Objectives: (1) To develop a new 20-item medication adherence questionnaire (MAQ-20) including test the psychometric properties; (2) To develop a medication adherence questionnaire for specific medications used for treatment of non-communicable chronic diseases (NCD); (3) To develop digital innovations for measuring medication adherence in patients with NCD. Method: This study was designed as research and development research. Part 1 The development of the MAQ included four steps: 1.1 Item generation-based on literature review and the medication self-management model as a theoretical framework; 1.2 Operationalization of the identified domains into items; 1.3 Content validity of the draft version 1 was assessed based on the item-objective congruence (IOC) by three experts; and 1.4 Reliability was evaluated by Cronbach’s alpha. Part 2 The development of medication adherence questionnaire for specific medications by experts in pharmacokinetics/pharmacokinetics: if a population pharmacokinetics/pharmacokinetics study for a specific medication is available, Monte Carlo simulation is performed for possible pattern of missed doses; if population pharmacokinetics/pharmacokinetics study for a specific medication is unavailable, pharmacokinetics/pharmacokinetics profiles of a specific medication is reviewed and determined a missed dose affecting therapeutic level by the expert group. Part 3 The development of the digital innovation comprised of 5 steps: 3.1 design of the application is based on concept of user friendly; 3.2 development of database for storage the server; 3.3 vigilance system for database security through Hypertext Transfer Protocol Secure: HTTPS and Secure Socket Layer (SSL); 3.4 database management system for preventing loss of data; and 3.5 basic test of the application’s functions and performance by experts.
Results: Part 1 The final version of questionnaire namely the MAQ covers 20 items rated on a 3-point Likert scale (“Always,” “Sometimes,” and “None”) organized into six domains: Refill, Understand, Organize, Take, Monitor and Sustain. The range of the IOC was from 0.67 to 1.00. In a pilot study (n=40), the MQA is easy to complete (mean completion time = 9.0 min). The reliability of questionnaire was 0.657, indicating acceptable internal consistency. One item deletion in the draft version 2 resulted in an increase Cronbach's alpha. Part 2 the medication adherence questionnaire for specific medications composed of 40 items according to the scope of medication list used in primary care healthcare settings. They were simply rated on 3 choices based on pharmacokinetics/pharmacokinetics profiles of a specific medication and expert opinion. Part 3 Web-based application namely MAQ plus© comprised of 4 main menus: home menu described the project details; medication adherence questionnaire developed from this study part 1 and 2; user manual; and frequently asked questions. The application was approved for basic functions and performance. Conclusion: The first version of the MAQ-20 has acceptability of validity and reliability. The medication adherence questionnaire for specific medications and the MAQ plus © web-based application were approved for basic quality by expert group. Future studies should examine the psychometric qualities (construct validity, criterion validity, and test–retest reliability) in larger populations and usability test of MAQ plus© web-based application with available similar applications.