TAI vs. MARS-A for assessing treatment adherence in asthma: a pilot study from respiratory nursing
DOI:
https://doi.org/10.60108/g7p7w150Keywords:
Treatment Adherence and Compliance, Asthma, Administration, Inhalation, Surveys and Questionnaires, Nursing CareAbstract
Background: Poor adherence in asthma is a relevant contributor to inadequate clinical control and exacerbations. The selection of the measurement instrument is key for nursing practice; however, no studies have directly compared the TAI (Test of Adherence to Inhalers) and the MARS-A (Medication Adherence Report Scale for Asthma) using an objective external criterion.
Objective: To compare the agreement, relationship with pharmacy dispensing records, and clinical applicability of both instruments in adult patients with asthma.
Methods: Mixed-methods study combining (i) a structured narrative review (2020–2025) and (ii) a cross-sectional pilot study with 35 patients in a respiratory nursing clinic. Questionnaires were administered in randomized order and correlated with pharmacy dispensing records.
Results: TAI and MARS-A showed moderate agreement (ρ = 0.359; p = 0.034). MARS-A showed a higher correlation with pharmacy dispensing records (ρ = 0.572; p < 0.001) than TAI (ρ = 0.316; p = 0.064). TAI identified non-adherence patterns (erratic: 22.9%; intentional: 17.1%; unconscious: 8.6%), a capability not available in MARS-A. Both showed good applicability (TAI: 2.9 min; MARS-A: 2.1 min).
Conclusions: MARS-A showed greater agreement with objective pharmacy dispensing data, being useful for screening and global monitoring of treatment adherence from a nursing perspective, while TAI offers advantages for designing personalized educational interventions by discriminating specific non-adherence patterns. Instrument selection should align with the clinical objective, considering that results reinforce the strategic role of respiratory nursing in the assessment of treatment adherence.
References
1. Martínez-Moragón E, Serra-Batllés J, De Diego A, Palop M, Casan P, Rubio-Terrés C, et al. Coste económico del paciente asmático en España (estudio AsmaCost). Arch Bronconeumol. 2009;45(10):481-6. doi:10.1016/j.arbres.2009.04.006
2. Sociedad Española de Neumología y Cirugía Torácica. Proyecto neumología H2030: nuestro futuro [Internet]. 2021. Disponible en: https://www.separ.es
3. Global Strategy for Asthma Management and Prevention [Internet]. Global Initiative for Asthma (GINA); 2025. Report No. Disponible en: https://ginasthma.org/
4. SEPAR. Guía Española para el Manejo del Asma (GEMA) 5.5 [Internet]. SEPAR; 2025. Report No. Disponible en: https://www.gemasma.com/
5. Adherence to long-term therapies: evidence for action [Internet]. Geneva: World Health Organization; 2003. Report No. Disponible en: https://iris.who.int/handle/10665/42682
6. Mäkelä MJ, Backer V, Hedegaard M, Larsson K. Adherence to inhaled therapies, health outcomes and costs in patients with asthma and COPD. Respir Med. octubre de 2013;107(10):1481-90. doi:10.1016/j.rmed.2013.04.005
7. Horne R. Compliance, Adherence, and Concordance. Chest. julio de 2006;130(1):65S-72S. doi:10.1378/chest.130.1_suppl.65S
8. Entrenas Costa, Luis Manuel, Entrenas Castillo, Marta. Cuestionarios para medir la adhesión al tratamiento en asma: pros y contras. Revista de Asma. 2022;7(1):1-8.
9. Plaza V, Fernández-Rodríguez C, Melero C, Cosío BG, Entrenas LM, De Llano LP, et al. Validation of the ‘Test of the Adherence to Inhalers’ (TAI) for Asthma and COPD Patients. J Aerosol Med Pulm Drug Deliv. abril de 2016;29(2):142-52. doi:10.1089/jamp.2015.1212
10. Vrijens B, De Geest S, Hughes et al. A new taxonomy for describing and defining adherence to medications. British Journal of Clinical Pharmacology. 2012;73:691-705. doi:10.1111/j.1365-2125.2012.04167.x
11. Lindsay JT, Heaney LG. Non-adherence in difficult asthma and advances in detection. Expert Rev Respir Med. diciembre de 2013;7(6):607-14. doi:10.1586/17476348.2013.842129 PubMed PMID: 24164107.
12. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. enero de 1986;24(1):67-74. doi:10.1097/00005650-198601000-00007 PubMed PMID: 3945130.
13. Cohen JL, Mann DM, Wisnivesky JP, Horne R, Leventhal H, Musumeci-Szabó TJ, et al. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma. Ann Allergy Asthma Immunol. octubre de 2009;103(4):325-31. doi:10.1016/S1081-1206(10)60532-7
14. Lugo González IV, Vega Valero CZ. Propiedades psicométricas de la Medication Adherence Report Scale-Asthma en adultos asmáticos mexicanos. Psicol Salud. 19 de junio de 2020;30(2):275-85. doi:10.25009/pys.v30i2.2663
15. Plaza V, Giner J, Curto E, Alonso-Ortiz MB, Orue MI, Vega JM, et al. Assessing Adherence by Combining the Test of Adherence to Inhalers With Pharmacy Refill Records. J Investig Allergol Clin Immunol. 17 de febrero de 2021;31(1):58-64. doi:10.18176/jiaci.0461 PubMed PMID: 31599726.
16. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 29 de marzo de 2021;n71. doi:10.1136/bmj.n71
17. Achterbosch M, Van De Hei SJ, Dierick BJH, Kocks JWH, Van Den Berge M, Kerstjens HAM, et al. Usability and feasibility of the Test of Adherence to Inhalers (TAI) Toolkit in daily clinical practice: The BANANA study. Npj Prim Care Respir Med. 28 de mayo de 2024;34(1):13. doi:10.1038/s41533-024-00372-z
18. Santibáñez M, Rodríguez I, López-Caro JC, Rodríguez-Porres M, Astruga MC, Arenal S, et al. Comparación de la adhesión terapéutica según el Test de Adherencia a Inhaladores y el registro de la retirada en farmacia de los fármacos prescritos en pacientes asmáticos. Estudio REFARMA. Open Respir Arch. abril de 2023;5(2):100238. doi:10.1016/j.opresp.2023.100238
19. Eldridge SM, Lancaster GA, Campbell MJ, Thabane L, Hopewell S, Coleman CL, et al. Defining Feasibility and Pilot Studies in Preparation for Randomised Controlled Trials: Development of a Conceptual Framework. PloS One. 2016;11(3):e0150205. doi:10.1371/journal.pone.0150205 PubMed PMID: 26978655; PubMed Central PMCID: PMC4792418.
20. Beauchamp T, Childress J. Principles of Biomedical Ethics. Oxford University Press; 2019.
21. Hou M, Wang Z, Zhu Y, Sun W. The Effect of Nurse-Led Educational Intervention on the Use of Inhalers in COPD Patients — Multisystem Review and Semi-quantitative Analysis. J Clin Nurs Res. 2025;9(8):95-107. doi:10.26689/jcnr.v9i8.11766
Additional Files
Published
Issue
Section
License
En caso de que el artículo sea publicado, los autores aceptan transferir todos los derechos del trabajo presentado, incluidos los derechos de autor y aquellos relativos a la transmisión electrónica, exclusivamente a CODEM, de manera universal, en todos los idiomas, una vez que el trabajo haya sido aceptado para su publicación dentro de la revista electrónica CONOCIMIENTO ENFERMERO.
El autor podrá hacer copias ilimitadas del trabajo para uso docente, reutilizarlo en su totalidad o parcialmente en un libro escrito por el autor o hacer copias para su distribución en la institución en la que trabaja. CODEM hará mención al nombre del autor en las publicaciones que se realicen del trabajo.
