Medication adherence Validation and feasibility testing of a novel questionnaire to identify barriers to medication adherence



To establish:

  • The psychometric properties of the ‘Identification of Medication Adherence Barriers Questionnaire’ (IMAB-Q), including construct and criterion validity, internal consistency reliability and test-retest reliability 
  • The feasibility of using IMAB-Q in routine Medicines Use Reviews (MURs) in community pharmacies
  • Community pharmacists’ perspectives on using IMAB-Q including barriers and facilitators to implementation.


A mixed methods approach was selected to quantitatively determine the IMAB-Q psychometric properties and qualitatively assess provisional acceptability of IMAB-Q in routine MURs in community pharmacy.


Patient non-adherence to prescribed medicines has been described by the World Health Organisation (WHO) as a worldwide problem of striking medicine yet recent Cochrane reviews have highlighted the paucity of effective interventions and progress in this field.  Medicines taking; a complex health behaviour is influenced by a plethora of inter-relating factors including those of both a practical nature (eg cognitive impairments or dexterity issues) and perceptual nature (eg illness perceptions and health beliefs).  To date, adherence interventions have lacked a valid and reliable means of identifying a patient’s barriers to medication adherence and thus a strategy for targeting intervention support to meet individual need.

The ‘Identification of Medication Adherence Barriers Questionnaire’ (IMAB-Q) was developed as part of Claire Easthall’s doctoral thesis at the University of East Anglia. It is a 30-item questionnaire representing relevant domains of the Theoretical Domains Framework (TDF), a composite of health psychology theory intended to identify determinants of behaviour.  The IMAB-Q is a robustly developed and theory guided tool with the potential to influence future adherence intervention design.  However, the validity and reliability of the questionnaire need to be established. 

In addition to establishing the psychometric properties of the IMAB-Q (and thus its candidature for progression to future intervention development) the feasibility of utilising the IMAB-Q in routine healthcare consultations must also be considered.  Community pharmacists are ideally placed to offer accessible adherence support and expert medicines advice.  This study, therefore, sought to establish the feasibility of using the IMAB-Q in routine, medicines-related community pharmacy consultations and the community pharmacists’ perspectives on this. 


Tracey J Brown, University of East Anglia

Michael Twigg, University of East Anglia

 Natalie Taylor, Australian Institute of Health Innovation, Macquarie University

Claire Easthall, University of Leeds

Jenny Hartt, Lay advisors, Norwich

Tony Budd, Lay advisors, Norwich

Zhicheng Li, Australian Institute of Health Innovation, Macquarie University

Alexandra Dima, Department of Communication Science, University of Amsterdam 

Debi Bhattacharya, University of East Anglia

Funding body: Pharmacy Research UK (£67,291)

Contact: Dr Claire Easthall