Validation of knowledge and adherence assessment tools among patients on warfarin therapy in a Saudi hospital anticoagulant clinic

Sireen Abdul Rahim Shilbayeh, Wejdan Ali Almutairi, Sarah Ahmed Alyahya, Nouf Hayef Alshammari, Eiad Shaheen, Alya Adam

Research output: Contribution to journalArticleResearchpeer-review

3 Citations (Scopus)

Abstract

Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients’ adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists’ interventions to improve these measures. Methods A cross-sectional survey was conducted. Patients’ knowledge about warfarin was rated using an Arabic-language tool. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). The international normalized ratio (INR) control was quantified by the Rosendaal Method. Setting At the Security Forces hospital anticoagulant clinic (ACC), Riyadh. Main outcome measure Validity of a Knowledge and adherence tool. Results Totally, 101 patients completed the questionnaires. Interestingly, the knowledge tool demonstrated good internal consistency (total Cronbach’s alpha = 0.75) and significant concurrent validity with adherence levels. Fifty-two patients were classified as having unsatisfactory knowledge. Deficiency in knowledge was most obvious with respect to the consequences of missing a dose and when to seek immediate medical attention. The MMAS-8 had moderate reliability (Cronbach’s alpha = 0.65); however, its concurrent validity with good INR control was not demonstrated. Conclusions This study revealed high prevalence of nonadherence and poor knowledge in the population visiting the ACC. Given that available knowledge and adherence tools seemed to have little validity in predicting clinical outcomes, structured tools should be designed, considering progression in clinical outcomes with future pharmacists’ interventions.

Original languageEnglish
Pages (from-to)56-66
Number of pages11
JournalInternational Journal of Clinical Pharmacy
Volume40
Issue number1
DOIs
Publication statusPublished - 1 Feb 2018

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Warfarin
Anticoagulants
International Normalized Ratio
Medication Adherence
Patient Compliance
Pharmacists
Language
Therapeutics
Cross-Sectional Studies
Outcome Assessment (Health Care)
Population

Keywords

  • Anticoagulation
  • Patient adherence
  • Patient knowledge
  • Reliability
  • Saudi Arabia
  • Validity
  • Warfarin

Cite this

Shilbayeh, Sireen Abdul Rahim ; Almutairi, Wejdan Ali ; Alyahya, Sarah Ahmed ; Alshammari, Nouf Hayef ; Shaheen, Eiad ; Adam, Alya. / Validation of knowledge and adherence assessment tools among patients on warfarin therapy in a Saudi hospital anticoagulant clinic. In: International Journal of Clinical Pharmacy. 2018 ; Vol. 40, No. 1. pp. 56-66.
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Validation of knowledge and adherence assessment tools among patients on warfarin therapy in a Saudi hospital anticoagulant clinic. / Shilbayeh, Sireen Abdul Rahim; Almutairi, Wejdan Ali; Alyahya, Sarah Ahmed; Alshammari, Nouf Hayef; Shaheen, Eiad; Adam, Alya.

In: International Journal of Clinical Pharmacy, Vol. 40, No. 1, 01.02.2018, p. 56-66.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Shaheen, Eiad

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N2 - Background Although it can result in serious complications due to its narrow therapeutic index, warfarin is widely used in the treatment and prevention of thromboembolic disorders. However, patients’ adherence and knowledge are determinants of therapeutic success. Objective We sought to validate instruments to provide a reliable means of identifying gaps in patient understanding and nonadherence to inform targeted pharmacists’ interventions to improve these measures. Methods A cross-sectional survey was conducted. Patients’ knowledge about warfarin was rated using an Arabic-language tool. Medication adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). The international normalized ratio (INR) control was quantified by the Rosendaal Method. Setting At the Security Forces hospital anticoagulant clinic (ACC), Riyadh. Main outcome measure Validity of a Knowledge and adherence tool. Results Totally, 101 patients completed the questionnaires. Interestingly, the knowledge tool demonstrated good internal consistency (total Cronbach’s alpha = 0.75) and significant concurrent validity with adherence levels. Fifty-two patients were classified as having unsatisfactory knowledge. Deficiency in knowledge was most obvious with respect to the consequences of missing a dose and when to seek immediate medical attention. The MMAS-8 had moderate reliability (Cronbach’s alpha = 0.65); however, its concurrent validity with good INR control was not demonstrated. Conclusions This study revealed high prevalence of nonadherence and poor knowledge in the population visiting the ACC. Given that available knowledge and adherence tools seemed to have little validity in predicting clinical outcomes, structured tools should be designed, considering progression in clinical outcomes with future pharmacists’ interventions.

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