Escalas de adesão terapêutica validadas no Brasil: uma revisão sistemática

Abstract

Adherence is the process in which patients take their medications as prescribed. When that does not happen, there can be consequences such as increases in morbidity, mortality, adverse effects, treatment failure, and health care expenses. Globally, there are countless medication adherence scales that have been submitted to validation processes to ensure they meet basic psychometric standards, creating instruments that can measure adherence and identify patients’ needs. However, to the present day, there are no reports of review studies in the scientific literature regarding the adherence scales which have been validated in Brazil. Thus, this study aimed to establish which scales have been validated in Brazilian Portuguese, as well as to assess the methodological quality of their validation processes. The present study was designed as a systematic review of the literature. The following databases were consulted: Pubmed, Scopus, LILACS, Embase, and Bireme. Studies were retrieved in March 2023, using the terms "medication adherence", "scale", "measurement", "Brazilian", and "Portuguese", and their synonyms. Inclusion criteria were: i) original articles of medication adherence scale validation studies; ii) scales in Brazilian Portuguese; iii) scales that measured adherence in chronic diseases or chronic clinical conditions. Were excluded studies that: i) did not produce psychometric properties as the outcomes of the validation process; ii) featured scales that measured constructs other than medication adherence; iii) scales that measure aspects of adherence other than medication use. The bibliometric data of the included studies were compiled and examined, and the quality of the studies was assessed using the QUADAS-2 tool. The search strategy identified 137 studies, but only 6 were included. It was found that there is still a small number of validated scales in Brazilian Portuguese, in addition to a lack of validated instruments for some chronic diseases of major epidemiological relevance. In the quality assessment of the studies, the one study that validated both the BMQ and the MMAS-4, as well as the validation study of the MMAS-8 were at low risk of bias. Both studies validated scales for hypertension.