Purposeful Nonadherence

Both pharmacists and pharmacy students commented that the 3 questions for measuring purposeful nonadherence would likely yield reliable information, as the language used in these questions was nonconfrontational and invited honest answers (Table 1). The inclusion of a direct question about the cost of medications was recommended.

Scoring

Participants raised the following issues related to scoring (Table 1). There was general agreement with the 3 types of scoring choices offered, but participants consistently requested clarification about the use of cueing. Participants in all groups expressed few concerns about calculation of the final score for each section of the tool and felt that the scoring methods would be easy to learn with practice. Finally, the weighting of the various sections was questioned, with participants asking which ones would receive the most emphasis. In particular, a change to the scoring system for the medication organization task was suggested.

General CommentsParticipants also identified themes related to the instru­ment in general, rather than its individual sections (Table 1). Overall, participants felt that the greatest benefit of the tool was its objectivity and the hands-on nature of the assessment. It was felt that recommendations based on concrete scores and information would be received and implemented more readily by patients and their families than more subjective recommen­dations. Recommended enhancements were the inclusion of other dosage forms (e.g., inhalers and injectables) and lifestyle questions (e.g., sleep patterns and eating habits). All participants, particularly pharmacists in community practice, expressed a concern about the time that would be required for a pharmacist to complete the assessment. Pharmacy students were confident that they would be able to administer the assessment, if given some practice.
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Table 2. Ratings of the Self-Medication Assessment Tool

Sample

Usefulness

Thoroughness

Ease of Use

Willingness to Use

Full sample(n= 20)


Mean (SD)


5.9 (1.1)


5.6 (1.1)


3.5 (1.7)


5.3 (1.7)*


Range


3-7


3-7


1-6


1-7


Result on
t

testt


9.27


8.46


0.13


4.44


(p

< 0.001)


(p

< 0.001)


(p

= 0.89)


(p

< 0.001)


Working in
hospital (n


= 12)


Mean (SD)


5.8 (1.2)


5.6 (1.2)


3.7 (1.6)


5.8 (1.3)


Range


3-7


3-7


1-6


3-7

Working in the

community(n = 7)


Mean (SD)


6.3 (0.95)


5.9 (1.2)


3.3 (2.0)


4.4 (2.2)


Range


5-7


4-7


1-6


1-7


Result on
t

testt


0.95


0.49


0.46


1.9


(p

= 0.35)


(p

= 0.64)


(p

= 0.65)


(p

= 0.08)

Pharmacists’ Ratings of the Tool

Interview participants used a 7-point scale to rate the SMAT for its usefulness, thoroughness, and ease of use and to rate their willingness to use the tool (Table 2). One-sample t tests indicated that respondents rated the SMAT significantly higher than the midpoint on the scale in terms of usefulness, thoroughness, and willingness to use (Table 2). The percentage of participants rating the SMAT at the top 2 scores on the scale (i.e., 6 or 7 out of 7) for each item was also determined: 70% (14/20) for usefulness, 35% (7/20) for ease of use, 60% (12/20) for thoroughness, and 55% (11/20) for willingness to use. In exploratory analyses, the overall sample was subdivided according to practice setting: hospital (n = 12) and community (n = 7) (1 pharmacist worked in neither setting). Independent group t tests used to compare the ratings of these 2 groups showed a tendency for pharmacists and pharmacy students working in hospital settings to be more willing to use the SMAT than those working in community settings (p = 0.08, effect size [^2] = 0.17). tadalis sx