Tzu Wang

Background: Medication adherence is a key determinant of treatment effectiveness, yet few brief, freely available, and culturally appropriate adherence assessment tools are available in Traditional Chinese for use in routine community pharmacy practice. The 15-item Screening Tool for AdheRence to medicineS (15-STARS) is a pharmacy-based questionnaire designed to identify medication non-adherence and its underlying barriers. Objective: To translate, culturally adapt, and validate the 15-STARS in Traditional Chinese and evaluate its utility for screening medication non-adherence and identifying barriers to adherence among patients with type 2 diabetes (T2D) in Taiwanese community pharmacies. Methods: This cross-sectional study comprised two sequential phases: translation and cross-cultural adaptation, followed by field testing. Translation involved forward-backward translation and cognitive debriefing with pharmacists and patients. The Traditional Chinese 15-STARS was administered to adults with T2D recruited from six community pharmacies in Taiwan. Psychometric evaluation included content validity, item-level criterion validity against the Traditional Chinese Adherence to Refills and Medications Scale (ChARMS-T), and internal consistency assessed using McDonald’s omega (ω). Associations among adherence, medication-related factors, and glycemic control were examined. Results: Ten pharmacists and ten patients participated in cognitive debriefing, and 215 patients completed field testing. Content validity was excellent, with item-level and scale-level content validity indices of 1.00 after revision. Items 6– 9 demonstrated good internal consistency (ω = 0.831), and selected 15-STARS items were significantly correlated with corresponding ChARMS-T measures. Among the participants, 53.0% of participants reported no missed medication doses during the previous two weeks, whereas 47.0% reported missing at least one dose. The most common reasons for non-adherence were forgetfulness (33.0%), concerns about taking too many medications (18.6%), and concerns about side effects (15.3%). Greater regimen complexity and higher dosing frequency were associated with lower adherence and poorer glycemic control. Conclusion: The Traditional Chinese 15-STARS demonstrated satisfactory content validity, evidence of criterion validity for selected items, and internal consistency among conceptually related belief-based items in Taiwanese community pharmacies. The instrument may serve as a practical screening tool for identifying patients at risk of non-adherence and exploring adherence-related barriers, thereby supporting targeted pharmacist-led interventions.

Background: Medication nonadherence in cardiometabolic syndrome negatively impacts patients’ quality of life, health care systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. SMS text messaging has emerged as a widely accessible and cost-effective intervention, particularly when the intervention is structured using behavioral theories. Objective: This study aimed to review existing literature and identify key factors in the design of SMS text messaging interventions for improving medication adherence among patients with diabetes, hypertension, or hyperlipidemia. Methods: We conducted a scoping review following the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Relevant literature on SMS text messaging interventions was searched in the PubMed and Scopus databases from inception to October 2024. The search terms included “diabetes,” “hypertension,” “hyperlipidemia,” “message,” “text,” “text message,” “app,” “application,” “digital,” “device,” “mobile,” “medical adherence,” and “medication adherence,” combined using logical operators “OR” and “AND.” Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages. Results: A total of 52 studies investigating SMS text messaging interventions to enhance medication adherence were identified. The targeted conditions included diabetes (26/52, 50%), hypertension (16/52, 31%), and various other chronic diseases (10/52, 19%). More than half of the studies (33/52, 64%) incorporated behavioral theories or techniques in their intervention design, using 19 distinct behavioral models. The most frequently used frameworks were the behavior change technique taxonomy (16/52, 31%) and the capability, opportunity, motivation, and behavior model (6/52, 12%). In addition, 33 (64%) studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (21/52, 40%), followed by personalized timing and frequency of messages (14/52, 27%), to enhance interventions’ adaptability and relevance to users’ needs. Conclusions: This review highlights critical factors influencing the design of SMS text messaging interventions for medication adherence in the management of diabetes, hypertension, and hyperlipidemia. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.

Background: Understanding personal beliefs about medications is an effective approach to improving adherence. A validated tool is essential for identifying these beliefs in routine clinical practice. Objective: To validate the factor structure and reliability of the Traditional Chinese version of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) among individuals with type 2 diabetes (T2D) in Taiwan. Methods: The original 10-item BMQ-Specific was translated into Traditional Chinese using a forward-backward translation process and reviewed by four experts in pharmacy practice and educational psychology. A cross-sectional study was conducted among adults with T2D who were using diabetes medications. Participants were recruited from five community pharmacies in Taiwan between June 2023 and May 2024. Internal consistency was assessed using McDonald’s omega (ω). Construct validity was examined through exploratory factor analysis, and criterion validity was determined by exploring associations between concern beliefs, medication adherence, and glycemic control, as measured by A1C levels. Results: Two hundred and seventy-three patients participated in the study. Exploratory factor analysis confirmed a two-factor structure consistent with the original English version, comprising the Specific-Necessity and Specific-Concerns subscales. All items loaded onto their respective subscales. The internal consistency reliability of the instrument was acceptable, with McDonald’s ω values of 0.785 for both the BMQ-Specific Necessity and BMQ-Specific Concerns subscales. These satisfactory properties were further supported by predictive validity data, which demonstrated the impact of treatment beliefs on adherence levels. The BMQ-Specific Concerns subscale showed a positive correlation with higher barriers to medication-taking (r = 0.270, p < 0.001) and poorer glycemic control (r = 0.130, p = 0.032). Conclusion: The Traditional Chinese BMQ-Specific is a reliable and valid tool for assessing medication beliefs among patients with T2D in Taiwan. It can be effectively incorporated into clinical practice to support patient-provider communication and improve medication adherence.

Objective: The study aimed to translate and assess the validity and reliability of the Traditional Chinese version of the Medication Understanding and Use Self‐Efficacy Scale (MUSE‐TC) among patients with type 2 diabetes (T2D) in Taiwan.Methods: The original 8‐item MUSE was translated into Traditional Chinese using a forward and backward translation method. The translations were reviewed by four experts in pharmacy practice and educational psychology. The validity and reliability of the MUSE‐TC were assessed in a cross‐sectional study among adults with T2D who were taking diabetes medications. Participants were recruited from five community pharmacies in Taiwan between June 2023 and May 2024. Internal consistency of the MUSE‐TC was measured using McDonald's omega (ω), while construct validity was evaluated through confirmatory factor analysis. Criterion validity was established by examining the relationship between self‐efficacy and medication adherence.Results: A total of 274 patients participated in the study. Confirmatory factor analysis identified a two‐factor structure for the 8‐item MUSE‐TC, consisting of the “taking medication” and “learning about medication” domains. All items loaded onto their intended factors, with factor loadings ranging from 0.433 to 0.511. The scale demonstrated excellent internal consistency, with McDonald's ω values of 0.914 for the “taking medication” domain and 0.906 for the “learning about medication” domain. These robust psychometric properties were further supported by criterion validity, as self‐efficacy was shown to be associated with medication adherence. Specifically, the “taking medication” domain was positively correlated with fewer barriers to medication‐taking (r = 0.382, p < 0.001), suggesting that individuals with higher self‐efficacy tend to adhere to their prescribed medication regimen.Conclusions: This study presents the MUSE‐TC with psychometrically sound properties that will enable healthcare professionals to prospectively assess self‐efficacy in medication use and evaluate the impact of self‐efficacy on a variety of health outcomes across patients with different chronic diseases.Patient or Public Contribution: Patients, pharmacists, pharmacy staff, and academic experts worked together on the translation and validation of this self‐efficacy scale for medication adherence among individuals with chronic illnesses. Community engagement played a key role in translating the scale, recruiting participants, collecting data, conducting analysis, and interpreting the findings. These collaborative efforts ensure the study relevance and applicability to patient care in routine healthcare settings.

BACKGROUND Medication nonadherence in cardiometabolic syndrome negatively impacts patients’ quality of life, health care systems, and economic stability. Despite extensive research, no universally recognized strategy has been established to improve adherence. SMS text messaging has emerged as a widely accessible and cost-effective intervention, particularly when the intervention is structured using behavioral theories. OBJECTIVE This study aimed to review existing literature and identify key factors in the design of SMS text messaging interventions for improving medication adherence among patients with diabetes, hypertension, or hyperlipidemia. METHODS We conducted a scoping review following the SPIDER (sample, phenomenon of interest, design, evaluation, research type) framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Relevant literature on SMS text messaging interventions was searched in the PubMed and Scopus databases from inception to October 2024. The search terms included “diabetes,” “hypertension,” “hyperlipidemia,” “message,” “text,” “text message,” “app,” “application,” “digital,” “device,” “mobile,” “medical adherence,” and “medication adherence,” combined using logical operators “OR” and “AND.” Full-text articles were analyzed for study design, author, country, year of publication, disease focus, behavioral theory, and the constructs or domains of text messages. RESULTS A total of 52 studies investigating SMS text messaging interventions to enhance medication adherence were identified. The targeted conditions included diabetes (26/52, 50%), hypertension (16/52, 31%), and various other chronic diseases (10/52, 19%). More than half of the studies (33/52, 64%) incorporated behavioral theories or techniques in their intervention design, using 19 distinct behavioral models. The most frequently used frameworks were the behavior change technique taxonomy (16/52, 31%) and the capability, opportunity, motivation, and behavior model (6/52, 12%). In addition, 33 (64%) studies implemented tailored messaging strategies, with the most common approach being content customization based on individual patient information (21/52, 40%), followed by personalized timing and frequency of messages (14/52, 27%), to enhance interventions’ adaptability and relevance to users’ needs. CONCLUSIONS This review highlights critical factors influencing the design of SMS text messaging interventions for medication adherence in the management of diabetes, hypertension, and hyperlipidemia. The findings underscore the importance of integrating behavioral theories and tailoring strategies to optimize patient engagement and intervention effectiveness. Further research is needed to evaluate the impact of different tailoring approaches and translate these insights into practical interventions.

Introduction: The rise in online health information access has shifted health-seeking behaviors, yet a validated tool to assess eHealth literacy for the Taiwanese context remains unavailable. This study aimed to translate the eHealth Literacy Scale (eHEALS) into Traditional Chinese and validate its factor structure and reliability among individuals with type 2 diabetes (T2D). Methods: The original 8-item eHEALS was translated into Traditional Chinese (eHEALS-TC) using forward and backward translation techniques, with input from four experts in pharmacy practice and educational psychology. A cross-sectional study was conducted to examine the validity and reliability of the eHEALS-TC in adults with T2D who were taking diabetes medication. Participants were recruited from five community pharmacies in Taiwan between June 2023 and May 2024. The internal consistency of the eHEALS-TC was assessed using McDonald's omega (ω), while construct validity was evaluated through exploratory factor analysis. Criterion validity was determined by exploring the correlation between the mean total eHEALS-TC score and demographic factors, self-efficacy, health status, medication adherence, and A1C levels. Results: A total of 273 patients participated in the study. Exploratory factor analysis revealed that all eHEALS-TC items were loaded onto a single factor, accounting for 84.95% of the total variance. The internal consistency reliability yielded a McDonald's ω of 0.974. The mean total eHEALS-TC score was positively associated with younger age ( r = .382, P  < .001), higher education attainment ( r _s = .525, P  < .001), greater household income ( r _s = .359, P  < .001), better self-reported health status ( r _s = .191, P  = .002), stronger self-efficacy in medication use ( r = .167, P = .006), and fewer barriers to medication-taking ( r = .143, P  = .018). However, no association was found between the mean total eHEALS-TC score and A1C levels ( r = .048, P  = .427). Conclusions: The findings provide empirical evidence supporting the validity, reliability, and efficiency of the eHEALS-TC as a tool for assessing eHealth literacy among individuals with varying demographics and health conditions in Taiwan.

This study aimed to translate and validate the Adherence to Refills and Medications Scale into Traditional Chinese (ChARMS-T) and to investigate common barriers to medication adherence among patients with type 2 diabetes (T2D) in Taiwan. The ChARMS-T was developed through translation and application phases. During the translation phase, the scale underwent forward translation, backward translation, and cognitive debriefing. In the application phase, the finalized ChARMS-T was administered to patients with T2D at five Taiwan community pharmacies over nine months starting in September 2023. Psychometric properties were assessed using criterion validity, construct validity through confirmatory factor analysis, and reliability through McDonald's omega. A total of 343 participants completed surveys. Factor analysis of the 12-item ChARMS-T revealed two dimensions: medication-taking (8 items) and medication refill (4 items). The instrument demonstrated acceptable internal consistency, with McDonald's omega scores of 0.841 for medication-taking and 0.647 for medication refill. The medication refill subscale showed strong agreement with the objective refill measure, proportion of days covered, with a coefficient of 0.84, suggesting that these measures evaluate similar constructs. Evidence of known-groups validity was demonstrated by a significant difference between ChARMS-T scores and glycemic control (p = 0.047). Patients with good glycemic control had a significantly higher adherence rate to both refills and medication-taking compared to those with poor glycemic control. The most frequently reported barriers to medication-taking were carelessness (55.7%), forgetfulness (54.8%), and frequent dosing intervals (43.1%). For medication refills, 9.6% of the participants identified a lack of planning as the main reason for not refilling their diabetes medications on time, followed by forgetfulness (7.6%). The ChARMS-T identified a broader range of non-adherence reasons and demonstrated good psychometric properties. It can be integrated into practice settings for screening and follow-up to enhance medication adherence through effective communication between healthcare professionals and patients, ultimately improving long-term patient health outcomes.

Background: Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. Objective: We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. Methods: We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. Results: The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. Conclusions: This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence.

BACKGROUND Medication is crucial for managing chronic diseases, yet adherence rates are often suboptimal. With advanced integration of IT and mobile internet into health care, mobile apps present a substantial opportunity for improving adherence by incorporating personalized educational, behavioral, and organizational strategies. However, determining the most effective features and functionalities for these apps within the specific health care context in Asia remains a challenge. OBJECTIVE We aimed to review the existing literature, focusing on Asian countries, to identify the optimal features of mobile apps that can effectively enhance medication adherence within the unique context of Asian societies. METHODS We conducted a narrative review with the SPIDER (sample, phenomenon of interest, design, evaluation, research type) tool. We identified studies on mobile apps for medication adherence from January 2019 to August 2024 on PubMed and Scopus. Key search terms included “Asia,” “chronic disease,” “app,” “application,” “survey,” “experiment,” “questionnaire,” “group,” “medical adherence,” “medication adherence,” “case-control,” “cohort study,” “randomized controlled trial,” “clinical trial,” “observational study,” “qualitative research,” “mixed methods,” and “analysis,” combined using logical operators “OR” and “AND.” The features of mobile apps identified in the studies were evaluated, compared, and summarized based on their disease focuses, developers, target users, features, usability, and use. RESULTS The study identified 14 mobile apps designed to enhance medication adherence. Of these, 11 were developed by research teams, while 3 were created by commercial companies or hospitals. All the apps incorporated multiple features to support adherence, with reminders being the most common, present in 11 apps. Patient community forums were the least common, appearing in only 1 app. In total, 6 apps provided lifestyle modification functions, offering dietary and exercise recommendations, generating individualized plans, and monitoring progress. In addition, 6 apps featured health data recording and monitoring functions, with 4 allowing users to export and share records with researchers or health care professionals. Many apps included communication features, with 10 enabling feedback from researchers or health care professionals and 7 offering web-based consultation services. Educational content was available in 8 apps, and 7 used motivation strategies to encourage adherence. Six studies showed that mobile apps improved clinical outcomes, such as blood glucose, lipid, and pressure, while reducing adverse events and boosting physical activities. Twelve studies noted positive humanistic effects, including better medication adherence, quality of life, and user satisfaction. CONCLUSIONS This review has identified key components integrated into mobile apps to support medication adherence. However, the lack of government and corporate involvement in their development limits the generalizability of any individual app. Beyond basic reminder functions, features such as multiuser support, feedback mechanisms, web-based consultations, motivational tools, and socialization features hold significant promise for improving medication adherence. Further pragmatic research is necessary to validate the effectiveness of these selected apps in enhancing adherence.