Internal validity of the research design: Explain the Instrumentation: Medication adherence was the primary outcome for this study. The seven-item version of the Adherence to Refills and Medication Scale (ARMS-7) is a reliable and valid self-report questionnaire of medication adherence with a 4-point response scale (Kripalani et al., 2015). The scale ranges from 1 to 4 per item, but 6/7 items are scored as 1 5 all of the time, and on the last question, 1 5 none of the time, to help correct for agreement bias. Scores on the ARMS-7 range from 7 to 28. The instrument was designed to be flexible, and in this study, higher values indicated better adherence (Kripalani et al., 2009). Pill count identifies how many pills remain in a person's bottle compared with refill timing and the number that should remain (Hawkshead