Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain

Pablo Martinez-Perez, Domingo Orozco-Beltrán, Francisco Pomares-Gomez, Juan L Hernández-Rizo, Anna Borras-Gallen, Vicente F Gil-Guillen, Jose A Quesada, Adriana Lopez-Pineda, Concepción Carratala-Munuera, Pablo Martinez-Perez, Domingo Orozco-Beltrán, Francisco Pomares-Gomez, Juan L Hernández-Rizo, Anna Borras-Gallen, Vicente F Gil-Guillen, Jose A Quesada, Adriana Lopez-Pineda, Concepción Carratala-Munuera

Abstract

Aims: To validate a translated and culturally adapted version of the Morisky Medication Adherence Scale for use in Spanish population, and to examine the psychometric properties of this scale in patients with type 2 diabetes mellitus in Spain.

Design: This cross-sectional study was conducted in a single university hospital in Spain. Patients diagnosed with type 2 diabetes mellitus at least 1 year before inclusion, being treated with anti-diabetic medication were included.

Intervention: We used the Spanish version of the scale to measure treatment adherence.

Principal measurements: three level categorical scale is broken down into low adherence (score of <6), medium adherence (score of 6 to <8) and high adherence (score of 8). To validate the questionnaire, we measured internal consistency through Cronbach's α, confirmed construct validity through an exploratory principal component analysis and assessed test-retest reliability.

Results: 232 patients met the inclusion criteria. The Cronbach's α coefficient was 0.40 (95% CI 0.28-0.52). The exploratory principal component analysis showed three components. The intraclass correlation coefficient was 0.718 (95% CI 0.564-0.823).

Conclusions: the Spanish version of the Morisky Medication Adherence scale showed low internal consistency, the exploratory factor analysis identified three dimensions, and the test-retest reliability was acceptable, therefore, psychometric properties of MMAS-8 are not suitable for measuring medication adherence in type 2 diabetes mellitus patients from Spain.

Keywords: Adaptación transcultural; Adherencia terapéutica; Cross-cultural adaptation; Diabetes; Encuestas y cuestionarios; Medication adherence; Surveys and questionnaires; Validación; Validation.

Copyright © 2020 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.

Figures

Figure 1
Figure 1
A cross-sectional study to validate a Spanish version of the MMAS-8 in patients with type 2 diabetes mellitus. T2DM: type 2 diabetes mellitus; PC: principal component; ICC: intraclass correlation coefficient.

References

    1. World Health Organisation. World Diabetes Report 2016. Geneva: World Health Organisation. Available from: [accessed 6.07.17].
    1. Soriguer F., Goday A., Bosch-Comas A., Bordiú E., Calle-Pascual A., Carmena R. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study. Diabetologia. 2012;55:88–93.
    1. World Health Organization (WHO). Adherence to long-term therapies. Evidence for action. Geneva, World Health Oranization; 2003. Available from: [accessed 9.07.17].
    1. Harries A.D., Satyanarayana S., Kumar A.M.V., Nagaraja S.B., Isaakidis P., Malhotra S. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. Public Health Action. 2013;3(Suppl. 1):S3–S9.
    1. Krass I., Schieback P., Dhippayom T. Adherence to diabetes medication: a systematic review. Diabetes Med. 2015;32:725–737.
    1. DiMatteo M.R., Giordani P.J., Lepper H.S., Croghan T.W. Patient adherence and medical treatment outcomes: a metaanalysis. Med Care. 2002;40:794–811.
    1. Global status report on non-communicable disease 2010. Geneva: World Health Organisation; 2010. Available from: [accessed 11.07.17].
    1. Al-Haj Mohd M., Phung H., Sun J., Morisky D.E. The predictors to medication adherence among adults with diabetes in the United Arab Emirates. J Diabetes Metab Disord. 2016;15:30.
    1. Sapkota S., Brien J.A., Greenfield J., Aslani P. A systematic review of interventions addressing adherence to anti-diabetic medications in patients with type 2 diabetes—impact on adherence. PLOS ONE. 2015;10 e0118296.
    1. Vignon Zomahoun H.T., de Bruin M., Guillaumie L., Moisan J., Grégoire J.P., Pérez N. Effectiveness and content analysis of interventions to enhance oral antidiabetic drug adherence in adults with type 2 diabetes: systematic review and meta-analysis. Value Health. 2015;18:530–540.
    1. Antoine S.L., Pieper D., Mathes T., Eikermann M. Improving the adherence of type 2 diabetes mellitus patients with pharmacy care: a systematic review of randomized controlled trials. BMC Endocr Disord. 2014;14:53.
    1. Stewart K., Mc Namara K.P., George J. Challenges in measuring medication adherence: experiences from a controlled trial. Int J Clin Pharm. 2014;36:15–19.
    1. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measurement of medication adherence and long-term predictive validity of blood pressure control. Med Care. 1986;24:67–74.
    1. Morisky D.E., Ang A., Krousel-Wood M., Ward H.J. Predictive validity of a medication adherence measure for hypertension control. J Clin Hypertens. 2008;10:348–354.
    1. Morisky D.E., DiMatteo M.R. Improving the measurement of self-reported medication nonadherence: final response. J Clin Epidem. 2011;64:258–263.
    1. Al-Qazaz H.K.H., Hassali M.A., Shafie A.A., Sulaiman S.A., Sundram S., Morisky D.E. The eight-item Morisky Medication Adherence Scale MMAS: translation and validation of the Malaysian version. Diabetes Res Clin Pract. 2010;90:216–221.
    1. Tandon S., Chew M., Eklu-Gadegbeku C.K., Shermock K.M., Morisky D.E. Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Type 2 diabetes patients in sub-Saharan Africa. Diabetes Res Clin Pract. 2015;110:129–136.
    1. Lee W.Y., Ahn J., Kim J.H., Hong Y.P., Hong S.K., Kim Y.T. Reliability and validity of a self-reported measure of medication adherence in patients with type 2 diabetes mellitus in Korea. J Int Med Res. 2013;41:1098–1110.
    1. Ashur S.T., Shamsuddin K., Shah S.A., Bosseri S., Morisky D.E. Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients. East Mediterr Health J. 2015;21:722–728.
    1. Lomax R.G., Schumaker R.E. Routledge Academic; New York, NY: 2012. A beginner's guide to structural equation modeling; pp. 33–53.
    1. Costello A.B., Osborne J.W. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval. 2005;10:1–9.
    1. Moharamzad Y., Saadat H., Nakhjavan Shahraki B., Rai A., Saadat Z., Aerab-Sheibani H. Validation of the Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Iranian hypertensive patients. Glob J Health Sci. 2015;7:173–183.
    1. Parsian N, Dunning T. Developing and validating a questionnaire to measure spirituality: a psychometric process. Glob J Health Sci. 2009;1:69–75.
    1. Tavakol M., Dennick R. Making sense of Cronbach's alpha. Int J Med Edu. 2011;2:53–55.
    1. de Oliveira-Filho A.D., Morisky D.E., Neves S.J., Costa F.A., de Lyra D.P. The 8-item Morisky Medication Adherence Scale: validation of a Brazilian-Portuguese version in hypertensive adults. Res Social Adm Pharm. 2014;10:554–561.
    1. Okello S, Nasasira B, Muiru ANW, Muyingo A. Validity and Reliability of a Self-Reported Measure of Antihypertensive Medication Adherence in Uganda. [published correction appears in PLoS One 2017 Oct 31;12(10):e0187620]. PLoS One 2016;11:e0158499.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren