Validation of the Persian Version of the 8-Item Morisky Medication Adherence Scale (MMAS-8) in Iranian Hypertensive Patients

Abstract

The reliability and validity of the 8-item Morisky Medication Adherence Scale (MMAS-8) was assessed in a sample of Iranian hypertensive patients. In this multi-center study which lasted from August to October 2014, a total of 200 patients who were suffering from hypertension (HTN) and were taking anti-hypertensive medication(s) were included. The cases were accessed through private and university health centers in the cities of Tehran, Karaj, Kermanshah, and Bafgh in Iran and were interviewed face-to-face by the research team. The validated Persian translation of the MMAS-8 was provided by the owner of this scale. This scale contains 7 questions with “Yes” or “No” response choices and an additional Likert-type question (totally 8 questions). The total score ranges from 0 to 8 with higher scores reflecting better medication adherence. Mean (±SD) overall MMAS-8 score was 5.57 (±1.86). There were 108 (54%), 62 (31%), and 30 (15%) patients in the low, moderate, and high adherence groups. Internal consistency was acceptable with an overall Cronbach’s α coefficient of 0.697 and test–retest reliability showed good reproducibility (r= 0.940); P< 0.001. Overall score of the MMAS-8 was significantly correlated with systolic BP (r= - 0.306) and diastolic BP (r= - 0.279) with P< 0.001 for both BP measurements. The Chi-square test showed a significant relationship between adherence level and BP control (P= 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the scale were 92.8%, 22.3%, 52.9%, and 76.7%, respectively. The Persian version of the MMAS had acceptable reliability and validity in Iranian hypertensive patients. This scale can be used as a standard and reliable tool in future studies to determine medication adherence of Persian-speaking patients with chronic conditions.

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“…In the treatment of hypertension, poor adherence affects the clinical outcome; hence 32.8% of DTPs were nonadherence with the prescribed medications. The significant association between adherence level and BP control was also supported by other studies 21 .Therefore, close monitoring of patients with hypertension is vital in order to trace any possible factor that could contribute to the poor control of BP while taking appropriate management. By doing so, it could be possible to prevent CV complications as well as minimize the occurrence of DTPs that might be resulted due to poor BP control.…”

Treatment Adherence in Patients with Hypertension: A Cross Sectional Study from Southeast of Iran

“…The present study revealed that more than half of the hypertensive patients who participated in our study had poor adherence to their medications based on P-MMAS-8. In a systematic review, Nielson et al revealed remarkable (15). Given that adherence to medication and other non-pharmacological recommendations is necessary to control the disease and prevent its complications, measuring adherence to treatment by a simple, valid, and reliable instrument should be included in follow-up visits in primary health care (17,18).…”

“…Acceptable reliability and validity were reported for the original and other versions (including Persian one) (12)(13)(14). Moharamzad et al revealed that the Persian version of the MMAS-8 had acceptable validity and reliability (Cronbach's Alpha coefficient: 0.69 and ICC = 0.940) in Iranian hypertensive patients (15).…”

Medication Adherence and its Predictors in Type 2 Diabetic Patients Referring to Urban Primary Health Care Centers in Kerman City, Southeastern Iran

“…The total MMAS score ranges from 0 to 8 and the adherence level could be categorized as high (score = 8), moderate (score = 6 to < 8), and low (score < 6) (14). Moreover, the original researchers suggested a cutoff point of six to categorize the MMAS scores and this method was applied by other researchers, as well (8,15,16). For data analysis, the patients were classified into two groups: non-adherent (MMAS score < 6) and adherent patients (MMAS score ≥ 6).…”