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Health Education Research Advance Access originally published online on July 14, 2004
Health Education Research 2005 20(1):24-35; doi:10.1093/her/cyg106
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Health Education Research Vol.20 no.1, © Oxford University Press 2005; All rights reserved

Assessing medication adherence self-efficacy among low-literacy patients: development of a pictographic visual analogue scale

Seth C. Kalichman1,3, Demetria Cain1, Andrea Fuhrel1, Lisa Eaton1, Kari Di Fonzo2 and Thom Ertl2

1 Department of Psychology, University of Connecticut, Storrs, CT 06269 and 2 Center for AIDS Intervention Research, Medical College of Wisconsin, 8701 Watertoiwn Plant Road, Milwaukee WI 53202, USA

3 Correspondence to: S. C. Kalichman; E-mail: seth.k{at}uconn.edu

Health behavior interventions are often grounded in Social Cognitive Theory, but instruments used to assess self-efficacy rely on verbal skills and yield scores that are highly positively skewed. Based on a review of the research literature and qualitative research with key informants, a pictographic medication adherence self-efficacy scale was developed. Two studies were conducted to test the pictographic and color visual analogue scale for assessing self-efficacy for medication adherence. Study 1 (N = 81) demonstrated that the pictographic self-efficacy scale was internally consistent ({alpha} = 0.68), time stable (2-week test–re-test r = 0.63), and showed evidence for convergent and divergent construct validity. Study 2 (N = 64) further supported the reliability of the pictographic self-efficacy scale with additional data supporting its convergent, divergent and criterion-related validity, including associations with medication adherence and HIV viral load. Distributions of self-efficacy scores approximated normal. This newly developed pictographic scale may be useful in assessing medication adherence self-efficacy in lower-literacy populations.


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