Transcultural Validation of the Indonesian Version of the Adherence Barriers Questionnaire Intravitreal Injection (ABQ-IVT) in Neovascular Age-related Macular Degeneration (nAMD)
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Sep 22, 2026
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Abstract
Introduction: Neovascular age-related macular degeneration (nAMD) is the leading cause of visual impairment and blindness worldwide. Intravitreal therapy (IVT) with anti-vascular endothelial growth factor (anti-VEGF) is the primary treatment option. However, there remains a substantial gap in visual acuity outcomes between clinical trial and real-world practice, with approximately 90% and 50%, respectively. Patient adherence with IVT influences treatment success; therefore, identifying the treatment burden is an important aspect. This study aimed to undertake the transcultural adaptation, validity, and reliability of the Indonesian version of the ABQ-IVT as an instrument to assess the treatment burden.
Methods: A cross-sectional study was conducted involving patients with nAMD who have received at least three routine anti-VEGF IVT treatments and were fluent in Indonesian language. The ABQ-IVT underwent a systematic validity and reliability process.
Results: The Indonesian version of the ABQ-IVT consisted of 17 items with content validity test showed an Individual-Content Validity Index (I-CVI) of 1.0, while construct validity testing produced correlation values (r) between 0.333 and 0.739 (r-calculated > r-table), indicating good result. The reliability test showed a Cronbach’s alpha value of 0.725, indicating good consistency across the items.
Conclusion: The Indonesian of the ABQ-IVT was proven to be a valid and reliable instrument for assessing the treatment burden among nAMD patients.
Keywords
Age-related macular degeneration, ABQ-IVT, validity test, reliability test
Article Details
How to Cite
PRISCILIA, Florentina et al.
Transcultural Validation of the Indonesian Version of the Adherence Barriers Questionnaire Intravitreal Injection (ABQ-IVT) in Neovascular Age-related Macular Degeneration (nAMD).
International Journal of Retina, [S.l.], v. 9, n. 2, p. 25-32, sep. 2026.
ISSN 2614-8536.
Available at: <https://www.ijretina.com/index.php/ijretina/article/view/347>. Date accessed: 23 sep. 2026.
doi: https://doi.org/10.35479/ijretina.2026.vol009.iss002.347.
Section
Research Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
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2. Wong WL, Su X, Li X, Cheung CMG, Klein R, Cheng CY, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: A systematic review and meta-analysis. Lancet Glob Health. 2014. Vol 2(2) : 106-16. doi: 10.1016/S2214-109X(13)70145-1.
3. Pambudy, Indra Maharddhika. Evaluasi Injeksi Bevacizumab Intravitreal pada Wet Age- Related Macular Degeneration di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. [Jakarta]: Universitas Indonesia; 2018.
4. Leonedine Z, Viona T. Arus Victor A, Djatikusumo A, Andayani G, Rama Yudanta A, et al. Clinical Characteritics and Management of Wet Age-Related Macular Degeneration at Cipto Mangunkusumo Hospital Kirana, Jakarta, Indonesia. Internatioal. IJRETINA. 2024. Vol 7(2):119. DOI: https://doi.org/10.35479/ijretina.2024.vol007.iss002.291
5. Medeiros, S. Mukamal, R. New treatments for Age-Related Macular Degeneration. American Academy of Ophthalmology. 2024.
6. Vinge E, Bro T. Treatment burden on patients receiving intravitreal anti-VEGF for wet age-related macular degeneration. Acta Ophthalmol. 2024. Vol 102(4):478–82. doi: 10.1111/aos.15783.
7. Shellvarajah M, Barthelmes D, Nguyen V, Steinmann S, Gillies MC, Sagkriotis A. Adherence to Anti-VEGF Treatment in Patients with Neovascular Age-Related Macular Degeneration: A Real-World Study. Ophthalmol Ther. 2025. Vol 14(6):1261–1269. doi: 10.1007/s40123-025-01140-z.
8. Müller S, Junker S, Wilke T, Lommatzsch A, Schuster AK, Kaymak H, et al. Questionnaire for the assessment of adherence barriers of intravitreal therapy: the ABQ-IVT. Int J Retina Vitreous. 2021. Vol 7(1) : 43. doi: 10.1186/s40942-021-00311-x.
9. Müller S, Kohlmann T, Wilke T. Validation of the Adherence Barriers Questionnaire - An instrument for identifying potential risk factors associated with medication-related non-adherence Quality, performance, safety and outcomes. BMC Health Serv Res. 2015. Vol 5(1) : 153. doi: 10.1186/s12913-015-0809-0.
10. Ranganathan P, Caduff C, Frampton CMA. Designing and validating a research questionnaire - Part 2. Perspect Clin Res. 2024. Vol 15(1):42–5. doi: 10.4103/picr.picr_318_23.
11. Ranganathan P, Caduff C. Designing and validating a research questionnaire - Part 1. Perspect Clin Res. 2023. Vol 14(3):152–5. doi: 10.4103/picr.picr_140_23
12. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000. Vol 25(24):3186-91. doi: 10.1097/00007632-200012150-00014. PMID: 11124735
13. Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi Journal of Anaesthesia. Medknow Publications; 2017.Vol 11 :. 80–9. doi: 10.4103/sja.SJA_203_17. PMID: 28616007
14. Fakultas Ekonomi H. Validitas isi: Tahap Awal Pengembangan Kuesioner. Vol. 2, Jurnal Riset Manajemen dan Bisnis (JRMB) Fakultas Ekonomi UNIAT. 2017.
15. Dillman DA, Smyth Leah Melarii Christian JD. CrÃtica de libros Internet Mail and Mixed-Mode Surveys: The Tailored Design Method. Lepkowski; Revista Española de Investigaciones Sociológicas, 2011, Vol 133 : 81-85 doi : doi.org/10.1002/9781394260645
16. Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye and Vision. 2015. Vol 2(1):1–25. doi: 10.1186/s40662-015-0026-2
17. Okada M, Mitchell P, Finger RP, Eldem B, Talks SJ, Hirst C, et al. Nonadherence or Nonpersistence to Intravitreal Injection Therapy for Neovascular Age-Related Macular Degeneration: A Mixed-Methods Systematic Review. Ophthalmology. Elsevier Inc.; 2021. Vol 128: 234–47. doi: 10.1016/j.ophtha.2020.07.060.
18. Vasilijević JB, KovaÄević IM, Bukumirić ZM, Marić GD, SlijepÄević NA, Pekmezović TD. Vision-Related Quality of Life and Treatment Satisfaction Following Panretinal Photocoagulation in Diabetic Retinopathy—A Panel Study. Medicina (Lithuania). 2022 Vol 58 (12) : 1741. doi: 10.3390/medicina58121741.
19. Martin DF. Evolution of Intravitreal Therapy for Retinal Diseases—From CMV to CNV: The LXXIV Edward Jackson Memorial Lecture. Am J Ophthalmol. 2018. Vol 191: xli–lviii. doi: 10.1016/j.ajo.2017.12.019.
20. S. Davoudi et al., "Socioeconomic Disparities in Patients Receiving Intravitreal Injections for Age-Related Macular Degeneration Amid the COVID-19 Pandemic," Journal of vitreoretinal diseases, 2023, doi: 10.1177/24741264231173771.
21. Polat O, İnan S, Özcan S, Doğan M, Küsbeci T, Yavaş GF, et al. Factors affecting compliance to intravitreal anti-vascular endothelial growth factor therapy in patients with age-related macular degeneration. Turk Oftalmoloiji Dergisi. 2017. Vol 47(4):205–10. doi: 10.4274/tjo.28003.
22. Hamed Taherdoost A, Lumpur K. Validity and Reliability of the Research Instrument; How to Test the Validation of a Questionnaire/Survey in a Research. International Journal of Academic Research in Management (IJARM). 2016. Vol 5.
23. Chi YC, Hsieh HM, Müller S, Sheu SJ. Chinese translation validation of the adherence barrier questionnaire (intravitreal anti-vascular endothelial growth factor therapy) in Taiwan. Kaohsiung Journal of Medical Sciences. John Wiley and Sons Inc. 2024. Vol 40(12) : 1121-1122. doi: 10.1002/kjm2.12905.
24. Mitchell J, Bradley C. Design and development of the MacTSQ measure of satisfaction with treatment for macular conditions used within the IVAN trial. J Patient Rep Outcomes. 2018. Vol 2 (1) : 5. doi: 10.1186/s41687-018-0031-z.
25. Ehlken C, Helms M, Böhringer D, Agostini HT, Stahl A. Association of treatment adherence with real-life VA outcomes in AMD, DME, and BRVO patients. Clinical Ophthalmology. 2018. Vol 12:13–20. doi: 10.2147/OPTH.S151611.