Assessing medication adherence self-efficacy among low-literacy patients: development of a pictographic visual analogue scale
Abstract
Health behavior interventions are often grounded in Social Cognitive Theory, but instruments used to assess self-efficacy rely on verbal skills and yield scores that are highly positively skewed. Based on a review of the research literature and qualitative research with key informants, a pictographic medication adherence self-efficacy scale was developed. Two studies were conducted to test the pictographic and color visual analogue scale for assessing self-efficacy for medication adherence. Study 1 (N = 81) demonstrated that the pictographic self-efficacy scale was internally consistent (alpha = 0.68), time stable (2-week test-re-test r = 0.63), and showed evidence for convergent and divergent construct validity. Study 2 (N = 64) further supported the reliability of the pictographic self-efficacy scale with additional data supporting its convergent, divergent and criterion-related validity, including associations with medication adherence and HIV viral load. Distributions of self-efficacy scores approximated normal. This newly developed pictographic scale may be useful in assessing medication adherence self-efficacy in lower-literacy populations.
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Confidence in one's ability to pursue goals affects how well people adhere to medication across many long-term illnesses.
“Self-efficacy or confidence in one’s ability to successfully engage in goal-directed behavior has been shown to influence medication adherence across many chronic illnesses.”
From Reliability and validity of a self‐efficacy instrument for hepatitis C antiviral treatment regimens (2012) · cites this paper as [22]
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- Authors
- Kalichman, S. C.
- Affiliations
- University of Connecticut (US)
- Corresponding author
- Kalichman, S. C.
- ORCID
- Kalichman, S. C.
- Venue
- Health Education Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-07-14
- Volume
- 20
- Issue
- 1
- Pages
- 24-35
- ISSN
- 0268-1153 (ISSN-L)
- 1465-3648
- OpenAlex
- W2153730979
- Cited by
- 83
- References
- 29
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 2 · 2016: 5 · 2015: 5 · 2014: 4 · 2013: 7 · 2012: 6
- FWCI
- 3.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Education Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01-MH/NR62287)
- National Institute of Nursing Research
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Social Sciences › Education › Health Education and Validation
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Keywords
- medication adherence, self-efficacy, visual analogue scale, low literacy, scale development, social cognitive theory, HIV viral load, psychometric validation, health behavior assessment
- MeSH terms
- Adult, Educational Status, Female, Humans, Male, Middle Aged, Patient Compliance, Surveys and Questionnaires, Health Behavior, HIV Infections, Anti-HIV Agents, Viral Load, Self Efficacy
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