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

Yashar Moharamzad,Zahra Saadat,Mohammad Mehdi Naghizadeh,Alireza Rai,Habibollah Saadat,Babak Nakhjavan Shahraki,Hossein Aerab-Sheibani,Donald E Morisky

doi:10.5539/gjhs.v7n4p173

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.

Highlights

Hypertension (HTN) is a major public health issue worldwide
This study aimed to validate the Persian version of the Morisky Medication Adherence Scale (MMAS)-8
In comparison to the original MMAS-8 which reported Cronbach’s α of 0.83 (Morisky et al, 2008), the estimated reliability here was lower (α= 0.697). This could be the result of differences in characteristics of the two studies and lower sample size here (200 patients) compared with 1400 patients studied in the original MMAS-8 psychometrics evaluation

Summary

Introduction

Hypertension (HTN) is a major public health issue worldwide. If uncontrolled with adequate and appropriate medication(s), it imposes serious health problems on sufferers such as heart attack, heart failure, stroke, renal failure, etc. There are effective medications available on the pharmaceutical market to control blood pressure (BP) of patients sufficiently. In spite of availability of these therapeutic agents, studies show that many patients who are taking anti-hypertensives do not meet the criteria for controlled BP within defined target limits (Ong, Cheung, Man, Lau, & Lam, 2007). Quiet similar to other communities, previous reports from Iran have documented uncontrolled BP in 62% (Arabzadeh et al, 2014) to 65% (Ebrahimi et al, 2006) of HTN patients, which obviously are significant numbers to be considered. Good adherence to (compliance with) anti-hypertensive www.ccsenet.org/gjhs

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