Acceso usuarios
José Fernando Mora Romo, Georgina E. Bazán Riverón
Se realizó una revisión sistemática con el objetivo de identificar y evaluar los instrumentos de medición sobre adherencia al tratamiento (AT) en personas con diabetes mellitus (DM) validados en población mexicana. Se incluyeron validaciones de escalas sobre AT en personas mexicanas con DM. Las bases de datos revisadas fueron EBSCO, SciELO, PsycINFO, Conricyt, Dialnet, Google Scholar, Pubmed y repositorios universitarios. Se utilizó el formato COSMIN para evaluar los instrumentos al considerar la validez estructural, de contenido, transcultural, de criterio, la consistencia interna y la confiabilidad.
Como resultado, se identificaron doce estudios en los que se describieron los objetivos de las escalas, las dimensiones, el número de reactivos, la base teórica, el número y la edad de los participantes. Se discuten las limitaciones identificadas mediante los criterios COSMIN y se invita a la reflexión sobre el escaso consenso al momento de definir la adherencia al tratamiento y su efecto sobre la validez y confiabilidad de su medición.
Diabetes mellitus (DM) is a group of metabolic disorders characterized by the glucose accumulation in the blood, resulting in a state called hyperglycemia (World Health Organization, 2019). One of the main causes of this state is attributable to the inability of β-cells from the pancreas to produce the necessary amount of insulin to metabolize the nutrients from the food that humans ingest, mainly carbohydrates that are converted into glucose. Due to the seriousness of the disease and its complications, diabetes education programs emphasize the importance of properly following the indications of the health team in a process called treatment adherence (ALAD, 2019). Treatment adherence (TA) is defined as the degree to which a person's behaviors such as medication intake, dietary adherence and habit change are in accordance with the health care provider's recommendations (WHO, 2003). The healthcare team can opt for indirect measurements of TA through scales or self-applied questionnaires that are usually available for free in scientific publications or undergraduate and postgraduate dissertations. However, to provide reliable and valid measurements of TA, these measurement instruments must meet certain criteria such as content validity, internal validity, structural validity and external validity. In addition, the use of measurement instruments constructed and validated in Mexico is insisted since Streiner et al. (2015) have argued that using scales from other countries can cause problems of reliability and interpretation of the scores obtained due to the lack of cultural, semantic, operational and/or measurement equivalence of the items. In view of the aforementioned, and given the lack of works that review this issue, the aim of this systematic review is to identify the instruments measuring treatment adherence in people with diabetes mellitus validated in the Mexican population and to evaluate their psychometric properties. It was included validations of treatment adherence scales in Mexican persons with diabetes mellitus, excluding pilot studies, evaluation by interview guides, ad hoc questions and studies whose participants were not exclusively Mexican. The databases searched were EBSCO, SciELO, PsycINFO, Conricyt, Dialnet, Google Scholar, Pubmed and university repositories. The COSMIN format was used to perform the psychometric evaluation of the measurement instruments considering structural, content, cross-cultural, criterion, internal consistency and reliability validity. Of 1,121 studies identified in the databases, 12 studies were included in the systematic review, where only four studies reported the assessment of treatment adherence as the objective of their measurement scale, while the others focused on aspects that interfere with adherence to medical indications, such as beliefs, perceived barriers, lifestyle and self-care, more than twenty different dimensions among all the scales were identified which were classified as factors like the relationship between the patient and the health care team, psychological variables related to adherence to treatment, medication and food intake, and specific behaviors in diabetes. The number of items varied from six to sixty-six, while only five scales reported a theorical basis for theirs items. It were observed a range of 81 to 539 participants in the different studies and a mean age of 49.89 years of the participants. In addition, only three studies considered any diabetic comorbidity or complication within their studies, such as diabetic foot and hypertension. The limitations identified through the COSMIN criteria are discussed and a reflection is proposed on the inconsistency regarding the measurement of TA, as well as the lack of Mexican measurement instruments with adequate psychometric quality that meet the criteria of content validity, internal consistency, reliability, structural validity, cross-cultural validity -or measurement invariance- and criterion validity. In addition, reflection is suggested on the scarce consensus at the moment of defining adherence to treatment and its effect on the validity and reliability of its measurement.
