Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8

Sun Jae Moon, Weon-Young Lee, Jin Seub Hwang, Yeon Pyo Hong, Donald E Morisky, Sun Jae Moon, Weon-Young Lee, Jin Seub Hwang, Yeon Pyo Hong, Donald E Morisky

Abstract

Background: This systematic review examined the reliability and validity of the Morisky Medication Adherence Scale-8 (MMAS-8), which has been widely used to assess patient medication adherence in clinical research and medical practice.

Methods: Of 418 studies identified through searching 4 electronic databases, we finally analyzed 28 studies meeting the selection criteria of this study regarding the reliability and validity of MMAS-8 including sensitivity and specificity. Meta-analysis for Cronbach's α, intraclass correlation coefficient (ICC), sensitivity and specificity to detect a patient with nonadherence to medication were performed. The pooled estimates for Cronbach's α and ICC were calculated using the random-effects weighted T transformation. A bivariate random-effects model was used to estimate pooled sensitivity and specificity.

Findings: The pooled Cronbach's α estimate for type 2 diabetes group in 7 studies and osteoporosis group in 3 studies were 0.67 (95% Confidence Interval(CI), 0.65 to 0.69) and 0.77 (95% CI, 0.72 to 0.83), respectively. With regard to test-retest, the pooled ICC for type 2 diabetes group in 3 studies and osteoporosis group in 2 studies were 0.81 (95% CI, 0.75 to 0.85) and 0.80 (95% CI, 0.74 to 0.85). For a cut-off value of 6, the pooled sensitivity and specificity in 12 studies were 0.43 (95% CI, 0.33 to 0.53) and 0.73 (95% CI, 0.68 to 0.78), respectively.

Conclusions: The MMAS-8 had acceptable internal consistency and reproducibility in a few diseases like type 2 diabetes. Using the cut-off value of 6, criterion validity was not enough good to validly screen a patient with nonadherence to medication. However, this study did not calculated a pooled estimate for criterion validity using the higher values than 6 as a cut-off value since most of included individual studies did not report criterion validity based on those values.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart of evidence selection.
Fig 1. Flow chart of evidence selection.
Fig 2. Assessment of methodological quality by…
Fig 2. Assessment of methodological quality by QUADAS-2.
Fig 3. Subgroup analysis of Cronbach's α…
Fig 3. Subgroup analysis of Cronbach's α by disease.
Fig 4. Subgroup analysis of ICC by…
Fig 4. Subgroup analysis of ICC by disease.
Fig 5. SROC plots of sensitivity and…
Fig 5. SROC plots of sensitivity and specificity based on cut-off of 6 using bivariate model.
Fig 6. SROC plots of sensitivity and…
Fig 6. SROC plots of sensitivity and specificity based on cut-off of 6 using bivariate model in the subgroup of hypertension and Type2DM.

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