8-item Morisky Medication Adherence Scale Research Articles

Validation of the 8-Item Morisky Medication Adherence Scale in Chronically Ill Ambulatory Patients in Rural Greece

Objective: To validate a Greek version of the structured self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) and determine its psychometric properties in patients with chronic illnesses. Methods: A cross-sectional survey was conducted in a small public hospital and a public health care centre, in a rural town in western Greece. The sample consisted of 100 patients with various chronic illnesses. Data were collected between January-May 2011, on the Greek version of the MMAS-8 and Beliefs about Medicines Questionnaire (BMQ). Results: Scale’s reliability analysis revealed an overall Cronbach’s alpha of 0.753 and the corrected item to total correlations, were greater than 0.30 for each of the 8 items comprising the medication adherence scale, showing good internal consistency. Convergent validity was supported by a significant correlation between the present scale’s total score and the BMQ-Specific Necessity score (Spearman’s rho = 0.492, p < 0.001). Conclusion: The current study showed acceptable reliability and validity of the Greek version of the 8-item MMAS to measure adherence to medications for various chronic illnesses. The validated Greek version of the MMAS-8 can help towards understanding adherence barriers in Greece so as to develop effective strategies to increase adherence and reduce the costs.

Revisiting the internal consistency and factorial validity of the 8-item Morisky Medication Adherence Scale.

Objective:To assess the internal consistency and factorial validity of the adapted French 8-item Morisky Medication Adherence Scale in assessing adherence to noninsulin antidiabetic drug treatment.Study Design and Setting:In a cross-sectional web survey of individuals with type 2 diabetes of the Canadian province of Quebec, self-reported adherence to the antidiabetes drug treatment was measured using the Morisky Medication Adherence Scale-8. We assessed the internal consistency of the Morisky Medication Adherence Scale-8 with Cronbach’s alpha, and factorial validity was assessed by identifying the underlying factors using exploratory factor analyses.Results:A total of 901 individuals completed the survey. Cronbach’s alpha was 0.60. Two factors were identified. One factor comprised five items: stopping medication when diabetes is under control, stopping when feeling worse, feeling hassled about sticking to the prescription, reasons other than forgetting and a cross-loading item (i.e. taking drugs the day before). The second factor comprised three other items that were all related to forgetfulness in addition to the cross-loading item.Conclusion:Cronbach’s alpha of the adapted French Morisky Medication Adherence Scale-8 was below the acceptable value of 0.70. This observed low internal consistency of the scale is probably related to the causal nature of the items of the scale but not necessarily a lack of reliability. The results suggest that the adapted French Morisky Medication Adherence Scale-8 is a two-factor scale assessing intentional (first factor) and unintentional (second factor) non-adherence to the noninsulin antidiabetes drug treatment. The scale could be used to separately identify these outcomes using scores obtained on each of the sub-scales.

Adherence and treatment satisfaction in liver transplant recipients.

Background/Aims:Liver transplantation (LT) is a life-saving intervention for patients with liver failure. LT recipients' adherence to their therapeutic regimen is an essential element for graft survival. According to WHO, the impact of medication non-adherence in solid organ transplantation has shown to cost $15–100 million annually. The aim of the present study was to identify the factors that best predict medication adherence and to explore the relationship between treatment satisfaction and medication adherence in liver transplant recipients.Patients and Methods:Adult liver transplant patients at King Abdulaziz Medical City were included in the study. Patients completed the 8-item Morisky Medication Adherence Scale (MMAS-8) and the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) in addition to several socio-demographic and transplant-related data.Results:A total of 154 patients were included in the study and of these 59.7% were adherent. Older age was a significant predictor of adherence (P < 0.05). The mean treatment satisfaction score was 91.9 ± 12.7 in Effectiveness, 80.0 ± 25.9 in Side Effects, 83.5 ± 15.7 in Convenience, and 94.6 ± 8.6 in Global Satisfaction. Further analysis indicated that patients in the adherent group had reported significantly higher satisfaction scores than those in the non-adherent group (P < 0.05) in all treatment satisfaction domains: Effectiveness (94.4 ± 10.4 vs. 88.6 ± 14.8), Side Effects (83.9 ± 22.0 vs. 74.2 ± 30.1), Convenience (87.0 ± 13.9 vs. 77.2 ± 16.1), and Global Satisfaction (96.9 ± 6.6 vs. 91.2 ± 8.6).Conclusion:Older patients and those who were more satisfied with their treatment tend to have better adherence to the prescribed medications. Therefore, increasing patients' satisfaction with their treatment should be an integral element of future care plans designed to improve treatment outcomes in liver transplant recipients.

Adherence to Antihypertensive Medications in Iranian Patients.

Introduction. Appropriate adherence to medication is still a challenging issue for hypertensive patients. We determined adherence to antihypertensive(s) and its associated factors among 280 Iranian patients. Methods. They were recruited consecutively from private and university health centers and pharmacies in four cities. The validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) was administered to measure adherence. Results. Mean (±SD) overall MMAS-8 score was 5.75 (±1.88). About half of the sample (139 cases, 49.6%) showed low adherence (MMAS-8 score < 6). There was a negative linear association between the MMAS-8 score and systolic BP (r = −0.231, P < 0.001) as well as diastolic BP (r = −0.280, P < 0.001). In linear regression model, overweight/obesity (B = −0.52, P = 0.02), previous history of admission to emergency services due to hypertensive crisis (B = −0.79, P = 0.001), and getting medication directly from drugstore without refill prescription in hand (B = −0.51, P = 0.04) were factors recognized to have statistically significant association with the MMAS-8 score. Conclusion. Antihypertensive adherence was unsatisfactory. We suggest that health care providers pay special attention and make use of the aforementioned findings in their routine visits of hypertensive patients to recognize those who are vulnerable to poor adherence.

Prevalence and Predictors of Medication Non-Adherence in Patients of Chronic Kidney Disease: Evidence from A Cross Sectional Study

Introduction: A high level of adherence to prescribed medication is essential to obtain the desired outcomes in patients of chronic kidney disease (CKD). Non-adherence to medication leads to increased morbidity and mortality. Non-adherence to medication has not been studied extensively in patients of CKD in India. Objective: To study the prevalence and predictors of medication non-adherence in patients of CKD. Method: Medication non-adherence was studied with the help of Morisky 8-item Medication Adherence Scale (MMAS-8) through a cross sectional study. Patients, aged 18 yrs or more, diagnosed with CKD according to Kidney Disease: Improving Global Outcomes (KDIGO) definition, and willing to participate in the study were included. On the basis of MMAS-8 scores, patients were classified to have high, medium and low adherence. Binary logistic regression was used to determine the various factors affecting adherence to drug therapy in CKD patients. Results: A total of 150 patients were included in study. Only 22% of the patients had high adherence to medications. Of all, 55% and 23% of the patients belonged to low and medium adherence, respectively. Adherence to drug therapy was found significantly different in different stages of CKD, gender, Body Mass Index (BMI) categories, hemodialysis status, co-morbidities, treatment funding and in patients of different socioeconomic status. Forgetfulness was found to be most common reason for non-adherence, while maximum non-adherence were reported for antihypertensive medications. Pill burden, age, literacy, reimbursement, medication by caregivers was found to significantly affecting the medication adherence. Conclusion: Medication non adherence was found to be highly prevalent in patients of CKD.

Patient-Reported Factors Associated With Poor Phosphorus Control in a Maintenance Hemodialysis Population

The purpose of this study was to determine the influence of patient-reported medication adherence and phosphorus-related knowledge on phosphorus control and pharmacy-reported adherence to phosphorus binding medication among patients on maintenance hemodialysis. Retrospective, cross-sectional cohort study. Seventy-nine hemodialysis patients (mean age 64.2 years, SD = 14 years; 46.8% female) in a stand-alone hemodialysis unit within an integrated learning healthcare system. Ten percent (10%) of subjects were Caucasian, 42% Latino, 19% African American, and 29% Asian. Forty-eight percent had diabetes; 72% had BMI ≥ 30. Inclusion criteria included the provision of survey data and having medication refill data available in the pharmacy system. 77.2% had mean phosphorus levels ≤ 5.5 mg/dL; 22.8% had mean phosphorus levels > 5.5 mg/dL. Subjects were administered the 8-item Morisky Medication Adherence Scale (MMAS-8) and also reported on their phosphorus-related knowledge. Phosphorus levels within an adequate range. The mean serum phosphorus level was 4.96 mg/dL (SD = 1.21). In the well-controlled group, mean phosphorus was 4.44 mg/dL (SD = 0.76). In the poorly controlled group, mean phosphorus was 6.69 mg/dL (SD = 0.74). A total of 61% of patients reported at least some unintentional medication nonadherence, and 48% reported intentional medication nonadherence. Phosphorus-specific knowledge was low, with just under half of patients reporting that they could not name two high-phosphorus foods or identify a phosphorus-related health risk. Phosphorus binder-related nonadherence was substantially higher in the uncontrolled than the controlled group. Adjusting for age, individuals with poorer self-reported binder adherence were less likely to have controlled phosphorus levels (odds ratio = 0.71, P = .06). Phosphorus-related non-adherence, but not low phosphorus-specific knowledge, was associated with poorer phosphorus control. Such findings provide important information for the development of evidence-based strategies for improving phosphorus control among patients on dialysis.

Self-reported adherence to oral cancer therapy: relationships with symptom distress, depression, and personal characteristics.

BackgroundTherapeutic cancer chemotherapy is most successful when complete dosing is achieved. Because many newer therapeutic agents are oral and self-administered by the patient, adherence is a concern. The purpose of our analysis was to explore relationships between adherence, patient characteristics, and barriers to adherence.MethodsThis secondary analysis utilized self-reported data from a randomized trial of self-care management conducted at two cancer centers in the US. Symptom distress was measured using the 15-item Symptom Distress Scale (SDS-15) and depression with the Patient Health Questionnaire-9 (PHQ-9). Adherence to oral medication was self-reported using the 8-item Morisky Medication Adherence Scale (MMAS-8). Measures were collected via Web-based, study-specific software ~8 weeks after treatment start date. Odds of low/medium adherence (score <8) were explored using univariate logistic regression. Given the number of factors and possible relationships among factors, a classification tree was built in lieu of a multivariable logistic regression model.ResultsOf the eligible participants enrolled, 77 were on oral therapy and 70 had an MMAS score. Forty-nine (70%) reported a high adherence score (=8). Higher odds of low/medium adherence were associated with greater symptom distress (P=0.09), more depression (P=0.05), chemotherapy vs hormonal oral medication (P=0.03), being female (P=0.02), and being randomized to the control group in the parent trial (P=0.09). Conversely, high adherence was associated with working (P=0.08), being married/partnered (P=0.004), and being older (P=0.02). Factors identified as significantly related to low/medium adherence from the univariate logistic regression analyses were supported by the classification tree results.ConclusionNonadherence to therapeutic oral medications in patients with cancer was associated with being unmarried/unpartnered, symptom distress, younger age, not working, and female sex. These findings may help to identify patients at risk for nonadherence and for whom supportive interventions to enhance adherence may be needed.

Psychosocial factors associated with adherence to non-insulin antidiabetes treatments

AimsTo discern psychosocial factors of non-insulin antidiabetes drug (NIAD) adherence. MethodsA cross-sectional study based on the theory of planned behavior (TPB). Adults with type 2 diabetes (T2D) who were members of Diabète Québec, a provincial association of persons with diabetes, and were prescribed at least one NIAD were invited to complete a web-based questionnaire. We measured variables ascertaining TPB constructs and other factors potentially associated with NIAD adherence (e.g., habit, social support, and mental health). NIAD adherence was assessed using the 8-item Morisky Medication Adherence Scale. Factors were identified using a multivariate logistic regression model. ResultsIn our study, 901 participants (373 women; 515 retired; mean age: 62.7years) with T2D for a mean of 10years, completed the questionnaire. Participants exhibited a high intention to adhere to their NIAD treatment (mean score=5.8/6), positive attitudes toward adherence (mean score=5.5/6), and elevated perceived behavioral control in taking their medication (mean score=5.7/6). Only 405 (45%) participants reported high adherence (score=8/8). Perceived behavioral control, habit, older age, no perceived side effects, a longer period since T2D diagnosis and a lower number of NIAD daily doses were significantly associated with adherence (p<0.05). ConclusionWe identified several factors that may be modified for NIAD adherence and thereby provided insight into future adherence-enhancing intervention targets.

Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Type 2 diabetes patients in sub-Saharan Africa

ObjectivesResearch in the field of adherence to medications has not been explored in sub-Saharan Africa. The goal of this manuscript is to (1) validate the use of an adherence tool: a translated 8-item Morisky Medication Adherence Scale (MMAS-8) for Type 2 diabetes and (2) assess association between levels of adherence and psychometric properties. Methods154 Type 2 diabetic patients being chronically treated were surveyed from Togolese Diabetes Association using a demographic survey, 4-item Morisky Medication Adherence Scale (MMAS-4) and MMAS-8 from January to March 2012. ResultsInternal reliability for the 8-item scale showed the Cronbach alpha being 0.47. The MMAS-8 and MMAS-4 showed a Pearson's correlation of 0.6851. For known groups validity, the chi-square (χ2) tests of proportions showed a significant relationship between blood glucose control and MMAS-8 (χ2=12.17; p=0.002). The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 48.39%, 56.76%, and 68.18% respectively. ConclusionsPsychometric analyses showed that the MMAS-8 was a suitable way of measuring medication adherence in the study population given its low cost, ease of use, and the low income status of the country.

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients.

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.

A study of treatment adherence and quality of life among adults with chronic urticaria in Singapore.

BackgroundChronic urticaria is a common skin condition that causes significant impact on patient's quality of life.ObjectiveThe purpose of the study was to assess adherence to therapy and quality of life of patients with chronic urticaria. We also aimed to study the relationship of medication adherence and quality of life of patients with chronic urticaria.MethodsA cross sectional study was conducted with 103 patients from the dermatology clinic of National University Hospital, Singapore. Patients with chronic urticaria were asked to fill out a questionnaire for assessment of adherence to therapy and quality of life. We used the Morisky 8-Item Medication Adherence Scale to categorize adherence as high, medium, low. For assessment of quality of life, we used the validated chronic urticaria quality of life questionnaire (CU-Q2oL) by Bairadani et al.ResultsThe highest median scores for the items measuring quality of life were interference with sleep and pruritus. We also observed that the majority of patients (71.9%) had low adherence to medical therapy. No difference in adherence was noted in patients on once daily medication or more frequent dosing. There was no significant difference in the quality of life among patients with low and medium adherence to therapy.ConclusionQuality of life of patients with chronic urticaria does not depend on the patients' adherence to medications. Dosing frequency does not affect adherence in our study population. It is also important to recognize the symptoms and issues most affecting quality of life of patients with chronic urticaria, so as to improve overall management.

Factors affecting medication adherence in Lebanese patients with chronic diseases.

Background:Non-adherence to prescribed medications represents an obstacle toward achieving treatment goals. This problem is more pronounced in patients with chronic illness.Objective:To identify the extent of adherence in Lebanese outpatients with chronic diseases, and to suggest possible predictors of non-adherence in this population. The secondary objective was to assess if medication adherence affects patients’ quality of life.Methods:A questionnaire was administered face-to-face to a sample of Lebanese adults visiting the external clinics at two Tertiary Care Hospitals in Beirut. The level of adherence was assessed using the 8-item Morisky Medication Adherence Scale which was first validated. The health-related quality of life (HRQoL) of patients was measured using the EQ-5D. Linear regression and logistic regression analyses examined possible predictors of adherence.Results:Out of the 148 patients included in this study, 42.6% were classified as adherent. In the univariate analyses, statistically significant predictors of high adherence included good physician-patient relationship (p=0.029) and counseling (p=0.037), a high level of HRQoL (p<0.001), and a high level of perceived health (p<0.001). Predictors of low adherence included a declining memory (p<0.001), anxiety/depression (p=0.002), little drug knowledge (p<0.001), and postponing physician appointments (p<0.001). The multivariate analyses revealed similar results. In the linear regression, the most powerful predictor of non-adherence was the disbelief that the drug is ameliorating the disease (beta=0.279), however, in logistic regression, patient who were willing to skip or double doses in case of amelioration/deterioration were found to be 7.35 times more likely to be non-adherent than those who were not (aOR=0.136, 95% CI: 0.037-0.503).Conclusion:The findings of this study reassure the view that patients should be regarded as active decision makers. Patient education should be regarded as a cornerstone for treatment success. Additional studies as well are needed to test the practicability and effectiveness of interventions suggested to enhance adherence.

Religious coping and its influence on psychological distress, medication adherence, and quality of life in inflammatory bowel disease.

Inflammatory bowel disease (IBD) is associated with elevated levels of anxiety and depression and a reduction in health-related quality of life (HRQoL). Nonadherence to treatment is also frequent in IBD and compromises outcomes. Religious coping plays a role in the adaptation to several chronic diseases. However, the influence of religious coping on IBD-related psychological distress, HRQoL, and treatment adherence remains unknown. This cross-sectional study recruited 147 consecutive patients with either Crohn's disease or ulcerative colitis. Sociodemographic data, disease-related variables, psychological distress (Hospital Anxiety and Depression Scale), religious coping (Brief RCOPE Scale), HRQoL (WHOQOL-Bref), and adherence (8-item Morisky Medication Adherence Scale) were assessed. Hierarchical multiple regression models were used to evaluate the effects of religious coping on IBD-related psychological distress, treatment adherence, and HRQoL. Positive RCOPE was negatively associated with anxiety (b = 0.256; p = 0.007) as well as with overall, physical, and mental health HRQoL. Religious struggle was significantly associated with depression (b = 0.307; p < 0.001) and self-reported adherence (b = 0.258; p = 0.009). Finally, anxiety symptoms fully mediated the effect of positive religious coping on overall HRQoL. Religious coping is significantly associated with psychological distress, HRQoL, and adherence in IBD.

Adherence to Antihypertensives in Patients With Comorbid Condition.

Background:Comorbidity has been noted as a potential barrier to proper adherence to antihypertensive medications.Objectives:We decided to investigate whether comorbidity could significantly affect adherence of Iranian patients with hypertension to their medication regimen.Patients and Methods:Two hundred and eighty consecutive hypertensive patients were interviewed in 4 cities of Iran. The 8-item Morisky medication adherence scale (MMAS-8) (validated in Persian) was used to assess medication adherence. This scale determines adherence by scores as lower than 6 (low adherence), 6 or 7 (moderate adherence), and 8 (high adherence). Comorbidity was considered as any concomitant medical condition, which necessitates the patient to take medicine for a minimum of 6 months prior to the interviews.Results:The most common comorbid conditions were ischemic heart disease (65 patients, 23.2%), diabetes mellitus (55 patients, 19.6%), and dyslipidemia (51 patients, 18.2%). Mean (± SD) MMAS-8 score in comorbid group was 5.68 (± 1.85) and in non-comorbid hypertensive patients, it was 5.83 (± 1.91) (P = 0.631). Mean (± SD) number of comorbidities was 1.53 (± 0.75) in low adherence group compared to 1.54 (± 0.77) in moderate/high adherers (P = 0.98). With increasing the number of comorbid diseases, the proportion of patients with high adherence decreased successively from 20% in those with no comorbid disease to 14.1% in those with one or two comorbid conditions, and finally 11.1% in those with 3 to 5 comorbid conditions.Conclusions:With increasing the number of comorbid conditions, the proportion of patients with high adherence decreases. In our opinion, this finding is a useful clinical note for healthcare providers when managing patients with hypertension who have other medical problems at the same time.

Association between adherence, treatment satisfaction and illness perception in hypertensive patients.

The relationship between adherence to antihypertension medications, treatment satisfaction and illness perception has not been studied so far. The primary objective of this study was to examine the association between adherence to medication, treatment satisfaction and illness perception in Lebanese hypertensive patients. The relation between medication adherence and blood pressure (BP) control was also assessed. In this cross-sectional study, patients were recruited from the physician's practice offices and community pharmacies in Beirut. Patients who had been treated for hypertension for at least 3 months were invited to participate in the study; they completed three questionnaires: the 8-item Morisky Medication Adherence Scale (MMAS-8), the Treatment Satisfaction Questionnaire for Medication (TSQM-4) and the Brief Illness Perception Questionnaire (BIPQ). BP was also measured and recorded. A total of 117 subjects were included, of whom 29.1% had poor adherence to their antihypertension treatment (MMAS-8 scores<6). The odds of having well-controlled hypertension was 3.5 times higher in patients with high adherence compared with patients with poor adherence (P=0.010). Treatment satisfaction was significantly greater in patients with good adherence (P<0.001). Neither socio-demographic, disease- nor drug-related characteristics of the participants were significantly associated with medication adherence. As for illness perception, even though the mean BIPQ score of adherent participants was lower than the mean score of non-adherent participants, this difference did not reach statistical significance. In conclusion, treatment satisfaction was found to be a predictor of adherence. Studies are needed to determine whether interventions to increase satisfaction can improve adherence and BP control.

Controlled Blood Pressure in Iranian Patients: A Multi-Center Report

We decided to determine the percentage of hypertensive patients whose blood pressure (BP) measurements were within recommended controlled range and to identify predictive factors for controlled BP. In this study carried out in 2014, 280 patients were included consecutively through sampling from both university and private medical centers/pharmacies in four Iranian cities. Demographic data as well as information about duration of HTN and prescribed medications, admission to emergency department (ED) because of HTN crisis, comorbidities, and control of HTN during the last 6 months by a healthcare provider were gathered. Adherence to anti-hypertensives was also determined using the validated Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Controlled BP was defined as systolic BP< 140 and diastolic BP< 90 mmHg in non-diabetics and < 130/80 mmHg in diabetics. Of 280 patients, 122 subjects (43.6%) had controlled BP. Among 55 diabetics, only two patients (3.6%) had controlled BP. Multiple logistic regression revealed the following variables as significant predictors of controlled BP: higher MMAS-8 score (adjusted odds ratio (OR)= 1.19, P= 0.03), fewer number of comorbid conditions (adjusted OR= 0.71, P = 0.03), having occupation as clerk/military personnel (adjusted OR= 1.03, P= 0.04), and not having history of ED admission during the last 6 months because of HTN crisis (adjusted OR= 2.11, P= 0.01). Considerable number of the studied patients had uncontrolled BP. Regarding the dramatic consequences of uncontrolled high BP in long term, it is advisable that careful attention by health care providers to the aforementioned factors could raise the likelihood of achieving controlled BP.

Effects of pharmacist-led patient education on diabetes-related knowledge and medication adherence: A home-based study

Objective: Patient education is key to the management of acute and chronic conditions. However, the majority of such educational interventions have been reported from health-care settings. In contrast, this study aims to evaluate whether a home-based intervention can result in better understanding about type 2 diabetes mellitus and can increase adherence to prescribed medications. Method: A non-clinical randomised controlled trial was conducted whereby participants received a home-based educational intervention through a registered pharmacist. A total of 150 patients were randomly assigned to two groups (75 patients in each arm). Diabetes knowledge and medication adherence were measured by means of the 14-item Michigan Diabetes Knowledge Test and the 8-item Morisky Medication Adherence Scale, respectively. Results: No significant differences were observed in either group for demographic variables. There was, however, a significant increase in the participants’ levels of knowledge about type 2 diabetes mellitus and medication adherence in the home-based intervention group at the completion of the intervention ( p &lt; .001). Significantly lower HbA1c levels were also observed among the home-based intervention group following the intervention ( p &lt; .001). Conclusion: A pharmacist-led home-based intervention can significantly increase disease-related knowledge and medication adherence in patients with type 2 diabetes mellitus. Home-based interventional programmes offer a promising method of patient education and counselling.

Assessment of medication adherence and knowledge regarding the disease among ambulatory patients with diabetes mellitus in Karachi, Pakistan

Objective: To report medication adherence among ambulatory patients with diabetes mellitus DM using Morisky 8-item medication adherence MMAS-8 scale and assess current standard of knowledge regarding their disease using a especially developed Patient 10-item Knowledge Assessment PKA-X scale. Methods: A quantitative cross sectional study was conducted for 3 months in Karachi, Pakistan using Morisky 8-item medication adherence scale® documenting the medication adherence of ambulatory patients with diabetes mellitus DM and to find out their knowledge regarding the disease using a newly developed Patient 10-item knowledge assessment PKA-X scale. Results: The mean MMAS-8 score of the total sample was 4.69 (1.9 SD) which was interpreted as ‘Low medication adherence’ (P value 0.05). Conclusion: The medication adherence of the patients is very low and adequate measures are the need of the hour to address this issue though the standard of knowledge has greatly improved. However, having good knowledge about the disease does not guarantee adherence to medication regimen. Key words: Diabetes mellitus, Karachi, Knowledge, Medication adherence, Patient, Pakistan.

Understanding barriers to optimal medication management for those requiring long-term dialysis: rationale and design for an observational study, and a quantitative description of study variables and data.

BackgroundRates of medication non-adherence in dialysis patients are high, and improving adherence is likely to improve outcomes. Few data are available regarding factors associated with medication adherence in dialysis patients, and these data are needed to inform effective intervention strategies.Methods/designThis is an observational cross-sectional study of a multi-ethnic dialysis cohort from New Zealand, with the main data collection tool being an interviewer-assisted survey. A total of 100 participants were randomly sampled from a single centre, with selection stratified by ethnicity and dialysis modality (facility versus home). The main outcome measure is self-reported medication adherence using the Morisky 8-Item Medication Adherence Scale (MMAS-8). Study data include demographic, clinical, social and psychometric characteristics, the latter being constructs of health literacy, medication knowledge, beliefs about medications, and illness perceptions. Psychometric constructs were assessed through the following survey instruments; health literacy screening questions, the Medication Knowledge Evaluation Tool (Okuyan et al.), the Beliefs about Medication Questionnaire (Horne et al.), the Brief Illness Perception Questionnaire (Broadbent et al.). Using the study data, reliability analysis for internal consistency is satisfactory for the scales evaluating health literacy, medication knowledge, and beliefs about medications, with Chronbach’s α > 0.7 for all. Reliability analysis indicated poor internal consistency for scales relating to illness perceptions. MMAS-8 and all psychometric scores are normally distributed in the study data.DiscussionThis study will provide important information on the factors involved in medication non-adherence in New Zealand dialysis patients. The resulting knowledge will inform long-term initiatives to reduce medication non-adherence in dialysis patients, and help ensure that they are addressing appropriate and evidence based targets for intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0097-2) contains supplementary material, which is available to authorized users.

Development and evaluation of the Measure of Drug Self-Management.

BackgroundCurrent adherence scales often fail to assess the full spectrum of behaviors associated with safe and appropriate drug use and may be unsuitable for patients with limited health literacy. We sought to develop and evaluate a comprehensive yet brief Measure of Drug Self-Management (MeDS) for use in research and clinical settings among diverse patient groups.MethodsExpert opinion, literature reviews, and interviews with patients and providers were utilized to create and revise potential items. Item performance testing was then conducted among 193 adult English-speaking patients with hypertension and diabetes. Factor analysis was used to inform item selection. Reliability was assessed via calculations of internal consistency. To assess construct and predictive validity, MeDS scores were compared with scores from the 8-item Morisky Medication Adherence Scale and relevant clinical measures (HbA1c, blood pressure, and low-density lipoprotein cholesterol).ResultsThe MeDS demonstrated adequate internal consistency with a Cronbach’s α of 0.72. The MeDS was significantly correlated with the Morisky Medication Adherence Scale (r= −0.62; P<0.001). The MeDS was also associated with clinical measures, with statistically significant correlations found between MeDS scores and low-density lipoprotein cholesterol (r= −0.27, P≤0.001) and diastolic blood pressure (r= −0.18, P=0.01).ConclusionThe MeDS seems to be a valid and reliable tool that can be used to assess medication self-management skills among diverse patients, including those with limited literacy skills. Future studies are needed to test the tool in actual use and explore clinical applications.