Medications Non-adherence Reasoning Scale (mednars): Development and Psychometric Properties Appraisal

Background: Proper elucidation of medication non-adherence reasoning especially in older adults might pave the way for an auspicious therapeutic outcome. The main of this study was to develop and psychometrically test the Medications Non-adherence Reasoning (MedNARS) questionnaire for application in research and probably practice settings. Methods: A mixed methods design was utilized to develop the MedNARS. The item pool was mainly generated based on a qualitative query and literature review. The expert panel approved version of the MedNARS was psychometrically assessed on a convenience sample of 220 older patients with chronic disease. The internal consistency, test-retest reliability, content and face validity of the scale were appraised and its construct validity was assed using exploratory and confirmatory factor analyses. Results: A nine-item version of the MedNARS was drafted based on the classical item analysis procedures and its estimated internal consistency measure of the Cronbach's alpha (0.85) and test-retest reliability (0.96) were in the vicinity of acceptable range. The exploratory factor analysis (EFA) output revealed a unidimensional structure for the MedNARS and the conducted confirmatory factor analysis (CFA) indicated an acceptable data fit for the extracted one-factor model. The goodness of fit indices were as the followings: chi 2/df = 1.63(90% CI: 0.02 to 0.11), root mean squared error of approximation (RMSEA) = (0.07), comparative fit index (CFI) = 0.95, Tucker-Lewis index (TLI) = 0.93 and standardized root mean squared residual (SRMSR) = (0.05). Conclusion: The study findings were indicative of MedNARS's applicability and feasibility for use in assessment of medication non-adherence reasoning among the elderly patients with chronic diseases. The MedNARS as a brief and elder-friendly instrument can be applied both in research and practice settings to enhance efficiency, safety, and health outcomes of the therapeutic recommendations.