Measuring patients’ self-efficacy in understanding and using prescription medication

https://doi.org/10.1016/j.pec.2010.06.029Get rights and content

Abstract

Objective

To create a brief assessment tool, the Medication Understanding and Use Self-Efficacy Scale (MUSE).

Methods

An existing scale (Communication and Attitudinal Self-Efficacy Scale) was modified, augmented, and piloted among 267 primary care patients in Chicago, New York City, and Shreveport, LA. Participant sociodemographics, literacy, current medication use, understanding medication instructions, and medication self-efficacy were measured.

Results

Using principal components analysis, two scales emerged: taking medication and learning about medication; these two factors accounted for 55% of the total variance of understanding medication instructions. Performance on the MUSE differed by literacy level; multivariate analysis detected no interaction between literacy level and MUSE score. Regression analysis, adjusted for age, education, literacy level and number of current prescription medications indicated that participants’ MUSE scores predicted patient understanding of common medication instructions (β = 0.07, 95% CI 0.001–0.14, p = 0.04).

Conclusion

The MUSE is a valid and reliable tool measuring self-efficacy of understanding and using prescription medication. This scale differs from existing medication-specific self-efficacy scales as it addresses both learning about one's medications and adherence to the prescribed regimen.

Practice Implications

The MUSE is an effective and brief research tool that can be utilized among participants with varying literacy levels.

Introduction

Patient misunderstanding of prescription medication instructions has been identified as both a patient safety and a health literacy concern [1], [2], [3]. Patients often misunderstand the proper dosage of the medication as well as misunderstand the warnings associated with the medication [4], [5], [6]. Medication errors and injuries often result from patients’ unintentional misuse of or non-adherence to prescription medication. Hence, there has been a focus on increasing provider-patient communication around the topic of medication and medication use [7], [8].

Among other factors, health literacy and self-efficacy have been repeatedly recognized as predictors in one's ability to understand medication instructions and ultimately to adhere to medication regimens. Prior studies have demonstrated that patients with limited health literacy are more likely to misunderstand or misinterpret prescription medication instructions [2], [3], [9], [10]. Self-efficacy, or one's beliefs in one's ability to successfully execute a behavior required to produce a certain outcome [11], also has been identified as a critical predictor of numerous health behaviors, including medication adherence [12], [13], [14], [15]. Multiple instruments have been developed to assess self-efficacy across a wide range of chronic conditions; however many are disease condition- or context-specific [15], [16], [17], [18], [19], [20]. Other more general self-efficacy scales related to medication use and behavior tend to focus on the act of taking medication under certain conditions, such as when travelling or when one's medication schedule is not convenient [21], [22]. Ultimately, taking a medication as directed is the patient's responsibility; however, if the patient has not received adequate information, or has left an encounter not understanding how to take the medication properly, medication misuse or non-adherence is not a surprising result. This critical issue of misunderstanding prescription medication instructions, particularly among individuals of lower literacy, leads us to focus on not only the act of taking the medication, but the precursor of that act—specifically a patients’ understanding of how the medication is to be taken. Thus, in this study we sought to begin to fill the existing lacuna between a provider's provision of information to a patient and the patient's ultimate adherence or lack thereof to the prescribed regimen by creating a brief tool to assess patients’ self-efficacy related to the concepts of both understanding and using prescription medication.

Section snippets

Participants and procedures

A cross-sectional study of in-person, structured interviews was conducted among 359 adult outpatients attending one of three primary care clinics in Chicago, Illinois, New York, New York, and Shreveport, Louisiana. From May to December 2006, consecutive patients in each clinic were approached while in the waiting room. Patients were eligible if they were 18 years of age or older and were excluded if they reported severely impaired vision, hearing problems, were acutely ill, or were non-English

Results

Participants’ mean age was 47.9 years (SD 13.4, range 20–78 years); 67.8% were female and 52.7% were African American. In this sample, 43.1% were recruited in Shreveport, 33.3% in New York City, and 23.6% in Chicago. Twenty percent of respondents had less than a high school education; 13.5% were identified as reading at or below a 6th grade level (low literacy), and 28.5% were reading at the 7–8th grade level (marginal literacy). On average, patients were currently taking 2.9 prescription

Discussion

The MUSE is a brief, valid and reliable research tool that can be used in clinical and research settings to assess patients’ understanding and use of prescription medication. This scale was derived initially from two subscales of the CASE-Cancer measure [25]; these subscales were augmented with additional items designed to reflect participants’ understanding of and confidence in taking their prescription medications. Measurement using the MUSE may offer a more general approach to measuring

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