Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension

Objective: This study aimed to develop the ARMS-C and test its psychometric properties in hypertensive patients, to assess the level of medication adherence and to identify associated predictors for medication adherence and blood-pressure control among Chinese hypertensive patients. Methods: Hypertensive elderly who met inclusion criteria were recruited from an aged-care facility in Henan Province between January 2019 and July 2019. The patients completed the adapted ARMS-C. The scale's factor structure, internal consistency, and construct validity were tested. Results: Good internal consistency (Cronbach's alpha=0.89) and test-retest reliability (r=0.86, p<0.01) were obtained. Item-total correlation coefficients for the ten-item ARMS-C were 0.505-0.801. Factor analysis of construct validity identified two factors, explaining a total variance of 63.3%. Binary regression showed that patients with scores at level 2 (<= 20 ARMS-10 scores <30) were six times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20, OR 6.6, 95% CI 1.7-25.1; p=0.006), and patients with scores at level 3 (ARMS-10 scores >30) were 115 times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20,0R 115, 95% CI 9-1,470; p=0). Conclusion: The ten-item ARMS-C is a reliable and valid self-reporting screening tool for adherence to medication and refills in elderly hypertensive Chinese patients.