Methods: A multi-center cross sectional study was conducted for a month in out-patient wards of hospitals in Khobar, Dammam, Makkah, and Madinah, Saudi Arabia. Patients were randomly selected from a registered patient pools at hospitals and the item-subject ratio was kept at 1:20. The tool was assessed for factorial, construct, convergent, known group and predictive validities as well as, reliability and internal consistency of scale were also evaluated. Sensitivity, specificity, and accuracy were also evaluated. Data were analyzed using SPSS v24 and MedCalc v19.2. The study was approved by concerned ethics committees (IRB-129-25/6/1439) and (IRB-2019-05-002).

Results: A total of 282 responses were received. The values for normed fit index (NFI), comparative fit index (CFI), Tucker Lewis index (TLI) and incremental fit index (IFI) were 0.960, 0.979, 0.954 and 0.980. All values were >0.95. The value for root mean square error of approximation (RMSEA) was 0.059, i.e., <0.06. Hence, factorial validity was established. The average factor loading of the scale was 0.725, i.e., >0.7, that established convergent validity. Known group validity was established by obtaining significant p-value <0.05, for the associations based on hypotheses. Cronbach's α was 0.865, i.e., >0.7. Predictive validity was established by evaluating odds ratios (OR) of demographic factors with adherence score using logistic regression. Sensitivity was 78.16%, specificity was 76.85% and, accuracy of the tool was 77.66%, i.e., >70%.

Methods: A 3-month cross-sectional study was conducted among patients with T2DM at Al-Daraja Health Center, located in Wad Medani, Sudan. A convenient sample of patients was selected, and the study sample size was calculated using the item response ratio. Factorial, known group, and construct validities were determined. Internal consistency and reliability were also determined.

Results: Responses were provided by 500 patients. The average medication adherence score was 30 (median 31). The normed fit index (NFI) was 0.950, the comparative fit index (CFI) was 0.963, the incremental fit index (IFI) was 0.963, and the root-mean-square error of approximation (RMSEA) was 0.071. The results from these fit indices indicated a good model. Factorial, known group and construct validities were all established. A significant association was found between adherence score and age (P = 0.03) since a larger proportion of older patients were found to have high adherence compared to patients in other age groups. The reliability (α) of the questionnaire was 0.834.