Limitations and Issues in Study
The generalizability of findings might be limited
since the participants were recruited with some inclusion
criteria such as in a stable condition, taking oral medication
and not having comorbid diseases. Additionally, even
though the ICC of the instruments in this study revealed
good reliability, these had low internal consistency
especially the PKRMQ.
Regarding participants’ cognition and cooperation
in recording, during telephone follow up, when their goal
and action plan from the previous week was evaluated,
most participants stated that they would remain on
implementing same goal and action plan. There was
no change in the goals set or the participants’ confidence
level from the previous week. This needs to be
considered in future studies since PWS’ thinking may
have limitations of cognition, such as dysfunctions
in attention, learning and memory. Secondly, the
mean pre-test medication adherence behavior in the
experimental group and the control group was quite
high (30.08 and 31.88, respectively) out from 40.
There were some reasons related to this result. Firstly,
the measurement used was a self-report questionnaire,
which has been criticized to measure medication
adherence since adherence is an observable behavior
and a can be measured using more objective means.34
Moreover, timing of measurement of medication
adherence behaviors was not tested in the long term
condition, and further research using a longitudinal
study will assist in knowing the sustainability and long
term consequences of the medication adherence behavior