2.3. Screening study and data collection
Screening followed a two-phase strategy to gather data on medication
adherence. First, patients were asked to self-complete a questionnaire
designed by the research team. This survey consisted of the Morisky
Medication- Taking Adherence Scale (MMAS-4)34 and
questions regarding demographic and identification data including age,
ID number, sex, education level, place of residence (rural or urban),
and body mass index. MMAS-4 license was obtained. Instructions on its
filling were provided by a trained medical undergraduate. After
questionnaire completion, a directed interview was conducted by the
cardiology attending physician or resident of the institution in the
office during the medical consultation to discern reasons for
nonadherence. New York Heart Association (NYHA) Functional
Classification was also determined at this point. Once the interview was
completed, electronic medical records were reviewed to complete
information on reperfusion therapy, the number of emergency visits and
major cardiovascular events (MACE) in the last two years, along with the
most recent laboratory findings including hemoglobin, creatinine, total
cholesterol, triglycerides, and HbA1c levels.
Patients were randomly selected prior to appointments from the attending
physician’s agenda to address potential bias. Electronic medical records
were reviewed afterward to validate inclusion criteria fulfillment.
All data were recorded in predesigned files for data management and
analysis by a research team member. Databases were encrypted in
password-protected files, limiting their access to research staff only.