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

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.

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“…Adherence to treatment was assessed at 3 and 6 months since treatment initiation based on the 8-item Morisky Medication Adherence Scale (MMAS-8) [ 15 – 19 ], which has been elsewhere used primarily in chronic diseases, e.g. type II diabetes [ 20 ], hypertension [ 21 ], etc. This self-reported scale contains 7 items answered with a yes or no and 1 item with a 5-point Likert scale, with scores ranging from 0 to 8.…”

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“…Quality of life was measured by using the EQ‐5D‐5L Score, 18 and medication adherence to anti‐diabetic drugs was measured using Morisky Medication Adherence Scale. 19,20 . The participants were also asked about their years of education, place of residence (rural, urban and semi‐urban), occupation, monthly household expenditures and any existing chronic diseases.…”

“…Quality of life was measured by using the EQ‐5D‐5L Score, 18 and medication adherence to anti‐diabetic drugs was measured using Morisky Medication Adherence Scale.. 19 , 20 The participants were also asked about their years of education, place of residence (rural, urban and semi‐urban), occupation, monthly household expenditures and any existing chronic diseases. We have defined multi‐morbidity as the co‐occurrence of at least one chronic disease with diabetes in participants 13 and that included the history of any sorts of diagnosed heart diseases, kidney diseases, peripheral vascular diseases, neurological insufficiencies and chronic arthritis for our study participants.…”

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“…Además, se ha comprobado que el médico suele sobreestimar la adherencia de sus pacientes cuando no se mide objetivamente 292 . En la tabla 15 se describen de menor a mayor complejidad, tres métodos para valorar la falta de adherencia: la pregunta de Haynes et al 293 , el cuestionario MMAS-8 de 8 items 294 y el recuento de comprimidos 231 . En el artículo de García Pérez et al 231 se describen todos los métodos.…”