Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma

Background A validated tool to assess adherence with inhaled corticosteroids (ICS) could help physicians and researchers determine whether poor asthma control is due to poor adherence or severe intrinsic asthma. Objective To assess the performance of the Medication Adherence Report Scale for Asthma (MARS-A), a 10-item, self-reported measure of adherence with ICS. Methods We interviewed 318 asthmatic adults receiving care at 2 inner-city clinics. Self-reported adherence with ICS was measured by MARS-A at baseline and 1 and 3 months. ICS adherence was measured electronically in 53 patients. Electronic adherence was the percentage of days patients used ICS. Patients with a mean MARS-A score of 4.5 or higher or with electronic adherence of more than 70% were defined as good adherers. We assessed internal validity (Cronbach α, test-retest correlations), criterion validity (associations between self-reported adherence and electronic adherence), and construct validity (correlating self-reported adherence with ICS beliefs). Results The mean patient age was 47 years; 40% of patients were Hispanic, 40% were black, and 18% were white; 53% had prior asthma hospitalizations; and 70% had prior oral steroid use. Electronic substudy patients were similar to the rest of the cohort in age, sex, race, and asthma severity. MARS-A had good interitem correlation in English and Spanish (Cronbach α = 0.85 and 0.86, respectively) and good test-retest reliability( r = 0.65, P