# Usability, reliability, and validity of the Arabic version of the ASK-20 questionnaire in Arab adults

## TL;DR

This study validates an Arabic version of the ASK-20 questionnaire to assess medication adherence barriers in Arab adults.

## Contribution

The study provides a culturally adapted and validated Arabic version of the ASK-20 questionnaire.

## Key findings

- The Arabic ASK-20 showed acceptable internal consistency with a Cronbach’s alpha of 0.751.
- Cost-related issues and medication availability were the most significant adherence barriers identified.
- The ASK-20 and TBC scores effectively differentiated between good and poor adherence groups.

## Abstract

Medication adherence is crucial for optimal therapeutic outcomes, yet it remains a significant challenge globally, including in Arabic-speaking populations. Existing tools like the “Adherence Starts with Knowledge 20” (ASK-20) questionnaire assess adherence barriers but lack a validated Arabic version. To address this gap, this study evaluated the usability, reliability, and validity of the Arabic ASK-20 questionnaire among Arab adults.

A cross-sectional study was conducted with 130 Arabic-speaking adults aged 18 years or older. The ASK-20 questionnaire was translated and culturally adapted using a rigorous linguistic validation process, including forward translation, expert review, and back-translation. Data were collected from November to December 2024. Internal consistency was assessed using Cronbach’s alpha, while floor and ceiling effects evaluated response biases. Statistical analyses included descriptive and inferential statistics, with significance set at p < 0.05.

The study sample comprised 69.2% males and 30.8% females, with a mean age of 36.6 years. The Arabic ASK-20 demonstrated acceptable internal consistency (Cronbach’s alpha = 0.751). Key adherence barriers identified included cost-related issues (76.9% ceiling effect) and medication availability (74.6% ceiling effect). The ASK-20 and Total Barrier Count (TBC) scores effectively differentiated between adherence levels, with lower scores observed in the “Good-1” adherence group compared to the “Poor-1” group.

The Arabic ASK-20 is a reliable and valid tool for identifying medication adherence barriers in Arab adults. By systematically assessing barriers such as cost, availability, and knowledge gaps, the tool equips healthcare providers to design targeted, patient-centered interventions. These findings highlight the potential of the Arabic ASK-20 to improve chronic disease management, enhance patient outcomes, and inform public health strategies within Arabic-speaking communities.