Portuguese version of the Medication Adherence Report Scale (MARS‐9): Validation in a population of chronic pain patients

Abstract

Aim: The aim of present study was to perform the translation, cultural adaptation, and validation of the Medication Adherence Report Scale (MARS-P9) for the European Portuguese language in a sample of chronic pain patients. Methods: A Portuguese version of the nine-item MARS (©Professor Rob Horne) scale (MARS-P9) was constructed through a process of translation, back translation, and experts' panel evaluation. A total of 141 chronic pain patients were subsequently evaluated at four time assessments during a 1-year pain medication treatment. The protocol interview included the assessment of pain intensity and interference (BPI), clinical outcomes and quality of life (S-TOPS), and MARS-P9.Results: The internal consistency coefficient was acceptable for the total scale (α = 0.84). Exploratory factor analysis revealed a two-factor structure (intentional and unintentional nonadherence) that explained 61% of the variance. Convergent and discriminant validity were demonstrated by correlations between MARS scores and pain interference (r = 0.180, P ≤ 0.01) and S-TOPS (r = 0.242, P ≤ 0.05).Conclusion: MARS-P9 has been shown to be an adequate instrument for Portuguese researchers and clinicians to assess the pattern of adherence during the management of chronic pain. ;25:346-352. wileyonlinelibrary.com/journal/jep the provider's recommendation with respect to timing, dosing, and frequency of medication taking during the prescribed length of time. 15 Despite the effectiveness of pain medicines, they are quite often misused, with almost 50% of medication not taken as prescribed. 13 Moreover, an important recent Portuguese study that analysed the direct and indirect costs associated with chronic pain revealed a total €481.59 million of annual costs for the Portuguese population (95% CI [423.63 to 552.68]) associated with pain medicines. 16Since the WHO Adherence meeting in 2001, it is well accepted that there is no "gold standard" for measuring adherence behaviour. However, it is recognized that using questionnaires meeting basic psychometric standards, to assess specific behaviours related to specific medical recommendations, allows a better prediction of the adherence behaviour. 15 The Medication Adherence Scale (MARS) (©Professor Rob Horne), developed in England, is a feasible self-reporting scale addressing nonadherence behaviour in a nonthreatening and nonjudgmental way, which may result in truthful answers, used in a range of long-term conditions. This is a generic tool, which can be used to assess any prescribed drug regardless of the health condition. Adherence is measured as a continuous scale, rather than dichotomous adherent/nonadherent categories, producing an ordinal instead of an interval-scale assessment. The MARS (©Professor Rob Horne) has been validated in different languagesin different clinical settings and countries and is available in 5, 9, and 10 items. 17-23 All versions contain a common set of five items (MARS-5), eg, "I forget to take my medicines". In other versions, condition-specific items are adde...

Barriers and Adherence to Pain Management in Advanced Cancer Patients

“…Patient‐related barriers include patients’ concerns about medication use, which may result in an inadequate adherence to prescribed regimens. When patients have concerns about drugs and opioid‐related adverse effects, the analgesic adherence seems to be poor 11,12 . Indeed, the adherence to opioid prescription was positively correlated with patients’ education, quality of patient–physician communication, and age 13…”

<p>Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients</p>

“…10 Direct and dichotomous (yes/no) questions about adherence were posed to those who decide what to do with each one of the prescription(s) receivedthe patients. Also, a specific adapted non-adherence questionnaire, the MARS-P9, was used to obtain standardized results for non-adherence behaviour, 22 but not as a unique measure of non-adherence because there is the possibility of underestimation of this behaviour. 14 Therefore, the authors advocate a multimethod NAO -Narcotic_Analgesics_Opioids ATE -Antiepileptics_and_anticonvulsants ATD -Antidepressants ANG -Analgesics_antipyretics TOG -Topical_non_steroidal_anti_inflammatory_drugs NSAID -Non_steroidal_anti_inflammatory_drugs OM -Other Medications * Chi-square test 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID OM NAD ATE ATD ANG TOG NSAID approach to measure the adherence behaviour, in the absence of a consensus rate of enough adherence to prevent poor outcomes in chronic pain.…”

“…The Portuguese version of scale -MARS-P9has been shown good psychometric properties and to be an adequate instrument for Portuguese researchers to assess the adherence patterns during the management of chronic pain. 22 MARS-P9 contains eight items assessing intentional aspects of non-adherence (e.g., "Only use medication when feeling pain") and one assessing unintentional nonadherence (e.g., "Forget to use medication"). 22…”

“…22 MARS-P9 contains eight items assessing intentional aspects of non-adherence (e.g., "Only use medication when feeling pain") and one assessing unintentional nonadherence (e.g., "Forget to use medication"). 22…”

Parent and Teacher Training Increases Medication Adherence for Primary School Children With Attention-Deficit/Hyperactivity Disorder

“…The Chinese Version of Swanson Nolan and Pelham, Version IV Scale (SNAP-IV) is used as the measure for the severity of ADHD symptoms. It consists of 26 items using a four-point scale ranging from 0 to 3 and three subscales: inattention, hyperactivity, and impulsivity (24). The primary outcome measure is the difference in the severity of ADHD core symptoms as measured by the SNAP-IV scales between the intervention group and the control group at baseline and 6 months follow-up.…”