Eliciting accurate reports of adherence in a clinical interview: development of the Medical Adherence Measure.

Nonadherence is a major public health concern but reliable assessment methods are limited. The Medical Adherence Measure (MAM) was designed as a semi-structured clinical interview to elicit comprehensive and accurate responses from patients regarding adherence during the course of standard clinical care. The measure was developed in three phases and administered to 219 pediatric patients (ages 1.3-23) and/or their parents to assess the content, clinical utility, and ease of use. The MAM has three general regimen domains (medication, diet, clinic attendance) and several treatment specific modules. Items assess knowledge of the prescribed regimen, self-reported adherence, organizational system used to manage the regimen, and perceived barriers to optimal management. The MAM is a screening tool that assists providers in identifying patients at risk for adherence problems, assessing the extent of nonadherence, and targeting specific barriers to care in interventions. The interview emphasizes a supportive patient-provider relationship with the goal of improving patient care.