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


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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