Psychometric Properties of the Thai Version of the 8-item Morisky

Medication Adherence Scale in Patients with Type 2 Diabetes

Phantipa Sakthong, Rossamalin Chabunthom, and Rungpetch Charoenvisuthiwongs

edication nonadherence in patients

M with diabetes has been associated
with poor blood glucose control.1-3 Poor
glycemic control can lead to develop-
ment of complications including neu-
ropathy, nephropathy, retinopathy, and
cardiovascular and cerebrovascular dis-
eases.4,5 In general, the adherence rate to
diabetic medications ranges from 36% to
93%.6
Nonadherence is also 1 of 7 drug ther-
apy problems that pharmaceutical care
providers must prevent, identify, and
solve.7 Tools used to measure adherence
include pill counts, electronic monitoring
systems, monitoring of drug concentra-
tions in blood and urine, medication
records at the pharmacy, and self-reports.8
Of these, the most convenient, least ex-
pensive, and easiest way to assess medica-
tion adherence is self-reporting. Morisky
et al.9 developed a 4-item self-report ques-
tionnaire to assess medication adherence.
The Morisky scale is one of the most
widely used self-reported medication ad-
10-13
herence measures. However, it has
shown poor psychometric properties. The
sensitivity and the specificity of the 4-item
adherence scale are 0.81% and 0.44%, re-
spectively. Cronbach’s α reliability value
is 0.61, which is below the acceptable val-
ue of 0.7.14
Morisky et al.15 recently developed a new self-reported
adherence measure called Morisky Medication Adherence
Author information provided at the end of the text.
BACKGROUND: A self-reporting questionnaire is the most convenient and cheapest
way to assess medication adherence. A new 8-item self-reported Morisky Medi-
cation Adherence Scale (MMAS) has been developed and has shown better
psychometric properties than the original 4-item Morisky scale.
OBJECTIVE: To examine the validity, including convergent known-groups and
construct validity, and reliability, including internal consistency and test–retest
reliability, of the MMAS in Thai patients with type 2 diabetes.
METHODS: The data were derived from a cross-sectional study. In a convenience
sample, 303 type 2 diabetic outpatients were interviewed at the General Police
Hospital in Bangkok, Thailand, between January and June 2007. Face-to-face
interviews included MMAS, medication adherence visual analog scale (MA-VAS),
and sociodemographic data. Medical records were reviewed for clinical data such
as hemoglobin A1C (A1C) levels.
RESULTS: Internal consistency reliability was moderate (Cronbach’s α = 0.61),
whereas the test–retest reliability of the MMAS was excellent (intraclass corre-
lation coefficient = 0.83; p < 0.001). Concerning convergent validity, the MMAS
had a high correlation with the 3-item Morisky scale (r = 0.77; p < 0.01) and a
medium correlation with the MA-VAS (r = 0.57; p < 0.01). Regarding known-
groups validity, a significant association between MMAS and A1C levels was
found (χ2 = 6.7; p < 0.05). The sensitivity, specificity, positive predictive value, and
negative predictive value of the MMAS were 51%, 64%, 71%, and 43%,
respectively. Our factor analysis showed that the MMAS had 3 dimensions
including forgetting to take medications, stopping medications when feeling better
or worse, and the complexity of the drug regimen.
CONCLUSIONS: The 8-item MMAS can be a tool to aid in assessing medication
adherence in diabetes. The poor sensitivity can be improved by increasing the
number of the response choices and the cut-off score of the scale and by using
specific words in some items. A modified Thai version of the 8-item MMAS may
be needed.
KEY WORDS: diabetes, Morisky Medication Adherence Scale, Thailand.
Ann Pharmacother 2009;43:950-7.
Published Online, 14 Apr 2009, www.theannals.com, DOI 10.1345/aph.1L453
Scale (MMAS). The MMAS comprises 8 items and has
better psychometric properties than the previous 4-item
medication adherence scale of Morisky. They found that
the MMAS had a sensitivity of 93% and a specificity of
53%, respectively. The α reliability value of the 8-item

950 n The Annals of Pharmacotherapy n 2009 May, Volume 43 www.theannals.com

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Morisky scale was 0.83, which is above the value of 0.7.
Because of the improved psychometric properties of the
MMAS, we were interested in testing the psychometric
properties of this new adherence scale in Thai people with
diabetes. Thus, the objective of this study was to assess the
validity, including convergent known-groups and construct
validity, and the reliability, including internal consistency
and test–retest reliability, of the MMAS in Thai type 2 dia-
betic patients.
Methods
DESIGN
The data used in this study were derived from a cross-
sectional study.16 In this study, a convenience sample of
315 type 2 diabetic outpatients was identified at the Dia-
betes Clinic of the General Police Hospital in Bangkok,
Thailand, between January and June, 2007. Approximately
97% (305) of the patients who were approached agreed to
participate. Patients who were eligible for the study were at
least 18 years old and able to understand the Thai lan-
guage. Patients who had severe health problems or cogni-
tive impairments who could not complete interviews were
excluded. Of the sample of 305 subjects, 99% (303) could
complete the interviews. Face-to-face interviews included
administration of the MMAS, followed by the medication
adherence visual analog scale (MA-VAS), and collection
of sociodemographic data. While the patients were inter-
viewed on adherence, they were asked to think about all
medications used. Nevertheless, since all were diagnosed
with diabetes, were taking at least one hypoglycemic drug,
and were interviewed at the Diabetes Clinic, they often re-
ferred to hypoglycemic drugs more than to other drug
groups.
On the same day of the interviews, medical records
were reviewed for hemoglobin A1C (A1C) levels, number
of hypoglycemic medications, whether the patient used in-
sulin, and the presence of diabetic complications such as
neuropathy, retinopathy, nephropathy, or cardiovascular
disease. In addition, about one-fifth of this sample (n = 64)
was randomly selected for a 1- to 2-week reliability test–
retest via telephone. All of the 64 patients agreed to partici-
pate in the telephone interview. All 303 face-to-face and 64
telephone interviews were done by one of the investiga-
tors, who is a pharmacist. This study was approved by the
Ethics Committee of the General Police Hospital.
MORISKY MEDICATION ADHERENCE SCALE
The MMAS was developed from the previous 4-item
Morisky Medication Adherence scale9 and supplemented
with additional items. The theory underlying this measure
was that failure to adhere to a medication regimen can be
caused by many factors, such as, “Do you sometimes for-
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get to bring medications with you when travelling?,” and
problems with the complexity of the medical regimen,
such as, “Do you feel hassled by sticking to your treatment
plan?” Each item of the MMAS items is measuring a spe-
cific behavior and is not a determinant of adherence be-
havior.15 Response choices are yes/no for items 1–7 and a
5-point Likert response for the last item. Scores obtained
from this scale range from 0 to 8, where higher scores indi-
cate higher adherence. Scores of 8, 6 to less than 8, and
less than 6 were classified as high, medium, and low ad-
herence, respectively.
For this study, the 8-item MMAS was translated into
Thai using a forward and back translation procedure. First,
2 bilingual people translated the MMAS from the English
version to a Thai version. Second, a third bilingual person
translated the Thai version back to English. Third, the orig-
inal and the back-translated English versions were com-
pared for conceptual equivalence. A pilot test (N = 25) was
done to ensure patient understanding of the wording of the
Thai version of the MMAS questionnaire.
DATA ANALYSIS
To summarize characteristics of the patients and de-
scriptive statistics, percents and frequencies were used for
categorical variables including sex, education, and type of
hypoglycemic drugs. Means, standard deviations, and
ranges (minimum and maximum) were calculated for con-
tinuous variables including age, A1C, the number of dia-
betic complications and hypoglycemic drugs, MA-VAS,
and MMAS. The characteristics of the whole sample and
adherent groups including high, medium, and low adher-
ence groups were presented. Analysis of variance (ANO-
VA) tests were used to determine the differences in contin-
uous variables among the 3 adherent groups. Regarding
categorical variables, χ2 tests were employed.
Internal consistency and test–retest reliability were as-
sessed using Cronbach’s alpha and intraclass correlation
coefficients (ICCs), respectively. The criteria of accepting
Cronbach’s α are equal to or above 0.70.14 The criteria for
interpretation of ICCs are based on Rosner (suggesting that
ICC < 0.40 = poor agreement, 0.40 ≤ ICC < 0.75 = fair to
good agreement, ICC ≥ 0.75 = excellent agreement).17
Convergent validity was evaluated using Pearson’s cor-
relation coefficients (r) to assess the association between
the MMAS and the previous 4-item Morisky scale. Three
items from the 8-item MMAS were employed to represent
the 4-item Morisky scale because they are the same items
as those of the previous scale. These 3 items included, “Do
you sometimes forget to take your medication?,” “Have
you stopped taking your medication without telling your
doctors when you felt worse?,” and “Have you stopped
taking your medications without telling your doctors when
you felt better?” In addition to the 4-item Morisky scale,
The Annals of Pharmacotherapy n 2009 May, Volume 43 n 951
P Sakthong et al.
the association between the MMAS and MA-VAS was ex-
plored. The MA-VAS showed a respondent a line with
endpoints of “no medication adherence at all” at 0 and
“full medication adherence” at 10. Correlations were inter-
preted using the criteria provided by Colton as follows:
0–0.25 = little or no correlation, 0.25–0.50 = fair correla-
tion, 0.50 – 0.75 = moderate to good correlation, and
greater than 0.75 = very good to excellent correlation.18
The known-groups validity was assessed through the as-
sociation of MMAS categories (high, medium, low adher-
ence) and A1C levels (≥7% and <7%) using χ2 tests. An
odds ratio with 95% confidence interval of the association
between MMAS categories and A1C levels was calculat-
ed. To provide helpful information in clinical practice, we
also determined the (1) sensitivity, as true positive: poorly
controlled (A1C ≥7%) indicates low adherence (MMAS
<6); (2) specificity, true negative: well controlled (A1C
<7%) indicates medium to high adherence (6 ≤ MMAS
≤8); (3) positive (pts. with low adherence are poorly con-
trolled) and negative (pts. with medium to high adherence
are well controlled) predictive values; and (4) efficiency
(true positive plus true negative) of the MMAS.19
Construct validity was tested using an exploratory factor
analysis. The factor analysis was conducted by a principal
component analysis, followed by Varimax rotation with
Kaiser normalization. Kaiser’s eigenvalue greater than 1
was used to determine the number of factors. Factor load-
ings greater than 0.4 on each item were considered to be-
long to the corresponding factors.
All analyses were performed using SPSS version 13.0
(SPSS Inc., chicago, IL). The level of significance was set
at p less than 0.05.
Results
Characteristics of the total sample and adherent groups
are shown in Table 1. Of 303 type 2 diabetic patients,
17.1% (52), 37.0% (112), and 45.9% (139) were high,
medium, and low adherent groups, respectively. There
were no significant differences in age, sex, education, or
the number of diabetic complications among the 3 adher-
ent groups (all p ≥ 0.5). Significance differences were
found in A1C levels, the number of hypoglycemic drugs,
type of hypoglycemic drugs, MA-VAS scores, and
MMAS scores among the 3 adherent groups (all p < 0.5).
Figure 1 presents the distribution of the 8-item MMAS
scores.
RELIABILITY
Regarding internal consistency reliability, Cronbach’s α
for MMAS was 0.61, which is below the acceptable value
of 0.7. However, for test–retest reliability the MMAS
showed an excellent ICC of 0.83 (p < 0.001).
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CONVERGENT VALIDITY
MMAS was positively associated with the original 3-
item Morisky scale (r = 0.77; p < 0.01) and MA-VAS (r =
0.57; p < 0.01). The MMAS had very good to excellent
correlation with the 3-item Morisky scale and medium to
good correlation with the MA-VAS.
KNOWN-GROUPS VALIDITY
As shown in Table 2, a significant relationship between
the MMAS and blood glucose control was found (χ2 = 6.7;
p = 0.035). Low medication adherence (MMAS score <6)
was associated with poor blood glucose control (A1C
≥7%; OR 1.84; 95% CI 1.16 to 2.92). However, the
MMAS showed a poor sensitivity. The sensitivity, speci-
ficity, positive predictive value, and negative predictive
value of the MMAS were 0.51, 0.64, 0.71, and 0.43, re-
spectively. This sensitivity means that 51% of diabetic pa-
tients who had poor glycemic control had low adherence,
while the specificity indicates that 64% of the patients with
good blood glucose control were highly adherent to drug
therapy. The positive predictive value indicates that 71%
of subjects with low adherence were poorly controlled,
whereas the negative predictive value means that 43% of
those with medium-to-high adherence had good glycemic
control. The efficiency of the MMAS as a screening test
was only 55.8%.
CONSTRUCT VALIDITY
Exploratory factor analysis showed 3 factors with eigen-
values greater than 1, which explained 57.4% of the total
variance. Factor loadings between the 8 items of MMAS
and the 3 factors are presented in Table 3. Factor 1 com-
prised items 1, 2, and 4, which mostly involved patients
forgetting to take medications. Factor 2 consisted of items
3, 5, and 6, which concerned patients stopping medications
when they were feeling better or worse. Factor 3 included
items 7 and 8, which were viewed as the complexity of the
drug regimen. Factor 1 had the highest correlation with the
8-item MMAS (r = 0.83; p < 0.01), followed by factor 2 (r
= 0.62; p < 0.01) and factor 3 (r = 0.54; p < 0.01).
Discussion
This study was the first to psychometrically tested the
new 8-item MMAS in a population whose first language is
not English. Other studies employed the 9-item MMAS
(adding 1 more item about reminder system for medicines)
in HIV-positive patients in Sweden.20,21 However, they did
not examine the psychometric properties of the MMAS.
Our study was also the first to apply the 8-item MMAS to
assess medication adherence in diabetic patients, whereas
Morisky et al.15 tested the psychometric properties of their
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 Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale

8-item MMAS in hypertensive patients. They found that
the 8-item MMAS was reliable, with good concurrent and
predictive validity and had good sensitivity. Our study
showed that the 8-item MMAS had good test–retest relia-
bility and convergent validity in Thai people with diabetes.
However, the 8-item MMAS showed poor sensitivity. We
also found that the 8-item MMAS was a 3-factor scale in
this sample.
The MMAS had excellent test–retest reliability (ICC =
0.83), whereas the internal consistency reliability was mod-
erate (Cronbach’s α = 0.61, which is <0.70). Our result is
different from that of Morisky et al.15 They reported that the
8-item MMAS had a Cronbach’s α of 0.83 and is a one-di-
mensional scale. An explanation for the unacceptable α
value in our study is scale multidimensionality. Internal
consistency reliability is a measure of the homogeneity of
the items within a scale. If all items measure the same trait,
the internal consistency reliability of the whole scale will be
high. Since our exploratory factor analysis showed that the
scale had 3 dimensions, meaning that there were 3 different
traits in this sample, the α of the whole scale is lower than
the acceptable value of 0.70. Internal consistency reliability
also depends on the number of items of a scale (ie, the more
items, the higher the internal consistency reliability). An-
other possible reason for the reduced α is that most items (7
of 8) on the scale use dichotomous response choices

Table 1. Characteristics of Type 2 Diabetic Patients

High Medium Low
Total Adherence Adherence Adherence
Sample (MMAS = 8) (6 ≤ MMAS < 8) (MMAS < 6)
Characteristic (N = 303) (n = 52) (n = 112) (n = 139)
a
Age, y
mean ± SD 61.1 ± 11.4 63.9 ± 11.2 62.31 ± 10.2 60.1 ± 12.3
range 27–90 37–90 35–85 27–89
Sex, %a
female 71 65 74 70
male 29 35 26 30
Education, %a
none 5.6 9.6 3.6 5.7
6th grade or less 42.6 42.3 41.1 43.9
7th–12th grade 30.7 34.6 27.7 31.6
college 2–4 y 18.2 7.7 23.9 15.8
higher than college 3 5.7 3.8 2.9
A1C level, %b
mean ± SD 7.7 ± 1.7 7.4 ± 1.9 7.4 ± 1.4 8.0 ± 1.8
range 4.0–15.8 4.5–15.8 5.3–13.3 4.0–14.9
Diabetic complications, na
mean ± SD 0.82 ± 0.88 0.67 ± 0.86 0.84 ± 0.94 0.85 ± 0.84
range 0–4 0–3 0–4 0–4
Hypoglycemic drugs, nb
mean ± SD 2.77 ± 1.22 2.50 ± 1.26 2.64 ± 1.09 2.96 ± 1.28
range 1–6 1–5 1–6 1–6
Type of hypoglycemic drug, %b
only oral hypoglycemic 60.7 73 69 50
oral hypoglycemic plus insulin 35.3 25 29 44
only insulin 4 2 2 6
MA-VASb,c
mean ± SD 8.68 ± 1.36 9.86 ± 0.38 9.05 ± 0.98 7.93 ± 1.43
range 3.50–10.00 8.00–10.00 5.00–10.00 3.50–10.00
MMASb, c
mean ± SD 5.71 ± 1.64 8.00 ± 0.00 6.43 ± 0.50 4.27 ± 1.11
range 0.50–8.00 8.00–8.00 6.00–7.75 0.50–5.75

A1C = hemoglobin A1C; MA-VAS = medication adherence visual analog scale; MMAS = Morisky Medication Adherence Scale.
a
No significance differences were found among adherent groups (p ≥ 0.05).
b
Significant differences were found among adherent groups (p < 0.05).
c
The higher MA-VAS and MMAS scores indicate higher medication adherence.

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P Sakthong et al.
(yes/no). Internal consistency reliability can be improved
by increasing the number of response choices to a threshold
of 7, because the more response choices, the lower the mea-
surement error of the scale.22
Not surprisingly, the MMAS had a high correlation with
the previous 3-item Morisky scale (r = 0.77). However, it
had only moderate correlation with MA-VAS (r = 0.57).
Morisky et al.,15 reported that the 8-item scale was signifi-
cantly correlated with the previous 4-item scale (Pearson
correlation of 0.64), which was lower than that of our
study.
As for known-groups validity, although there was a sig-
nificant association between the MMAS results and blood
glucose control (χ2 = 6.7; p < 0.05), it showed a poor sensi-
tivity (51%), a specificity (64%), a positive predictive val-
ue (71%), and a negative predictive value (43%). Morisky
et al.15 showed that the 8-item MMAS had a sensitivity of
93% and a specificity of 53%. We showed higher speci-
ficity but lower sensitivity than those of the study of
Morisky et al. The decreased sensitivity of the MMAS in
this study may have been contributed to by social desir-
ability; our subjects may have answered untruthfully that
they adhered to their diabetic medications, although they
did not.
When we tried to change the cut-off score of low adher-
ence from 6 to 7 (low adherence = MMAS scores <7), the
sensitivity, specificity, positive predictive value, negative
predictive value and the efficiency of the MMAS were
75%, 38%, 68%, 46%, and 61%, respectively. Similarly, if
the cut-off score was increased to be 8 (low adherence =
MMAS scores <8), the sensitivity, specificity, positive pre-
Figure 1. Distribution of the 8-item Morisky Medication Adherence Scale scores.
954 n The Annals of Pharmacotherapy n 2009 May, Volume 43
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dictive value, negative predictive value, and efficiency of
the MMAS were 85%, 21%, 65%, 46%, and 62%, respec-
tively. Thus, the higher the cut-off scores of the MMAS
were, the higher the sensitivity and the higher the efficien-
cy of the scale. The increased cut-off scores did not greatly
affect the positive predictive value and the negative predic-
tive value of the MMAS. However, we have to trade off
the higher sensitivity against lower specificity. In clinical
practice, healthcare providers are more interested in identi-
fying patients with poor glycemic control and low adher-
ence than well-controlled patients with high adherence;
therefore, increasing the cut-off score of the scale can be a
good option for solving its low sensitivity problem. How-
ever, this solution may not work well if the hospital lacks
sufficient healthcare personnel, because use of the in-
creased cut-off score will result in more patients with low
adherence, causing increased burden for the providers.
Thus, the appropriate cut-off point of the MMAS to detect
low medication adherence may compromise the number of
hospital personnel who can monitor adherence.
In addition to the problem of social desirability, reduced
sensitivity could be caused by the dichotomous response
choices on most items of the scale, as previously men-
tioned. Moreover, the wording of some items is not specif-
ic. For example, “Do you sometimes forget to take your
medication?” could include both patients who missed a
few doses and those who regularly forgot to take their
medicines. Therefore, rewording the question to be eigen-
value more specific, such as, “Have you ever forgotten to
take your medications in the past month?,” would improve
the sensitivity of the scale. In addition, Morisky et al. have
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 Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale
stated that each item of the MMAS is measuring a specific
medication-taking behavior and is not a determinant of ad-
herence behavior.15 This may lead to a poor relationship
between the MMAS and A1C levels, since the MMAS
does not directly predict the blood glucose level.
Because A1C is the average blood glucose level in the
past 2–3 months, it can reflect medication adherence. Nev-
ertheless, because of its cost, A1C is not measured on a
regular basis in Thailand; it is mostly determined in large
hospitals. Fasting blood glucose levels are common mea-
sures in Thailand, but they do not reveal medication adher-
ence as well as A1C levels do. In this study, fasting blood
glucose levels were also not significantly associated with
MMAS scores (data not shown). Therefore, the 8-item
MMAS can be an initial tool to help in assessing adher-
ence in any Thai healthcare setting where A1C is not avail-
able, since it is simple and economical to use and yielded
acceptable reliability and validity. For example, a health-
care provider can apply the MMAS to aid in identifying
drug therapy problems such as low adherence due to ad-
verse effects or complexity of drug regimens in diabetic
patients at risk of uncontrolled blood glucose. As for pa-
tients with high medication adherence and good blood glu-
cose control, the MMAS can also be used to remind pa-
tients of the importance of continued adherence and the
benefits of well-controlled glucose control.
Table 2. Relationship Between MMAS and Blood
Glucose Controla
A1C ≥7% A1C <7%
(poor (good
Parameter control) control) Total
Low adherence (MMAS < 6) 99 (71) 40 (29) 139
Medium adherence (6 < MMAS < 8) 66 (59) 46 (41) 112
High adherence (MMAS = 8) 28 (54) 24 (46) 52
Total 193 110 303
A1C = hemoglobin A1C; MMAS = Morisky Medication Adherence Scale.
a
Number (%) of patients; χ2 = 6.7; p = 0.035.
Table 3. Exploratory Factor Analysis of the 8-Item Morisky Medication Adherence Scale in Patients with Type 2 Diabetesa
Item
1. Sometimes forget to take medications?
2. Did not take medications in the past 2 wk?
3. Stop taking medications when feeling worse?
4. Sometimes forget to bring medications when traveling?
5. Took medications yesterday?
6. Stop taking medications when well controlled?
7. Feeling hassled about sticking to treatment plan?
8. How often do you have difficulty remembering to take medications?
a
Factor loading in 303 patients. Bold-faced numbers indicate factor loadings >0.4.
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Our results may limit the ability to generalize the results
to other disease groups. Thus, more research on the psycho-
metric properties of the new MMAS in Thai people with
other clinical conditions is needed. Since this study was a
cross-sectional design, other important psychometric proper-
ties, including responsiveness and predictive validity, were
not conducted. Further research on these properties is en-
couraged.
We conclude that the 8-item MMAS can be a useful
self-report medication adherence measure in Thai people
with diabetes because it shows acceptable test–retest relia-
bility and convergent and construct validity. However, the
poor sensitivity of the scale can be improved by increasing
the number of the response choices and the cut-off score of
the scale and using specific words in some items. A modi-
fied Thai version of the 8-item MMAS may be needed.
Phantipa Sakthong PhD, Assistant Professor, Department of Phar-
macy Practice, Faculty of Pharmaceutical Sciences, Chulalongko-
rn University, Bangkok, Thailand
Rossamalin Chabunthom MS, Hospital Pharmacist, Sawang-
dandin Crown Prince Hospital, Sakonnakorn Province, Thailand
Rungpetch Charoenvisuthiwongs PhD, Assistant Professor,
Department of Pharmacy Administration, Faculty of Pharmaceuti-
cal Sciences, Chulalongkorn University
Reprints: Dr. Sakthong, Department of Pharmacy Practice, Facul-
ty of Pharmaceutical Sciences, Chulalongkorn University, Prayathai
Rd., Pathumwan, Bangkok (10330), Thailand, fax 662-218-8403,
phantipa_sakthong@yahoo.com
This study was supported by a fund from Chulalongkorn University.
We thank the participants for providing valuable data, and the nurs-
es and physicians for their assistance in collecting the data. We also
thank Dr. Donald Morisky for his permission to use the MMAS.
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Propiedades Psicométricas de la Versión Tailandesa de la Escala de
Morisky de Cumplimiento Terapéuticos de 8 Cuestiones en Pacientes
con Diabetes Tipo 2
P Sakthong, R Chabunthom, y R Charoenvisuthiwongs
Ann Pharmacother 2009;43:950-7.
EXTRACTO
ANTECEDENTES: La forma más adecuada y económica de evaluar el cumpli-
miento terapéutico es usando un cuestionario de declaración de síntomas.
956 n The Annals of Pharmacotherapy n 2009 May, Volume 43
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Se ha desarrollado una nueva Escala de Morisky de Cumplimiento Tera-
péutico (MMAS) para declaración de síntomas formada por 8 cuestiones y
ha demostrado presentar mejores propiedades psicométricas que la primera
escala de Morisky, que constaba de 4 cuestiones.
OBJETIVOS: Determinar la validez, incluida la validez convergente, la
validez con grupos conocidos y la validez de constructo y la fiabilidad,
incluida la consistencia interna y la fiabilidad “test–retest” de la MMAS
en pacientes tailandeses con diabetes tipo 2.
MÉTODOS: Los datos se obtuvieron a partir de un estudio transversal. Se
entrevistó a una muestra por conveniencia de 303 pacientes ambulatorios
con diabetes tipo 2 en el General Police Hospital en Bangkok, Tailandia,
entre enero y junio de 2007. Las entrevistas realizadas cara a cara
incluyeron la MMAS, la escala analógica visual de cumplimiento
terapéutico (MA-VAS), y datos sociodemográficos. Se revisaron los
archivos médicos para comprobar datos clínicos como los niveles de
HbA1C.
RESULTADOS: La fiabilidad como consistencia interna fue moderada (α de
Cronbach = 0.61), mientras que la fiabilidad como “test–retest” de la
MMAS fue excelente (ICC = 0.83; p < 0.001). En cuanto a la validez
convergente, la MMAS presentó una alta correlación con la escala de
Morisky de tres cuestiones (r = 0.77; p < 0.01) y una correlación media con
la MA-VAS (r = 0.57; p < 0.01). En relación a la validez con grupos
conocidos, se encontró una asociación significativa entre la MMAS y
los niveles de HbA1C (χ2 = 6.7; p < 0.05). La sensibilidad, especificidad,
y los valores pronósticos positivos y negativos de la MMAS fueron de
51%, 64%, 71%, 43%, respectivamente. Nuestro análisis de factores
demostró que la MMAS presentaba 3 dimensiones como olvidar tomar la
medicación, dejar de tomar la medicación cuando los síntomas
mejoraban o empeoraban y la complejidad del régimen terapéutico.
CONCLUSIONES: La escala MMAS de 8 cuestiones puede constituir una
herramienta para la evaluación del cumplimiento terapéutico en la
diabetes. La baja sensibilidad puede mejorarse incrementando el número
de opciones de respuesta y la puntuación de corte de la escala utilizando
determinadas palabras en algunas cuestiones. Puede ser necesario crear
una versión tailandesa modificada de la MMAS de 8 cuestiones.
Traducido por Violeta Lopez Sanchez
Les Propriétés Psychométriques de la Version Thai de l’Échelle
d’Adhésion à la Médication en 8 Points de Morisky chez des
Patients Souffrant de Diabète de Type 2
P Sakthong, R Chabunthom, et R Charoenvisuthiwongs
Ann Pharmacother 2009;43:950-7.
RÉSUMÉ
ÉTAT DES CONNAISSANCES: Un questionnaire d’autoévaluation est le
moyen le plus commode et le moins dispendieux pour évaluer
l’adhésion à la médication. Une nouvelle échelle d’adhésion à la
médication de Morisky (ÉAMM) en 8 points a été développée et a
démontré des propriétés psychométriques supérieures à l’échelle
originale de Morisky en 4 points.
OBJECTIFS: Examiner la validité incluant la validité convergente, la
validité du construit et la validité pour groupes différents et examiner la
fiabilité incluant la cohérence interne et la fiabilité test–retest de
l’ÉAMM chez des patients Thai diabétiques de type 2.
MÉTHODOLOGIE: Les données ont été obtenues à partir d’une étude
transversale. Un échantillon de 303 patients diabétiques de type 2 vus en
externe ont été interviewés à l’hôpital General Police de Bangkok,
Thailand, entre janvier et juin 2007. Les interviews en tête à tête
comprenaient l’ÉAMM, l’échelle visuelle analogue d’adhésion à la
médication (ÉVA-AM), et des données sociodémographiques. Les
dossiers médicaux ont été révisés pour obtenir des données cliniques tels
les taux d’HbA1C.
RÉSULTATS: La cohérence interne s’est révélée modérée (coefficient α de
Crohnbach = 0.61) alors que la fiabilité test–retest de l’ÉAMM a été
excellente (ICC = 0.83; p < 0.001). Concernant la validité convergente,
l’ÉAMM a obtenu une corrélation élevée avec l’échelle de Morisky en 3
points (r = 0.77; p < 0.01), et une corrélation moyenne avec l’ÉVA-AM
www.theannals.com
 Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale

(r = 0.57; p < 0.01). En ce qui regarde la validité de groupes différents
connus, une association significative entre l’ÉAMM et les taux d’HbA1C
a été trouvée (χ2 = 6.7; p < 0.05). La sensibilité, la spécificité, la valeur
prédictive positive et la valeur prédictive négative de l’ÉAMM ont été
respectivement 51%, 64%, 71%, et 43%. L’analyse factorielle a
démontré que l’ÉAMM comportait 3 dimensions incluant l’oubli de
prendre ses médicaments, l’arrêt de prendre la médication quand on se
sent mieux ou pire, et la complexité du régime médicamenteux.
CONCLUSIONS: L’ÉAMM en 8 points peut être un outil pour aider à
évaluer l’adhésion aux médicaments chez les diabétiques. La faible
sensibilité peut être améliorée en augmentant le nombre de choix de
réponses et le seuil des résultats et en utilisant des mots spécifiques dans
certains points. Une version Thai modifiée de l’ÉAMM en 8 points peut
être nécessaire.
Traduit par Marie Larouche

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