Translation and validation study of Morisky Medication Adherence Scale (MMAS): the Urdu version for facilitating person-centered healthcare in Pakistan

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Fahad Saleem
Mohamed Azmi Hassali
Shafie Akmal
Donald E. Morisky
Muhammad Atif
Harith Kh Al-Qazaz
Imran Masood
Noman ul Haq
Hisham Aljadhey
Maryam Farooqui

Abstract

Objective: The study aims to translate and examine the psychometric properties of the Urdu version of Morisky Medication Adherence Scale (MMAS) among hypertensive patients in Quetta, Pakistan.Method: A standard ‘‘forward–backward’’ procedure of translation was used to translate the English version of MMAS into Urdu. The translated version was than validated on a convenience sample of 150 hypertensive patients attending a public hospital in Quetta, Pakistan, between July and September 2010. The reliability of the translated questionnaire was tested for internal consistency. Validity was confirmed using convergent and known group validity.Results: Adopting the recommended scoring method, the mean ± SD of MMAS scores was 6.23 ± 0.9. The instrument demonstrated good internal consistency (Cronbach’s a = 0.701). The test–retest reliability value was 0.8 (p < 0.001). A positive correlation between the 8 and 4 item MMAS was found (r = 0.765; p ≤ 0.01). There was a significant relationship between MMAS categories and the hypertension control groups (χ2 = 19.996; p < 0.001). The MMAS sensitivity and specificity, with positive and negative predictive values, were 46.15%, 60.00%, 45.0% and 61.11%, respectively.Conclusions: Results from this translation and validation study conclude that the Urdu version of the MMAS is a reliable and valid measure of medication adherence and therefore a valid tool for the advancement of person-centered healthcare.

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Regular Articles

References

Pakistan Medical Research Council. (1998). National Health Survey of Pakistan, 1990-1994. Karachi, Pakistan. Available from <http://www.pmrc.org.pk/researchactivities.htm>

Saleem, F., Hassali, A.A. & Shafie, A.A. (2010). Hypertension in Pakistan: time to take some serious action. British Journal of General Practice 60, 449-450.

Mohan, S., Campbell, N. & Chockalingam, A. (2005). Management of hypertension in low and middle income countries: Challenges and opportunities. Prevention and Control 1, 275-284.

Rose, A.J., Berlowitz, D.R., Orner, M.B. & Kressin, N.R. (2007). Understanding Uncontrolled Hypertension: Is It the Patient or the Provider? Journal of Clinical Hypertension 9, 937-943.

Lüscher, T.F., Vetter, H., Siegenthaler, W. & Vetter, W. (1985). Compliance in hypertension: facts and concepts. Journal of Hypertension 3, s3-s9.

Mant, J. & Mcmanus, R.J. (2006). Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. Journal of Human Hypertension 20, 551-553.

Nichols-English, G. & Poirier, S. (2000). Optimizing adherence to pharmaceutical care plans. Journal of the American Pharmacists Association 40, 475-485.

Alexander, M., Tekawa, I., Hunkeler, E., Fireman, B., Rowell, R., Selby, J.V., Massie, B.M. & Cooper, W. (1999). Evaluating hypertension control in a managed care setting. Archives of Internal Medicine 159, 2673-2677.

Stockwell, D.H., Madhavan, S., Cohen, H., Gibson, G. & Alderman, M.H. (1994). The determinants of hypertension awareness, treatment, and control in an insured population. American Journal of Public Health 84, 1768-1774.

Lafleur, J. & Oderda, G.M. (2004). Methods to measure patient compliance with medication regimens. Journal of Pain & Palliative Care Pharmacotherapy 18, 81-87.

Mcdonnell, P.J. & Jacobs, M.R. (2002). Hospital admissions resulting from preventable adverse drug reactions. The Annals of Pharmacotherapy 36, 1331-1336.

Senst, B.L., Achusim, L.E., Genest, R.P., Cosentino, L.A., Ford, C.C., Little, J.A., Raybon, S.J. & Bates, D.W. (2001). Practical approach to determining costs and frequency of adverse drug events in a health care network. American Journal of Health-System Pharmacy 58, 1126-1132.

World Health Organization. (2003). Chapter XIII Hypertension in Adherence to Long- Term Therapies-Evidence for Action. Available from: http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf>

Dimatteo, M.R. (2004). Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Medical Care 42, 200-209.

Haynes, R.B., Mcdonald, H.P. & Garg, A.X. (2002). Helping patients follow prescribed treatment. Journal of the American Medical Association 288, 2880-2883.

Krousel-Wood, M., Hyre, A., Muntner, P. & Morisky, D. (2005). Methods to improve medication adherence in patients with hypertension: current status and future directions. Current Opinion in Cardiology 20, 296-300.

Osterberg, L. & Blaschke, T. (2005). Adherence to medication. New England Journal of Medicine 353, 487-497.

Vik, S.A., Maxwell, C.J. & Hogan, D.B. (2004). Measurement, correlates, and health outcomes of medication adherence among seniors. Annals of Pharmacotherapy 38, 303-312.

Donnan, P.T., Macdonald, T.M. & Morris, A.D. (2002). Adherence to prescribed oral hypoglycaemic medication in a population of patients with Type 2 diabetes: a retrospective cohort study. Diabetic Medicine 19, 279-284.

Rcmar Measurement Tools. (2006). Measuring Medication Adherence. Available from: <http://www.musc.edu/dfm/RCMAR/MedAdherence.html>

Al-Qazaz, H.K., Hassali, M.A., Shafie, A.A., Sulaiman, S.A., Sundram, S. & Morisky, D.E. (2010). The eight-item Morisky Medication Adherence Scale MMAS: Translation and validation of the Malaysian version. Diabetes Research and Clinical Practice 90, 216-221.

Morisky, D.E., Green, L.W. & Levine, D.M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care 24, 67-74.

Morisky, D.E., Ang, A., Krousel-Wood, M. & Ward, H.J. (2008). Predictive validity of a medication adherence measure in an outpatient setting. The Journal of Clinical Hypertension 10, 348-354.

Trindade, A.J., Ehrlich, A., Kornbluth, A. & Ullman, T.A. (2010). Are your patients taking their medicine? Validation of a new adherence scale in patients with inflammatory bowel disease and comparison with physician perception of adherence. Inflammatory Bowel Diseases 17, 599-604.

Institute for Health and Care Research. (2010). Questionnaires: selecting, translating and validating. Available from: <http://www.emgo.nl/kc/preparation/research%20design/8%20Questionnaires%20selecting,%20translating%20and%20validating.html>

Harkness, J.A., & Schoua-Glusberg, A.S. (1998). Questionnaires in translation. In: Cross-cultural survey equivalence (ZUMA-Nachrichten Spezial 3), J.A. Harkness ed., pp. 87-126. Mannheim, Germany: ZUMA.

Behling, O. & Law, K.S. 2000. Translating questionnaires and other research instruments: Problems and solutions. Thousand Oaks, CA: Sage Publications, Inc.

Santos, J.R.A. (1999). Cronbach’s alpha: A tool for assessing the reliability of scales. Journal of Extension 37, 1-5.

Sakthong, P., Chabunthom, R. & Charoenvisuthiwongs, R. (2009). Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale in Patients with Type 2 Diabetes. Annals of Pharmacotherapy 43, 950-957.

Södergård, B., Halvarsson, M., Tully, M.P., Mindouri, S., Nordström, M.L., Lindbäck, S., Sönnerborg, A. & Lindblad, Å.K. (2006). Adherence to treatment in Swedish HIV infected patients. Journal of Clinical Pharmacy and Therapeutics 31, 605-616.