Optimising the validity and completion of adherence diaries: a multiple case study and randomised crossover trial

Rachael Frost, Doreen McClurg, Marian Brady, Brian Williams

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Diaries are the most commonly used adherence measurement method in home-based rehabilitation trials, yet their completion and validity varies widely between trials. We aimed to: (1) generate theory to explain this variation, (2) create an optimised diary and (3) evaluate the optimised diary’s validity.

Stage 1. Development: using a multiple case study approach, we collected trialist interviews (n¿=¿7), trial publications (n¿=¿16) and diaries (n¿=¿7) from seven purposively sampled UK rehabilitation trials. We explored return rates, diary designs and trialists’ ideas as to what affected diary completion and validity. Using explanatory case study analysis, we developed a diary optimisation model. Stage 2. Evaluation: we compared a diary optimised according to several model components to one nonoptimised according to the same components in a randomised AB/BA crossover trial. Healthy adults aged 60+ years without mobility impairments undertook a home-based 8-week walking programme. They recorded walking duration and frequency for 4 weeks per diary. We hypothesised that the optimised diary would possess greater validity for self-reported adherence to walking duration (criterion: the Activpal accelerometer), assessed during each diary’s final week. Participants were blinded to the hypothesis. Secondary outcomes included test-retest reliability and acceptability. Ethical approval was granted from Glasgow Caledonian University.
Original languageEnglish
Issue number489
Early online date10 Oct 2016
Publication statusPublished - 2016


  • adherence diaries
  • crossover trial


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