Adherence to Asthma Medication Questionnaire – Chinese Version

Abstract

The Adherence to Asthma Medication Questionnaire—Chinese Version (AAMQ-CV), published by Huo et al. in 2024, represents a rigorously validated translation and cultural adaptation of the original 13-item Adherence to Asthma Medication Questionnaire (AAMQ) developed by Nassar et al. (2022). This specialized instrument is designed for the psychometric assessment of asthma medication adherence among patients in China. The validation process involved a rigorous evaluation of its factor structure, internal consistency, and various forms of validity, confirming its suitability for identifying factors influencing adherence behavior in this specific population.

The AAMQ-CV is structured around three core factors: Belief, Behavior, and Barrier. Its successful validation supports its use in clinical and research settings across China to understand and potentially mitigate medication non-adherence in adults suffering from asthma.

Keywords

Belief, Behavior, Barrier, Asthma Medication Adherence, Chinese Version, Psychometric Assessment, Translation.

Authors

Huo, Mingshu, Zhao, Rui, Deng, Xiaoxue, Wang, Ying, Liu, Qiaoli, Yan, Jiarong, Yu, Hongyu

Purpose

The primary purpose of the AAMQ-CV is to serve as a diagnostic and research tool to specifically identify the underlying causes and contributing factors associated with medication non-adherence among adult asthma patients residing in China. By isolating these causes, clinicians can develop targeted and culturally sensitive interventions designed to improve patient compliance with their prescribed treatment regimens.

The development and validation of the Chinese version were essential to overcome linguistic and cultural barriers inherent in using the original scale, ensuring that the instrument accurately captures adherence determinants relevant to the Chinese healthcare context and patient experience.

Construct

The AAMQ-CV measures Asthma Medication Adherence, defined as the extent to which a patient follows the prescribed medication regimen for their chronic asthma condition. This construct is recognized as complex and multidimensional, encompassing psychological, behavioral, and environmental elements.

The instrument operationalizes adherence across three distinct factors, allowing researchers and clinicians to assess specific areas of difficulty:

• Belief: Reflects the patient’s perception and conviction regarding the necessity, safety, and effectiveness of their asthma medication.
• Behavior: Captures the actual actions, habits, and execution of the prescribed medication schedule, such as timing and dosage consistency.
• Barrier: Addresses external and internal obstacles (e.g., cost, complexity of regimen, forgetfulness, side effects) that impede consistent adherence.

Validity

The validation study provided strong evidence for the measure’s psychometric suitability within the Chinese population. Content Validity was established through expert review, yielding a high Scale-level Content Validity Index (S-CVI) of 0.923. The item-level CVI scores ranged robustly from 0.857 to 1.000, indicating excellent relevance and comprehensiveness of the translated items based on clinical relevance.

Construct Validity was supported by rigorous statistical analysis. The use of both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) confirmed that the instrument successfully measures the theorized three-factor structure (Belief, Behavior, Barrier). This factorial support is essential for accurately interpreting the subscale scores and applying the model in research.

Reliability

The AAMQ-CV demonstrated high levels of reliability across multiple parameters, confirming its consistency in measurement. The overall Internal Consistency, measured using Cronbach’s alpha, was excellent at 0.866. Subscale (domain) coefficients further confirmed internal homogeneity, ranging between 0.702 and 0.798, indicating that items within each factor measure the same underlying dimension.

Additional reliability measures included a Split-Half Reliability coefficient of 0.794, suggesting consistency between different halves of the test. Furthermore, Test-Retest Reliability, assessed over a two-week interval, showed a stability coefficient of 0.772, indicating that the scores are suitably stable over short periods, which is crucial for monitoring patient adherence over time.

Factor Analysis

The underlying dimensionality of the AAMQ-CV was thoroughly investigated using advanced multivariate techniques. Exploratory Factor Analysis (EFA) confirmed the presence of the three hypothesized components (Belief, Behavior, Barrier). These three factors collectively accounted for 58.86% of the total variance observed in the scale items, demonstrating strong structural integrity.

Confirmatory Factor Analysis (CFA) was subsequently performed to test the fit of the three-factor model to the collected data. The model fit indices were reported to be within acceptable clinical and statistical limits, notably demonstrating a favorable chi-square/degrees of freedom ratio ($chi^2$/df) of 1.484, providing strong empirical support for the factorial validity of the measure in the Chinese population and confirming the theoretical structure.

Instrument

Test Type: Translation and Validation Study

Format: The instrument utilizes a 5-point Likert scale. Responses range from 1 (always) to 5 (never). The scale consists of 13 items, resulting in a total score range from 13 to 65. Higher scores on the scale are interpreted as indicative of greater medication adherence.

Language Available: Chinese (Validated Version)

Population Group: Clinical population (Asthma patients)

Age Group: Adulthood (18+); Specifically validated across patients in the Middle Age range (40–64).

Population Details: Respondents were asthma patients located in China, recruited specifically for the validation and psychometric testing of the translated instrument.

Test Methodology: Inventory/Questionnaire focused on self-reported adherence behaviors, beliefs, and barriers related to chronic asthma medication use.

Keywords

Asthma, Adherence, Psychometrics, Validation, Factor Analysis, Reliability, China, Inventory.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: The corresponding author is affiliated with Jinzhou Medical University School of Nursing and the First Affiliated Hospital of Jinzhou Medical University, Department of Respiratory Medicine.

Correspondence Address: Yu, Hongyu: Jinzhou Medical University, School of Nursing, Liaoning, China, [email protected]

Permissions & Fee and Test Year

Test Year: 2024

Permissions and Fees: Information regarding specific usage permissions and associated fees is not provided in the original publication details. Researchers should contact the corresponding author, Yu Hongyu, for licensing inquiries and full implementation details.

Files Available: No file is available for direct download from the source documentation. No original PDF file was linked.

Reference’s

• Huo, M., Zhao, R., Deng, X., Wang, Y., Liu, Q., Yan, J., & Yu, H. (2024). Psychometric assessment of the adherence to Asthma Medication Questionnaire in asthma patients in China: A validation study. Journal of Asthma, 61(4), 300–306. https://doi.org/10.1080/02770903.2023.2267142

Items of the Adherence to Asthma Medication Questionnaire–Chinese Version

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The specific 13 items comprising the Adherence to Asthma Medication Questionnaire–Chinese Version were not provided in the source documentation for this entry. Researchers interested in utilizing the scale items must refer directly to the publication by Huo et al. (2024) or contact the corresponding author for the full instrument.