Abstract
BackgroundLong-term anticoagulation therapy, particularly with warfarin, is usually associated with poor adherence and low patient satisfaction. However, previous studies have highlighted the possibility that individual perceptions of warfarin differ according to cultural practices. This study validated the psychometric properties of the translated Arabic version of the Anti-Clot Treatment Scale (ACTS) for patients on warfarin therapy in Saudi Arabia.MethodsA cross-sectional multicenter study was conducted at the three main medical centers in Riyadh. Stratified sampling was employed to recruit Arabic-speaking patients who had been taking warfarin for a minimum of 3 months for any indication. The patients completed the specific ACTS along with the generic Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) at two clinic visits. The psychometric performance of the ACTS was evaluated using well-established criteria: feasibility, reliability, and validity.ResultsOne hundred thirty-six patients participated in the study (mean age: 50.68 ± 14.6 years; range: 19–97). Overall, the patients reported moderate Burdens and Benefits scores (44 ± 9.9 and 11.92 ± 2.4, respectively) compared to the reference range for each subscale (12–60 and 3–15, respectively); however, they reported lower Burdens scores than other populations. Consistent with the original ACTS validation study, the criteria for acceptability (data targeting, floor/ceiling effects, and skewness) were satisfied; in fact, the Arabic version exhibited better item- and scale-level distributions of data than versions in other languages. The ACTS subscales also demonstrated satisfactory test-retest reliability with significant intraclass correlation coefficients ((ICC ≥ 0.5); p < 0.001) and good internal consistency (all Cronbach’s alpha values exceeded 0.7). Exploratory factor analysis supported the 2-factor loading model. Interestingly, the Arabic version exhibited greater convergent validity with the TSQM subdomains (r = 0.61).ConclusionsThis study provides convincing evidence that the Arabic versions of both the ACTS Burdens and ACTS Benefits scales are equivalent to other versions in terms of psychometric performance, as measured using reliability and validity criteria. These properties support the great potential of the Arabic ACTS to accurately reflect patient satisfaction, identify aspects of treatment that need improvement in clinical practice, and compare treatment satisfaction across different anticoagulant therapies or cultures in research.
Highlights
Long-term anticoagulation therapy, with warfarin, is usually associated with poor adherence and low patient satisfaction
At the time of recruitment, the patients had been taking warfarin for an average of 3.6 years (SD = 3.2), and their average Time in the therapeutic range (TTR) score was at the poor control level (< 60%; mean = 58.8; Standard deviation (SD) = 33.6)
In conclusion, this study provides convincing evidence supporting the psychometric validity of the Arabic version of the Anti-Clot Treatment Scale (ACTS) as a feasible measure of satisfaction with anticoagulant therapy in patients visiting Anticoagulant clinic (ACC)
Summary
Long-term anticoagulation therapy, with warfarin, is usually associated with poor adherence and low patient satisfaction. Previous studies have highlighted the possibility that individual perceptions of warfarin differ according to cultural practices. Long-term anticoagulation therapy, with warfarin and other vitamin K antagonists (VKAs), is mostly indicated for the prevention of recurrent venous thromboembolism (VTE) complications [1]. Patients’ adherence was reported to decrease over the course of treatment due to their concerns about the risk of anticoagulant-associated bleeding complications and the burdens of frequent monitoring, dietary restrictions and dose adjustment [4, 5]. A previous review of observational studies examining anticoagulation therapy has highlighted possible variability in individual perceptions of barriers to adherence and in associated lifestyle experiences according to psychosocial factors, attitudes and cultural practices [7]. Studies that directly addressed quality of life reported considerable variability in patients’ quality-of-life preferences regarding warfarin therapy, and their conclusions were often controversial [8, 9]
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