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On the other hand, a more serious potential risk of measurement error in regard to measuring adherence is the lack of information regarding how closely the number of modules correlates with actual therapeutic activity.
A focus on adherence to care and measuring adherence is all but missing in the discussion of the consumer's role in healthcare, which I find unfortunate.
Thus, to fully explore the relationship between personality traits and other factors that may influence adherence to medication, advanced prospective and objective measures of adherence have been proposed, although measuring adherence is complicated [6].
The "gold standard" for measuring adherence is currently electronic medication event monitoring (eMEMs).
Because no one method of measuring adherence is considered a gold standard, we will measure adherence in several ways including pharmacy dispensing records, self-report using the MAM-MM, and variability in tacrolimus or sirolimus trough levels [ 36- 38].
The major limitation of measuring adherence is the so called Hawthorne effect: the measuring of adherence itself influences the adherence because the awareness of patients that adherence is being measured may influence their behaviour.
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Methodological issues in measuring adherence are addressed and suggestions for improving the design of future adherence studies highlighted, of which there is a great need.
Finally, improved methods of measuring adherence are required for large-scale studies.
At present, several direct and indirect methods for measuring adherence are available.
The most common methods of measuring adherence were discussed including patient questioning, patient logs, pill counts 44 and the widely used medication electronic monitoring system (MEMS).
Lastly, the generalizability of the study results is limited as majority of the studies identified as measuring adherence were in HIV and few were in hypertension, schizophrenia and diabetes.
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