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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Feb 8, 2019
Open Peer Review Period: Feb 11, 2019 - Mar 28, 2019
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The internet intervention Patient Adherence Scale (iiPAS): Development and psychometric evaluation in a clinical sample of children and adolescents

  • Fabian Lenhard; 
  • Kajsa Mitsell; 
  • Maral Jolstedt; 
  • Sarah Vigerland; 
  • Tove Wahlund; 
  • Martina Nord; 
  • Johan Bjureberg; 
  • Hanna Sahlin; 
  • Per Andrén; 
  • Kristina Aspvall; 
  • Karin Melin; 
  • David Mataix-Cols; 
  • Eva Serlachius; 
  • Jens Högström



Patient adherence is defined as the extent to which a patient complies with medical or health advice. Previous results from the psychotherapy field indicate that there are clinically relevant associations between patient adherence and treatment outcomes. However, measures of adherence have not been adapted to modern, internet-delivered formats of psychological interventions.


The objective of this study was to develop and psychometrically evaluate a novel measure, the internet intervention Patient Adherence Scale (iiPAS).


In collaboration with experienced clinicians and researchers in the field, a five item clinician-rated internet intervention Parent Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavior therapy (ICBT). A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various mental health conditions receiving ICBT. The scale was evaluated according to a classical test theory framework.


The iiPAS demonstrated overall excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance. The iiPAS was associated with objective measures of patient activity in ICBT (number of logins, number of written characters, completed modules). Furthermore, the iiPAS demonstrated a significant association with treatment outcome.


This evaluation demonstrated sound psychometric characteristics of the iiPAS in a clinical sample of children and adolescents receiving ICBT. The iiPAS could be a useful measurement tool to capture adherence to to a broad range of internet-delivered behavioural interventions.


Please cite as:

Lenhard F, Mitsell K, Jolstedt M, Vigerland S, Wahlund T, Nord M, Bjureberg J, Sahlin H, Andrén P, Aspvall K, Melin K, Mataix-Cols D, Serlachius E, Högström J

The internet intervention Patient Adherence Scale (iiPAS): Development and psychometric evaluation in a clinical sample of children and adolescents

JMIR Preprints. 08/02/2019:13602

DOI: 10.2196/preprints.13602


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