Abstract
BackgroundThe Morisky Medication Adherence scale (MMAS-8) is a widely used self-reported measure of adherence to antihypertensive medications that has not been validated in hypertensive patients in sub-Saharan Africa.MethodsWe carried out a cross-sectional study to examine psychometric properties of a translated MMAS-8 (MMAS-U) in a tertiary care hypertension clinic in Uganda. We administered the MMAS-U to consecutively selected hypertensive adults and used principal factor analysis and Cronbach’s alpha to determine its validity and internal consistency respectively. Then we randomly selected one-sixth of participants for a 2-week test-retest telephone interview. Lastly, we used ordinal logistic regression modeling to explore factors associated with levels of medication adherence.ResultsOf the 329 participants, 228 (69%) were females, median age of 55 years [Interquartile range (IQR) (46–66)], and median duration of hypertension of 4 years [IQR (2–8)]. The adherence levels were low (MMAS-U score ≤ 5) in 85%, moderate (MMAS-U score 6–7) in 12% and high (MMAS-U score ≥8) in 3%. The factor analysis of construct validity was good (overall Kaiser’s measure of sampling adequacy for residuals of 0.72) and identified unidimensionality of MMAS-U. The internal consistency of MMAS-U was moderate (Cronbach α = 0.65), and test-retest reliability was low (weighted kappa = 0.36; 95% CI -0.01, 0.73). Age of 40 years or greater was associated with low medication adherence (p = 0.02) whereas a family member buying medication for participants (p = 0.02) and purchasing medication from a private clinic (p = 0.02) were associated with high adherence.ConclusionThe Ugandan version of the MMAS-8 (MMAS-U) is a valid and reliable measure of adherence to antihypertensive medication among Ugandan outpatients receiving care at a public tertiary facility. Though the limited supply of medication affected adherence, this easy to use tool can be adapted to assess medication adherence among adults with hypertension in Uganda.
Highlights
High blood pressure is the leading risk factor for morbidity and accounts for 7% of global disability-adjusted life years (DALYs) and nearly 10 million deaths per year [1]
The Morisky Medication Adherence scale (MMAS-8) is a widely used self-reported measure of adherence to antihypertensive medications that has not been validated in hypertensive patients in sub-Saharan Africa
The internal consistency of MMAS-U was moderate (Cronbach α = 0.65), and test-retest reliability was low
Summary
High blood pressure is the leading risk factor for morbidity and accounts for 7% of global disability-adjusted life years (DALYs) and nearly 10 million deaths per year [1]. Despite global declines in blood pressure, the blood pressures of adults in sub-Saharan Africa (SSA) continue to rise [2, 3], and the age-adjusted prevalence of hypertension in SSA is estimated to be the highest of any region in the world [4]. Adherence to antihypertensive medications is necessary in order to achieve blood pressure control, and improve outcomes [8, 9]. Uganda faces unique challenges in achieving blood pressure control partly because the health care system is ill equipped to address the rising burden of non-communicable diseases [10]. In order for health care providers to promote medication adherence, an easy to use, reliable and valid measure of medication adherence is needed. The Morisky Medication Adherence scale (MMAS-8) is a widely used self-reported measure of adherence to antihypertensive medications that has not been validated in hypertensive patients in sub-Saharan Africa
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