Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: Results from the French Housing First experience

Abstract

The Medication Adherence Rating Scale (MARS) is one of the most widely used measurements of adherence in schizophrenia (SZ), but there is no available data regarding its psychometric properties in homeless SZ patients (HSZ). The aim of this study was therefore to assess the psychometric properties of the MARS in a large multicenter sample of HSZ subjects. This multi-centre prospective study was conducted in the following 4 French cities: Lille, Marseille, Paris and Toulouse. Three hundred and fifty-three patients were included. The 3-factor structure of the MARS was confirmed using confirmatory factor analysis: RMSEA = 0.045, CFI = 0.98, TLI = 0.97 and WRMR = 0.76. The unidimensionality of each factor was supported by the satisfactory INFIT statistics. Item internal consistencies were all higher than 0.20 and the Kuder–Richardson were higher than to 0.6, except for factor 2, which was closed to 0.5. Significant associations with symptoms, functioning and quality of life showed satisfactory external validity. The acceptability was satisfactory with missing data lower than 5% for each dimension. The MARS is a short self-administered instrument with acceptable psychometric properties in homeless SZ patients that yields interesting information about medication adherence.

Validation of the 5-Item Medication Adherence Report Scale in Older Stroke Patients in Iran

“…21 Although no studies have used Rasch analysis on the MARS-5, our results are comparable with the findings of 2 recent studies that applied Rasch analysis to the MARS-10 in people with mental illness. 19,20 All of their findings and ours in fit statistics were satisfactory: infit MnSq ranged between 0.74 and 1.25 in our study, between 0.90 and 1.03 in Fond et al, 19 and between 0.92 and 1.03 in Zemmour et al 20 There has been a debate as to whether the MARS-5 is an appropriate measure for medication adherence 24Y27 and whether different characteristics of disease patients may affect the accuracy of the MARS-5. 28 Based on our rigorous psychometric findings (unidimensionality of the MARS-5, no DIF items in the MARS-5, and a high correlation with the MPR), we are confident that the MARS-5 is able to accurately measure medication adherence for older patients with stroke.…”

“…A potential candidate to assess medication adherence is the Medication Adherence Report Scale (MARS), which has a 10-item version (MARS-10) and a 5-item version (MARS-5). The MARS-10 has been validated for its unidimensionality among people with mental illness; 19,20 however, no studies have examined the psychometric properties of MARS-10 in people with stroke. Similarly, we found that the psychometric evaluation of the MARS-5 has only been done on populations without stroke using classical test theory.…”

Reliability and validity of the Medication Adherence Rating Scale in a cohort of patients with schizophrenia from Nigeria

“…13 No study has assessed the validity of the MARS in a non-western setting. There is also a need to utilize a brief assessment tool for medication adherence research in schizophrenia in these settings, facilitating the development of specific interventions to improve schizophrenia treatment outcomes.…”

Illness and drug modifiable factors associated with violent behavior in homeless people with severe mental illness: results from the French Housing First (FHF) program

“…Several hypotheses may be suggested. First, these patients may have more adherence issues that have been extensively described elsewhere (Paudyal et al, 2017;Zemmour et al, 2016). Second, antidepressants may have lower intrinsic efficacy in this population due to differences in neuronal pathways activation, according to the substance intake.…”