About ASK-12

• ASK-12 was developed to increase effectiveness of the intervention by quickly identifying the most prevalent factors that influence medication adherence.
• ASK-12 contains the questions most often identified as barriers by patients taking the ASK-20.
• Three domains – Inconvenience/forgetfulness, Treatment beliefs, Behavior – may help streamline decision-making by the healthcare provider for quick conversation-building around medication adherence.

Derivation of the ASK-12

• This survey was derived from the ASK-20 using a study population of 112 patients with either asthma or diabetes.
• Items were extracted using exploratory factor analysis.¹
  • Analysis identified 3 subscales highlighting behavior, treatment beliefs, and inconvenience/forgetfulness.
  • Subscales allow for separate assessment of adherence-related behavior and barriers.

Items that were dropped from ASK-20 include²:

• My alcohol use gets in the way of taking my medicines.
• I sometimes forget things that are important to me.
• I have felt sad, down, or blue during the past month.
• I understand my doctor's/nurse's instructions about the medicines I take.
• I am able to read and understand pill bottle labels.
• I worry about how medicine will affect my sexual health.
• I have to take too many medicines a day.
• It is hard for me to swallow the pills I have to take.

These items may still be useful when studying a more defined population based on criteria such as disease condition, specific ethnicity, or age-group.

Reliability and Concurrent Validity³:

• ASK-12 total score demonstrated adequate internal consistency reliability with a Cronbach’s alpha of 0.75.
• The ASK-12 demonstrated correlations with self-report measures and objective measures.
• I have felt sad, down, or blue during the past month.
  • The 12-item scale demonstrated a strong correlation between ASK-12 total score and the Morisky Adherence Survey (-0.74).
  • The ASK-12 total score was significantly correlated with the proportion of days covered as indicated by insurance claims (r=-0.21; P<0.05).

ASK-12 Score

• There are two ways to interpret ASK-12. A score assists in the overall evaluation and interpretation when using the survey as a pre-/post-measure in a study.
• Score can range from 12-60, with higher score representing greater barriers to adherence.
• As with ASK-20, the barriers total count (average number of barriers identified) can be used as a pre-/post-measure.
• In a clinical setting it is not necessary to score the instrument, only review the items in the dark blue boxes and begin a conversation about taking medicines.

Summary

• The ASK-12 is a convenient, brief measure that can be used to identify potential barriers to adherence that may limit treatment effectiveness.¹

References:

1. Data on file, GlaxoSmithKline.
2. Hahn SR, Park J, Skinner EP, et al. Development of ASK-20 adherence barrier survey. Curr Med Res Opin. 2008; 24(7): 2127-2138.
3. Matza L, Coyne K, Park J, et al. Validation of the ASK-12 Survey Assessing Barriers to Medication Adherence. 2008 International Society for Quality of Life Research. Poster presented at 2008 International Society for Quality of Life Research Meeting; October 22-25, 2008; Montevideo, Uruguay.