Aims and objectives: To translate and validate a Taiwanese version of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS). Background: The major barrier in the management of atrial fibrillation is the lack of self-efficacy to medications adherence. Patients’ knowledge of the nature of atrial fibrillation and cardiovascular, cerebrovascular risk factors and anticoagulants is a significant factor affecting individuals’ adherence. However, few instruments have been developed to assess patients’ self-efficacy to medications adherence and none has been translated into Taiwanese. Design: This study used a standard ‘‘forward-backward’’ procedure, which was used to translate SEAMS into Taiwanese language. Reliability was tested for internal consistency. Validity was confirmed by computing a content validity index. Methods: Data collection for this research occurred from October 13, 2015 to October 26, 2016. The sample included atrial fibrillation outpatient. Participants simultaneously completed the Taiwanese version of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS-T). A total of 151 individuals completed the questionnaire. Results: Coefficient alpha was 0.931 for atrial fibrillation patients. Conclusions: Findings provide support for the validity of the Taiwanese version of the Self-Efficacy for Appropriate Medication Use Scale (SEAMS-T). Relevance to clinical practice: The translation and validation of an instrument evaluating the self-efficacy for medication adherence in atrial fibrillation contribute to assessing the provided educational intervention.
Atrial fibrillation is the most common type of arrhythmia [
Approximately 2.7 to 6.1 million people are affected by atrial fibrillation in the United States, and this number is expected to increase [
According to the study of several Asian teams, the prevalence of atrial fibrillation in Asia is about 1% of the adult population, lower than white people (about 2%) [
Atrial fibrillation causes 15% - 20% of chances to suffer ischemic strokes [
Compared with patients without atrial fibrillation, atrial fibrillation patients had three to four times risk of stroke in Asia [
Atrial fibrillation increases an individual’s risk of stroke, heart failure, and other heart-related complications [
The reasons why only a small proportion of patients with atrial fibrillation in Taiwan use warfarin include that they are afraid of taking blood tests regularly, and they are tired of coming back to the clinic, taking blood tests, and getting a revised dosage of medication frequently. Also, they are worried about the side effects of medications, using secret recipes for clearing blood vessels from neigh- bors without authorization, or turning to famous doctors. All these phenomena mentioned above show that patients with atrial fibrillation in Taiwan have poor adherence of treatment. Thus, focusing more attention on finding out what patients need or what they are confused about, and explaining principles of treatment and methods of medication uses to them is the only way to reach effective prevention.
Disease management of patients with atrial fibrillation aims at reducing sym- ptoms and preventing complications associated with atrial fibrillation, and anticoagulants are able to prevent complications related to atrial fibrillation [
The term “adherence” is defined as “the extent to which a person’s behavior- taking medication, following a diet, and executing lifestyle changes, corresponds with agreed recommendations from a health care provider” [
In addition to health beliefs, self-efficacy beliefs also motivate an individual to adopt a healthy way of living [
The Self-efficacy for Appropriate Medication Use Scale (SEAMS) provides assessment of medication self-efficacy in the object of study’s use of anticoagulants [
The aim of the present study was to validate the SEAMS in Taiwanese adults with atrial fibrillation. The importance of this study is to translate and validate the scale into Taiwanese, since this would provide the applicability and relevance of an instrument in the Taiwan population. Furthermore, scientists will have the ability to design surveys, giving important findings about the role of healthcare system. In addition, the study allows healthcare providers to assess the provided educational intervention.
The study design was cross-sectional. This study was undertaken as a part of a study to evaluate an educational intervention, improving adherence to atrial fibrillation among Taiwanese adults. We used the SEAMS which was translated into Taiwanese and was then administered to participants.
This study was conducted at two teaching hospitals in Taiwan, from October 13, 2015 to October 26, 2016. They provide health care, emergency treatment for patients with all illnesses and accidents, and primary and advance medical health- care.
The inclusion criteria for atrial fibrillation were the following: 1) age of 20 and above, 2) be proficient in Mandarin and Taiwanese, 3) the doctor diagnosed patients with atrial fibrillation, and 4) patients who use anticoagulants (warfarin or NOACs) participate. The exclusion criteria for atrial fibrillation were the following: 1) patients diagnosed with mental illnesses, 2) patients with instability and uncontrolled hypertension, 3) patients with heart failure (NYHA stage IV), 4) installed pacemaker, AICD for patients, 5) patients with cardiac surgery in the last three months, and 6) patient who only has the last three months was hospitalized for treatment of atrial fibrillation.
This consisted of six items regarding socio-demographic characteristics of the samples such as age, gender, education level, marital status, economic, and employment status.
This consisted of four items regarding disease-demographic characteristics of the samples such as atrial fibrillation diagnosis time, CHA2DS2-VASC, HAS- BLED, and INR.
The Self-Efficacy for Appropriate Medication Use Scale (SEAMS) contains from 13 to 39. The response were encoded as “not confident = 1”, “somewhat confident = 2” and “very confident = 3”. The score for the 13-item scale ranged from 13 to 39. Higher scores indicated higher levels of self-efficacy for medication adherence.
This research includes the work of translating the SEAMS, which will be translated according to the method of back-translation indicated by Waltz, Strickland, and Lenz et al. [
Researchers distributed the demographic questionnaire, the SEAMS-T to patients. The questionnaire takes about 8 - 10 min to complete.
Internal consistency reliability: The Cronbach alpha coefficient was calculated to test the reliability of the questionnaire in its entirety.
Content validity: Three content experts rated the item relevance of the scale. Item-level content validity indexes (I-CVIs) and a scale-level content validity index (S-CVI) were computed to provide evidence of content validity. A universal agreement among experts was required for the S-CVI [
This study was approved by the Ethics of the “Taipei Medical University-Joint Institutional Review Board”. The Ethical approval number is 201505054. The participants in the study were informed about the purpose of the study. All subjects were provided with written consent before participation. The researcher also guaranteed that the documents would be kept confidential.
Descriptive statistics were used to describe socio-demographic and disease characteristics of the patients and their SEAMS-T scores. Percentages and frequencies were used for the categorical variables, while means and standard deviations were calculated for the continuous variables. Internal consistency was assessed using Cronbach’s alpha. The significance level was set at p-value < 0.05. All analyses were performed using SPSS version 23.0.
The final analysis included 151 patients with atrial fibrillation. The socio-demo- graphic and disease characteristics of the total are shown in
socio and disease demographic | n | Percentages (%) | Mean | SD |
---|---|---|---|---|
Age | 71.98 | 8.61 | ||
Gender | ||||
Female | 56 | 37.1 | ||
Male | 95 | 62.9 | ||
Education Level | ||||
No formal education | 8 | 5.3 | ||
Primary school | 43 | 28.5 | ||
Secondary school | 21 | 13.9 | ||
High school | 33 | 21.9 | ||
College or higher | 46 | 30.4 | ||
Marital status | ||||
Unmarried | 4 | 2.6 | ||
Married | 125 | 82.8 | ||
Divorced/Widowed | 22 | 14.6 | ||
Economic status | ||||
Not enough | 16 | 10.6 | ||
More enough | 106 | 70.2 | ||
Profit | 29 | 19.2 | ||
Employment status | ||||
Full time/Part time | 29 | 19.2 | ||
Unemployed | 4 | 2.6 | ||
Retired | 107 | 70.9 | ||
Another | 11 | 7.3 | ||
Time of illness (month) | 73.97 | 61.06 | ||
CH2DS2-VASc score | 4.03 | 1.64 | ||
Low risk (score = 0) | 3 | 2.0 | ||
Medium risk (score = 1) | 6 | 4.0 | ||
High risk (score ≥ 2) | 142 | 94.0 | ||
HAS-BLED score | 2.85 | 1.11 | ||
Low risk (score = 1 - 2) | 60 | 39.7 | ||
High risk (score ≥ 3) | 91 | 60.3 | ||
INR | 1.67 | 0.75 |
Cronbach’s alpha test of internal consistency was 0.931 for the SEAMS-T, and its item to total correlation coefficient ranged from 0.584 to 0.781 (
The S-CVI was 1 for the SEAMS-T and all its I-CVIs were 1 as well, indicating good content validity [
Mean | SD | Corrected item-total correlation | Cronbach’s alpha if item deleted | |
---|---|---|---|---|
Question 1 | 2.66 | 0.49 | 0.591 | 0.929 |
Question 2 | 2.50 | 0.64 | 0.584 | 0.929 |
Question 3 | 2.74 | 0.49 | 0.710 | 0.926 |
Question 4 | 2.61 | 0.58 | 0.740 | 0.924 |
Question 5 | 2.19 | 0.77 | 0.681 | 0.927 |
Question 6 | 2.70 | 0.53 | 0.673 | 0.927 |
Question 7 | 2.59 | 0.61 | 0.772 | 0.923 |
Question 8 | 2.52 | 0.60 | 0.739 | 0.924 |
Question 9 | 2.34 | 0.77 | 0.724 | 0.925 |
Question 10 | 2.47 | 0.69 | 0.781 | 0.922 |
Question 11 | 2.50 | 0.70 | 0.780 | 0.922 |
Question 12 | 2.41 | 0.71 | 0.658 | 0.927 |
Question 13 | 2.66 | 0.53 | 0.588 | 0.929 |
Cronbach’s alpha was 0.931 for the total scale with significant intra-class correlation coefficient (p < 0.001).
The main objective of the study was to report the reliability and validity of the translated of SEAMS in a sample of patients with atrial fibrillation people. This study was the first one which translated and validated the 13-item SEAMS into the Taiwanese language. The original SEAMS was tested by Risser et al. [
Finally, regarding factors affecting the self-efficacy for medication adherence with atrial fibrillation patients, the analysis indicated that socioeconomic and disease characteristics of the sample were not associated with the self-efficacy of medication adherence. More specifically, no correlation was observed among the level self-efficacy of medication adherence and socioeconomic and disease characteristics. The study findings could be explained by the lack of significant variety regarding these characteristics in the sample.
Furthermore, the results are important for health professionals in the development and evaluation of strategies to promote atrial fibrillation patients’ positive self-management. Strategies focusing upon self-efficacy enhancement could be provided to atrial fibrillation patients to improve their medication adherence.
The main limitation of our results is that the study was conducted with atrial fibrillation patients making generalization to other diseases difficult. Future study can continue to examine the applicability of the SEAMS-T across other populations. Moreover, the present study was not conducted as responsiveness and predictive validity. Further research on these properties is encouraged.
For the first time in our study, the SEAMS is used and validated in the Taiwanese language. The Taiwanese version is proved to be acceptable to atrial fibrillation patients; it is a simple questionnaire that can be administered by a trained nurse in face-to-face interviews to overcome non-response by those who cannot read. The findings from this validation study indicate that the Taiwanese version of SEAMS is a reliable and valid measure because it shows acceptable reliability and validity.
The psychometric testing and validation of an instrument assessing the medication adherence of atrial fibrillation contribute to assessing the provided educational intervention. Nurses will have the opportunity to amplify their role in patients’ education and develop a relationship based on honesty and respect.
We honestly want to thank Dr. Ming-Hsiung Hsieh and Dr. Ju-Chi Liu for his contribution in collection of the data. We would like to thank all participants for reviewing the questionnaire.
The authors declare that there are no conflicts of interest.
Chen, P.-T. and Wang, T.-J. (2017) Translation and Validation of the Taiwanese Version of the Self- Efficacy for Appropriate Medication Use Scale. Open Journal of Nursing, 7, 28-38. http://dx.doi.org/10.4236/ojn.2017.71003