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Fulltext The Malaysian Medication Adherence Scale (MALMAS): concurrent validity using a clinical measure among people with type 2 diabetes in Malaysia

Chung WW, Chua SS, Lai PS, Morisky DE

PLoS One, 2015;10(4):e0124275.
PMID: 25909363 DOI: 10.1371/journal.pone.0124275

Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C). Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565) and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412). The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715). Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032). The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37) of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.
Fulltext Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients

Ashur ST, Shamsuddin K, Shah SA, Bosseri S, Morisky DE

East Mediterr Health J, 2015 Dec 13;21(10):722-8.
PMID: 26750162 DOI: 10.26719/2015.21.10.722

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.
Fulltext Effect of self-administration of medication programme on cardiovascular inpatients' medication adherence and nurses' satisfaction: A randomized clinical trial

Hajialibeigloo R, Mazlum SR, Mohajer S, Morisky DE

Nurs Open, 2021 Jul;8(4):1947-1957.
PMID: 33811803 DOI: 10.1002/nop2.870

AIM: To investigate the effect of self-administration of medication programme on medication adherence in cardiovascular inpatients and nurse's satisfaction.
DESIGN: Randomized clinical trial with parallel-group design guided by the CONSORT checklist.
METHODS: In this study, sixty cardiovascular inpatients were selected through convenience sampling and then randomly assigned to control and intervention groups, in 2018, Iran. The intervention group took responsibility for consuming their prescribed medication according to the self-administration of medication programme and the control group took medications routinely. Medication adherence was measured one and two weeks after the discharge via telephonic follow-up by Morisky Medication Adherence Scale MMAS-8-item and nurses' satisfaction by researcher-made questioner.
RESULT: There was a higher medication adherence level in the intervention group rather than the usual care group at the follow-up. Most nurses in the study environment were very satisfied.
CONCLUSION: The self-administration of medication programme can effectively increase patients' medication adherence and nurses' satisfaction.
Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli

Ashur ST, Shah SA, Bosseri S, Morisky DE, Shamsuddin K

Libyan J Med, 2015 Jan;10(1):29797.
PMID: 28349791 DOI: 10.3402/ljm.v10.29797

Background The surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence. Methods A cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale. Results The respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044), high diabetes identity perception (p=0.008), being male (p=0.026), and employed (p=0.008). Conclusion Diabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.
Fulltext The eight-item Morisky Medication Adherence Scale MMAS: translation and validation of the Malaysian version

Al-Qazaz HKh, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE

Diabetes Res Clin Pract, 2010 Nov;90(2):216-21.
PMID: 20832888 DOI: 10.1016/j.diabres.2010.08.012

AIMS:
To translate and examine the psychometric properties of the Malaysian version of the Morisky Medication Adherence Scale (MMAS) among patients with type 2 diabetes.

METHODS:
A standard "forward-backward" procedure was used to translate MMAS into Malay language. It was later validated on a convenience sample of 223 type 2 diabetes outpatients between May and September 2009. Reliability was tested for internal consistency. Validity was confirmed using convergent and known group validity.

RESULTS:
Employing the recommended scoring method, the mean±SD of MMAS scores was 6.13±1.72. Moderate internal consistency was found (Cronbach's α=0.675), the test-retest reliability value was 0.816 (p<0.001). A positive correlation between the eight- and four-item MMAS was found (r=0.792; p<0.01). A significant relationship between MMAS categories and HbA1c categories (χ(2)=20.261; p≥0.001) was found. The MMAS sensitivity and specificity, with positive and negative predictive values were 77.61%, 45.37%, 46.84% and 76.56%, respectively.

CONCLUSIONS:
The findings of this validation study indicate that the Malaysian version of the MMAS is a reliable and valid measure of medication adherence which can now be used.
Health-related quality of life associated with treatment adherence in patients with hypertension: a cross-sectional study

Zyoud SH, Al-Jabi SW, Sweileh WM, Wildali AH, Saleem HM, Aysa HA, et al.

Int J Cardiol, 2013 Oct 3;168(3):2981-3.
PMID: 23647601 DOI: 10.1016/j.ijcard.2013.04.105
Fulltext Effectiveness and sustainability of a structured group-based educational program (MEDIHEALTH) in improving medication adherence among Malay patients with underlying type 2 diabetes mellitus in Sarawak State of Malaysia: study protocol of a randomized controlled trial

Ting CY, Ahmad Zaidi Adruce S, Hassali MA, Ting H, Lim CJ, Ting RS, et al.

Trials, 2018 Jun 05;19(1):310.
PMID: 29871651 DOI: 10.1186/s13063-018-2649-9

BACKGROUND: Amidst the high disease burden, non-adherence to medications among patients with type 2 diabetes mellitus (T2DM) has been reported to be common and devastating. Sarawak Pharmaceutical Services Division has formulated a pharmacist-led, multiple-theoretical-grounding, culturally sensitive and structured group-based program, namely "Know Your Medicine - Take if for Health" (MEDIHEALTH), to improve medication adherence among Malay patients with T2DM. However, to date, little is known about the effectiveness and sustainability of the Program.
METHODS/DESIGN: This is a prospective, parallel-design, two-treatment-group randomized controlled trial to evaluate the effectiveness and sustainability of MEDIHEALTH in improving medication adherence. Malay patients who have underlying T2DM, who obtain medication therapy at Petra Jaya Health Clinic and Kota Samarahan Health Clinic, and who have a moderate to low adherence level (8-item Morisky Medication Adherence Scale, Malaysian specific, score <6) were randomly assigned to the treatment group (MEDIHEALTH) or the control group. The primary outcome of this study is medication adherence level at baseline and 1, 3, 6 and 12 months post-intervention. The secondary outcomes are attitude, subjective norms, perceived behavioural control, intention and knowledge related to medication adherence measured at baseline and 1, 6 and 12 months post-intervention. The effectiveness and sustainability of the Program will be triangulated by findings from semi-structured interviews with five selected participants conducted 1 month after the intervention and in-depth interviews with two main facilitators and two managerial officers in charge of the Program 12 months after the intervention. Statistical analyses of quantitative data were conducted using SPSS version 22 and Stata version 14. Thematic analysis for qualitative data were conducted with the assistance of ATLAS.ti 8.
DISCUSSION: This study provides evidence on the effectiveness and sustainability of a structured group-based educational program that employs multiple theoretical grounding and a culturally sensitive approach in promoting medication adherence among Malays with underlying T2DM. Both the quantitative and qualitative findings of this study could assist in the future development of the Program.
TRIAL REGISTRATION: National Medical Research Register, NMRR-17-925-35875 (IIR). Registered on 19 May 2017. ClinicalTrials.gov, NCT03228706 . Registered on 25 July 2017.