Hamostaseologie 2020; 40(05): 621-630
DOI: 10.1055/a-1249-4645
Original Article

Evaluation of the U.S. Adherence Questionnaires VERITAS-PRO and VERITAS-PRN for Use in Patients with Hemophilia in the German Healthcare System

Sylvia von Mackensen
1   Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
Yves Douma
2   GZRR – Gerinnungszentrum Rhein-Ruhr, Duisburg, Germany
Susan Halimeh
2   GZRR – Gerinnungszentrum Rhein-Ruhr, Duisburg, Germany
› Author Affiliations


Aim Since the U.S. adherence instruments VERITAS-PRO and VERITAS-PRN were developed in another healthcare system, we assumed that they are not appropriate for the German solidarity healthcare system. This study aims to evaluate the relevance of these instruments for the German healthcare system both by people with hemophilia (PWH) and by healthcare professionals (HCP).

Methods A total of 50 PWH (23 adult hemophilia patients and 27 parents of children with hemophilia) and 25 HCP rated the relevance of the single items of the VERITAS-PRO and VERITAS-PRN on a 5-point Likert scale. In addition, both groups were asked to make suggestions for additional adherence questions. To investigate the relevance of these instruments, the accordance between the raters' evaluations was determined calculating the content validity index (CVI) and the content validity ratio (CVR) based on the critical values of the CVR (CVRcritical) to exclude chance and subjectivity.

Results CVI (CVR) calculations revealed three (5) “very important” items for PWH and six (11) items for HCP. Only two (3) “very important” items were evaluated by both groups. Four domains were considered not important by both groups. Six PWH made 14 suggestions and 14 HCP made 24 suggestions for additional adherence questions.

Conclusion VERITAS-PRO and VERITAS-PRN have only very limited benefits for the German healthcare system. Since nonadherence has a great impact on the morbidity of PWH and on the costs for the healthcare system, there is a need for adherence instruments that are adapted to the specific needs of PWH in the German healthcare system.


Ziel Der Umstand, dass die Adhärenz-Messinstrumente VERITAS-PRO und VERITAS- PRN für das US-amerikanische Gesundheitssystem entwickelt wurden, lässt vermuten, dass sie im solidarisch finanzierten deutschen Gesundheitssystem nur eingeschränkten Nutzen haben. Diese Studie zielt darauf ab, die Relevanz der beiden Instrumente für das deutsche Gesundheitssystem sowohl von Personen mit Hämophilie (PWH) als auch von Angehörigen der Gesundheitsberufe (HCP) evaluieren zu lassen.

Methoden 50 PWH (23 erwachsene Hämophilie-Patienten und 27 Eltern von Kindern mit Hämophilie) und 25 HCP bewerteten die Relevanz der einzelnen VERITAS-PRO und VERITAS-PRN-Items auf einer 5-Punkt-Likert-Skala. Darüber hinaus wurden beide Gruppen gebeten, Vorschläge für zusätzliche Fragen zur Messung von Adhärenz zu machen. Um die Relevanz dieser Instrumente zu bestimmen, wurde die Übereinstimmung zwischen den Expertenurteilen anhand des Inhaltsvaliditäts-Indexes (CVI) und des Inhaltsvaliditäts-Verhältnisses (CVR) basierend auf den kritischen CVR-Werten (CVRcritical) berechnet, um somit Zufall und Subjektivität ausschließen zu können.

Ergebnisse CVI (CVR) Berechnungen ergaben drei (5) „sehr wichtige“ Items für PWH und sechs (11) Items für HCP. Nur zwei (3) Items wurden von beiden Gruppen als „sehr wichtig“ bewertet. Vier Domänen wurden von beiden Gruppen als nicht wichtig erachtet. Sechs PWH machten 14 und vierzehn HCP machten 24 Vorschläge für zusätzliche Adhärenz-Fragen.

Konklusion Im deutschen Gesundheitssystem haben der VERITAS-PRO und der VERITAS-PRN nur sehr eingeschränkten Nutzen. Da Nicht-Adhärenz deutlich negative Effekte sowohl auf die Morbidität der PWH als auch auf die Kostenentwicklung im deutschen Gesundheitssystem hat, gibt es einen Bedarf an Adhärenz-Messinstrumenten, die an die spezifischen Bedürfnisse von PWH im deutschen Gesundheitssystem angepasst sind.

Authors' Contributions

Sylvia von Mackensen (S.v.M.) and Susan Halimeh (S.H.) were involved in the planning of the project. S.v.M. analyzed the data; S.H. was involved in patient recruitment. S.v.M. and Yves Douma (Y.D.) wrote the first draft of the manuscript. S.H. reviewed the results and gave relevant input during the review of the manuscript. All authors revised and agreed upon the final version of the manuscript.

Conflict of Interest

S.v.M. received an unrestricted educational grant from Swedish Orphan Biovitrum Germany to conduct this research. The other authors have nothing to disclose.

Publication History

Received: 01 June 2020

Accepted: 28 August 2020

Article published online:
21 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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