Questionnaire for quantitative assessment of treatment adherence: modification for adolescents aged 15–17 years, validation, and reliability assessment

In Russia, the QAA-25 questionnaire is used to quantify the adherence to treatment of adult patients. The accumulated experience of its use made it possible to identify several cohorts of respondents, including adolescents, whose characteristics required special adaptation of the formulations of a number of questions.

Purpose. The study aimed at modifying the questionnaire for quantitative assessment of treatment adherence QAA-25 for adolescents aged 15–17 years and evaluate it according to the criteria of validity and the measure of consent.

Material and methods. In a descriptive one-stage study with the participation of 108 high school students at secondary schools in Omsk, the level of adherence to treatment was determined according to the QAA-25 scale, using traditional and alternative formulations of individual questions, with the formation of a modified scale and an assessment of its constructive and factor validity and a measure of consent.

Results. Applying various options for testing alternative questions, the possibility and expediency of using them to assess the adherence to treatment of adolescents, including separately evaluated subsamples of male and female individuals, was shown. 94% of respondents rated alternative questions as “more acceptable,» 5% of respondents «did not notice significant differences,» and 1% of respondents rated them as «less acceptable.» The QAA-25 scale modified for adolescents demonstrated good structural and internal validity (α = 0.818, α_st = 0.857), with high reliability (consistent exclusion of scale items preserves the validity of the questionnaire in the range of 0.793–0.858) and almost perfect agreement (κ = 1.000).

Conclusion. The modified QAA-25 questionnaire is recommended to be used to assess the adherence to treatment and potential adherence to treatment of adolescents who have reached the age of 15 but have not reached the age of 18, both for research purposes and when making decisions related to the provision of medical care and the organization of preventive measures. 

1. Chemekov V.P., Shasheleva A.V. Paediatric patient: Child, adult, or both? Vopr Sovrem Pediatr 2018; 17: 408-412. (in Russ.)] DOI: 10.15690/vsp.v17i5.1958

2. Gorlanov I.A., Mikirtichan G.L., Zaslavskiy D.V., Kaurova T.V., Murashkin N.N. Clinical and social problems of compliance in pediatric dermatology. Vestnik dermatologii i venerologii 2011; 1: 36-40. (in Russ.) DOI: 10.25208/vdv937

3. Nikolayev N.A., Skirdenko Yu.P., Zherebilov V.V. Quantitative assessment of adherence to treatment in clinical medicine: protocol, procedure, interpretation. Kachestvennaya klinicheskaya praktika 2016; 1: 50-59. (in Russ.)

4. Nikolayev N.A., Skirdenko Yu.P. Russian generic questionnaire for evaluation of compliance to drug therapy. Klinicheskaya farmakologiya i terapiya 2018; 1(27): 74-78. (in Russ.)

5. Drapkina O.M., Livzan M.A., Martynov A.I., Moiseev S.V., Nikolaev N.A., Skirdenko Yu.P. et al. The first Russian expert consensus on the quantitative evaluation of the treatment adherence:pivotal issues, algorithms and recommendations. Meditsinskii vestnik Severnogo Kavkaza 2018; 13: 259-271. (in Russ.) DOI: 10.14300/mnnc.2018.13039

6. Nikolaev N.A., Martynov A.I., Drapkina O.M., Livzan M.A., Moiseev S.V., Skirdenko Yu.P. et al. The first Russian consensus on the quantitative assessment of the adherence to treatment (approved by the XII National congress of physicians — Moscow, 22-24 November 2017). Terapiya 2018; 5: 11-32. (in Russ.) DOI: 10.18565/therapy.2018.5.11-32

7. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P., Anisimov V.N., Vasil’eva I.A., Vinogradov O.I. et al. Management of treatment on the basis of adherence. Consilium-Medicum 2020; 5: 9-18. (in Russ.) DOI: 10.26442/20751753.2020.5.200078

8. Nikolaev N.A., Martynov A.I., Skirdenko Yu.P., Anisimov V.N., Vasil’eva I.A., Vinogradov O.I. et al. Treatment management based on adherence: patient recommendation algorithms. Cross-disciplinary guidelines. Meditsinskii vestnik Severnogo Kavkaza 2020; 15(4): 461-468. (in Russ.) DOI: 10.14300/mnnc.2020.15109

9. Nikolaev N.A., Skirdenko Yu.P., Balabanova A.A., Gorbenko A.V., Andreev K.A., Fedorin M.M. et al. The Scale of Quantitative Assessment Adherence to Treatment «QAA25»: Updating of Formulations, Constructive and Factor Validity and a Measure of Consent. Ratsional’naya Farmakoterapiya v Kardiologii 2021; 17(6): 845-852. (in Russ.) DOI: 10.20996/1819-6446-2021-12-12

10. Skomorokhova E.N. Psychological features of adolescence. The future of science — 2019. Collection of scientific articles of the 7th International Youth Scientific Conference. Publishing house of Southwestern State University. 2019: 275-277. (in Russ.)

11. HIV infection in children. Clinical recommendations 2020. (in Russ.) https://cr.minzdrav.gov.ru/schema/459_1./

12. Lehr R. Sixteen s squared over d squared: a relation for crudesample size estimates. Statistics in Med 1992; 11: 1099-1102. DOI: 10.1002/sim.4780110811

13. Landis J.R., Koch G.G. Share the Measurement of Observer Agreement for Categorical Data. Biometrics 1977; 1(33): 159. DOI: 10.2307/2529310