Background: Multiple tools measure self-reported medication adherence, however, there is no established standard. Previous studies have validated a 12-item Adherence to Refills and Medication scale (ARMS) and a single-item priming question. The 18-item Patient Accountability Tool (PAcT) serves as a precedent to adherence.

Objective: 1) To compare the priming question with ARMS and 2) To examine the associations between a) priming question and PAcT b) ARMS and PAcT.

Methods: Surveys were administered from February 22-25, 2021 to a Qualtrics panel of 525 participants at least 18 years of age and taking at least one chronic medication. Data analyses included psychometric analyses of ARMS and PAcT, tests for correlation, and model regression.

Results: Cronbach’s alpha showed excellent reliability for ARMS (0.925) and good reliability for PAcT (0.895). Validation of PAcT using factor analysis revealed that Communication (C) and Awareness (A) domains loaded as hypothesized. Belief (B) and Self-Efficacy (S) merged into one component. Two items were removed due to poor loading and fit. Correlations were significant between A, B, C, and S. Path analysis using regression showed that B and C significantly explained S (adjR²=0.493), which in turn predicted accountability (adjR²=0.429). The priming question separated NonAdherent (122) from Adherent (403) respondents, as did the ARMS, NonAdherent (52) vs Adherent (473). T-test indicated PAcT scores were significantly different (25.74, 23.94, p<0.01) using priming question but not using ARMS (24.13, 24.37, p=0.788). The priming question was significantly associated with PAcT (eta=0.345) and with ARMS (p<0.01). Only the priming question was able to distinguish between high and low accountability individuals.

Conclusion: PAcT demonstrated good reliability and validity. ARMS and priming question were not similar in determining adherent individuals, and thus one tool cannot be used in place of the other. The priming question is a valid tool in distinguishing adherence as well as accountability.