of colours being based on a review of the colour perception literature): white (presented twice), pale yellow, dark yellow, pale green, dark green, pale blue, dark blue, pale purple, and dark purple.
Some participants expressed concerns about the subjectivity involved in assessing hearing, vision, and swallowing deficits. These evaluations were therefore removed from the formal scoring system, although the pharmacist administering the SMAT is encouraged to consider these issues when making recommendations for adherence aids.
On the basis of their clinical experience, the participants in this study strongly endorsed the dosette-filling task in the cognitive assessment, although some proposed that the use of 3 vials created a task that was too complex for elderly patients. In a recently published survey of pillbox use in a sample of community-dwelling older adults, 93% of participants were able to fill pillboxes themselves with an average (± standard deviation) of 6.8 ± 3.4 medications. Given the frequency of complex regimens in this population, the research team felt it was important to continue using 3 test medications for this task. However, the scoring systems for the organization and dosette-filling tasks were modified on the basis of interview feedback. Specifically, each medication is now rated individually, rather than testers being asked to provide a combined score for all 3 medications. This change has accomplished the dual objectives of giving more weight to these important skills and simplifying the scoring system for cases in which the patient can manage 1 medication but has difficulty with 2 or more medications.
Participants requested clarification of the source of the reference drug list. The reference drug list is key to the recall, self-reported adherence, and purposeful nonadherence sections of the tool. The drug list is compiled using a process established by the Safer Healthcare Now! initiative and is based on multiple sources, including the patient’s prescription containers, community pharmacy and hospital records, and interviews with the patient and/or family members. cheap cialis canadian pharmacy