Refinement and Evaluation of a Chinese and Western Medication Adherence Scale for Patients with Chronic Kidney Disease: Item Response Theory Analyses.

PURPOSE: This study aimed to simplify the version-1 Chinese and Western medication adherence scale for patients with chronic kidney disease (CKD) to a version-2 scale using item response theory (IRT) analyses, and to further evaluate the performance of the version-2 scale. MATERIALS AND METHODS: Firstly, we refined the version-1 scale using IRT analyses to examine the discrimination parameter (a), difficulty parameter (b) and maximum information function peak (Imax). The final scale refinement from version-1 to version-2 scale was also decided upon clinical considerations. Secondly, we analyzed the reliability and validity of version-2 scale using classical test theory (CTT), as well as difficulty, discrimination and Imax of version-1 and version-2 scale using IRT in order to conduct scale evaluation. RESULTS: For scale refinement, the 26-item version-1 scale was reduced to a 15-item version-2 scale after IRT analyses. For scale evaluation using CTT, internal consistency reliability (total Cronbach α = 0.842) and test-rest reliability (r = 0.909) of version-2 scale were desirable. Content validity indicated 3 components of knowledge, belief and behaviors. We found meritorious construct validity with 3 detected components as the same construct of medication knowledge (items 1-9), medication behavior (items 13-15), and medication belief (items 10-12) based upon exploratory factor analysis. The correlation between the version-2 scale and Morisky, Green and Levine scale (MGL scale) was weak (Pearson coefficient = 0.349). For scale evaluation with IRT, the findings showed enhanced discrimination and decreased difficulty of most retained items (items 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15), decreased Imax of items 1, 2, 3, 4, 6, 11, 14, as well as increased Imax of items 5, 7, 8, 9, 10, 12, 13, 14, 15 in the version-2 scale than in the version-1 scale. CONCLUSION: The original Chinese and Western medication adherence scale was refined to a 15-item version-2 scale after IRT analyses. The scale evaluation using CTT and IRT showed the version-2 scale had the desirable reliability, validity, discrimination, difficulty, and information providedoverall. Therefore, the version-2 scale is clinically feasible to assess the medication adherence of CKD patients.

A chronic kidney disease patient awareness questionnaire: Development and validation.

BACKGROUND: With the advance of medical care, chronic non-communicable diseases, like chronic kidney disease (CKD), have become the predominant diseases around the world. With heavy society and economy burden, we shall make full use of chronic disease management, including precision therapies. And the prerequisite for implementing precision medicine is to fully understand the characteristics of patients. Being the basis of the Knowledge-Attitude-Practice Model, patient's awareness is essential to conduct individualized treatments. However, there have been no validated questionnaires specific to the awareness of patients with CKD. Therefore, this study aims to develop and validate an awareness questionnaire for patients with CKD. METHODS: From March 2013 to September 2014, a cross-sectional study was conducted at Guangdong Provincial Hospital of Chinese Medicine. Age 18 or above were enrolled in the study. After signing the informed consent, they received a self-developed questionnaire to evaluate their CKD-related awareness. Then we collected their demographic data for further analyses. We also conducted item analyses/ validity and reliability analysis to filter out improper items and to retain the eligible ones. RESULTS: We totally distributed 110 copies of the questionnaires and 100 of them were returned. After item analyses, 2 items were excluded because of Cronbach's Alpha analysis. In total, 18 items were retained, comprising the final set of the questionnaire. For validity analysis, 4 components could explain the cumulative 73.966% extraction sums of the squared loadings; for reliability analysis, the Guttman Split-Half coefficient was 0.918. CONCLUSIONS: This awareness questionnaire has favorable validity and reliability. It is a sound method for evaluating and measuring levels of disease-related awareness in CKD patients.

A Chinese and Western medication adherence scale in patients with Chronic Kidney Disease.

OBJECTIVE: The self-reported scale is a widely used method to assess patients' medication adherence in clinical practice, but there is still a lack of medicine adherence measurement scale for patients with Chronic Kidney Disease (CKD). Therefore, this study aimed to develop a medication adherence measurement scale of traditional Chinese medicine and Western medicine, providing a tool for evaluating medicine adherence of CKD patients. METHODS: In the preliminary stage, we formed the prediction scale after three rounds Delphi method and it was filled by 20 patients, who were selected randomly. After pre-investigation and language adaption, we adjusted the prediction measurement scale which included 31 items based on Knowledge-Attitude-Belief Theory. Then, 222 CKD patients in Guangdong Hospital of traditional Chinese Medicine were investigated by this 31-item scale. We screened 31 items by Items analysis theory, including critical ratio, item correlation analysis, internal consistency analysis, principal component analysis and other methods. The left 26 items made up a formal scale. We collected and analyzed data of the 26-item scale and Chinese version of MGL scale, and took their scores correlation analysis as the criterion validity of the 26-item scale. At the same time, we evaluated content validity, Cronbach alpha coefficient and retest reliability of the 26-item scale. RESULTS: We developed a scale with 26 items and 5 dimensions finally. In the validation analysis, the scale had good construct validity and content validity. The Pearson relation index between respective scores of the scale and Chinese version of MGL scale was 0.426, P<0.01. The scale also had good reliability as its 0.915 in Cronbach alpha, 0.753 in retest reliability and P<0.01. CONCLUSION: The scale revealed great reliability and validity, which could be used as a measurement tool to evaluate the medication adherence of patients with CKD.

Telehealth for the management of blood pressure in patients with chronic kidney disease: A systematic review.

BACKGROUND: Most patients with chronic kidney disease (CKD) fail to achieve blood pressure (BP) management as recommended. Meanwhile, the effects of promising intervention and telehealth on BP control in CKD patients remain unclear. We aimed to evaluate the efficacy of telehealth for BP in CKD non-dialysis patients. METHODS: Databases including MEDLINE, EMBASE, CENTRAL, CNKI, Wanfang, VIP and CBM were systematically searched for randomised controlled trials or quasi-randomised controlled trials on telehealth for BP control of CKD3-5 non-dialysis patients. We analysed systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), serum creatinine, and estimated glomerular filtration rate (eGFR) with a fixed-effects model. RESULTS: Three studies, with total 680 subjects, were included in our systematic review and two were included for meta-analysis. Pooled estimates showed decreased SBP (pooled mean difference (MD), -5.10; 95% confidence interval (CI), -11.34, 1.14; p > 0.05, p = 0.11), increased DBP (pooled MD, 0.45; 95% CI, -4.24, 5.13; p > 0.05, p = 0.85), decreased serum creatinine (pooled MD, -0.38; 95% CI, -0.83, 0.07; p > 0.05, p = 0.10) and maintained eGFR (pooled MD, 4.72; 95% CI, -1.85, 11.29; p > 0.05, p = 0.16) in the telehealth group. There was no significant difference from the control group. MAP (MD, 0.6; 95% CI, -6.61, 7.81; p > 0.05, p = 0.87) and BP control rate ( p > 0.05, p = 0.8), respectively, shown in two studies also demonstrated no statistical significance in the telehealth group. CONCLUSIONS: There was no statistically significant evidence to support the superiority of telehealth for BP management in CKD patients. This suggests further studies with improved study design and optimised intervention are needed in the future.