An adherence self-report questionnaire facilitated the differentiation between nonadherence and nonresponse to antihypertensive treatment

J Clin Epidemiol. 2008 Mar;61(3):282-8. doi: 10.1016/j.jclinepi.2007.04.007. Epub 2007 Aug 23.


Objectives: To evaluate, among hypertensive patients, a brief adherence self-report questionnaire (ASRQ), using electronic monitors (medical event monitoring system, MEMS) as the gold standard comparator.

Study design and setting: A total of 239 patients with hypertension in five general practices in Bristol, UK completed the ASRQ before and at the end of the 4-week study period. Patients were asked to choose one of six descriptions (from level 1=perfect adherence to level 6=nonadherence) to express their medication taking. The main outcome measure was "timing adherence" (correct interdose intervals) as measured through electronic monitors.

Results: Most patients (89%) stated perfect or nearly perfect adherence, and data from the electronic monitors showed a mean timing adherence of 88.3% (n=216). Using the cutoff of those who reported ASRQ levels 1 and 2 (all tablets taken but not always at the same time of day), a high percentage of those with comparatively high adherence according to MEMS were correctly identified (specificity, 90-93%; negative predictive value, 66-96%). However, sensitivity (detection of true nonadherers) and positive predictive value were poor to moderate (14-42% and 22-66%, respectively).

Conclusion: The questionnaire could be a useful aid to facilitate the difficult differentiation between nonadherence and nonresponse to prescribed antihypertensive medication.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Antihypertensive Agents / administration & dosage*
  • Epidemiologic Methods
  • Family Practice
  • Female
  • Humans
  • Hypertension / drug therapy*
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Primary Health Care
  • Self Administration / statistics & numerical data
  • Self Disclosure*
  • Treatment Outcome


  • Antihypertensive Agents