The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults

Association Between Body Mass Index and the Efficacy of Calcium Channel Blockers for Hypertension in Cardiovascular Disease Patients

BACKGROUND

Hypertension, or high blood pressure, is a major risk factor for cardiovascular diseases (CVDs) worldwide. Variations in body mass index (BMI) may influence the efficacy of calcium channel blockers (CCBs) by affecting drug metabolism, vascular resistance, and inflammatory responses associated with adipose tissue.

OBJECTIVE

This study aims to evaluate the association between BMI and the short-term efficacy of CCBs in managing hypertension among patients with CVDs over a six-month follow-up period.

METHODOLOGY

This prospective observational study was conducted at the Department of General Internal Medicine, Royal Alexandra Hospital, Glasgow, UK, from June 2023 to June 2024, enrolling 220 patients diagnosed with hypertension and at least one underlying cardiovascular condition, such as coronary artery disease, heart failure, or atrial fibrillation. Patients were categorized into BMI groups based on the World Health Organization (WHO) classification, and all were prescribed CCBs either as monotherapy or in combination with other antihypertensive medications. Blood pressure was measured using an automated sphygmomanometer with follow-up ambulatory monitoring, while lipid levels were assessed via fasting blood samples.

RESULTS

The study involved 220 participants, categorized into four BMI groups: underweight (n = 40), normal weight (n = 60), overweight (n = 60), and obese (n = 60). Underweight patients had a baseline systolic/diastolic blood pressure of 150/95 mmHg, which decreased to 135/85 mmHg, showing a reduction of 15/10 mmHg. Normal weight patients experienced a drop from 145/90 mmHg to 130/80 mmHg, overweight patients from 155/95 mmHg to 140/85 mmHg, and obese patients from 160/100 mmHg to 145/90 mmHg, all with the same reduction of 15 mmHg in systolic and 10 mmHg in diastolic pressure. Low-density lipoprotein (LDL) levels decreased in all groups, with a reduction of 5 mg/dL in the underweight (130 to 125 mg/dL) and normal weight (125 to 120 mg/dL) groups, while the overweight (140 to 130 mg/dL) and obese (150 to 140 mg/dL) groups showed a greater reduction of 10 mg/dL. High-density lipoprotein (HDL) levels improved in all categories, increasing by 5 mg/dL in each group. LDL reduction was more pronounced in overweight and obese groups, likely due to metabolic changes associated with higher body fat. Adverse effects, including peripheral edema and dizziness, were more common in higher BMI groups, with a noticeable decline in medication adherence in obese patients. These results suggest that BMI may influence treatment efficacy, particularly in lipid regulation and the occurrence of adverse effects.

CONCLUSION

BMI does not significantly affect the blood pressure-lowering efficacy of CCBs in patients with hypertension and CVDs. However, a greater reduction in LDL levels was observed in overweight and obese groups, suggesting that BMI may influence lipid metabolism differently than blood pressure regulation.

Adherence Definitions, Measurement Modalities, and Psychometric Properties in HIV, Diabetes, and Nutritional Supplementation Studies: A Scoping Review

Measuring adherence has been a priority for researchers to help inform effective care for patients regularly consuming medications for chronic conditions. As a widely accepted "gold standard" adherence measure or operational definition does not exist, studies measure adherence using different modalities, which may lead to different conclusions about adherence patterns. The purpose of the scoping review was to identify modalities used to measure adherence to HIV medication, diabetes medication, and nutritional supplementation and explore the variation in adherence definitions, measurement modalities, and psychometric properties being reported across studies. Comprehensive searches were performed in PubMed, Scopus, and PsycINFO from January 2012 to January 2022. We included studies reporting psychometric properties of adherence/compliance to HIV medication, diabetes medication, or nutritional supplements. In total, we included 88 studies in the review. The 8-item Morisky Medication Adherence Scale (MMAS-8) was the most frequently used self-reported measure. We found almost no relationship between country income level and triangulation levels. The operational definition of adherence fell into four categories: numerical, dichotomous, ranked ordinal, and undefined. The amount of variation in an adherence definition category within a modality depended on whether the measures within the modality could be assessed numerically and whether widely accepted cutoffs existed for the measure. Across studies, 46 (52%) reported both validity and reliability, 28 (31%) reported validity only, and 14 (16%) reported reliability only. Fourteen types of validity and six types of reliability were identified across the studies. Measuring adherence accurately and reliably continues to be a challenge for research in HIV, diabetes, and nutritional supplementations. When reporting adherence measurements, we suggest including adherence results from multiple measures and modalities, presenting adherence results numerically, and reporting multiple types of validity and reliability.

Adherence to recommended diet among patients with diabetes mellitus type 2 on follow-up at Adama Hospital Medical College, Ethiopia

Introduction

Non-adherence to dietary guidelines is a significant challenge in managing diabetes mellitus and its complications. Its consequences were significantly associated with a deterioration in patients' quality of life and an increased socioeconomic burden on healthcare delivery systems. This study aimed to assess the magnitude of adherence to recommended diet and associated factors among patients with diabetes mellitus type 2 on follow-up care at Adama Hospital Medical College Oromia, Ethiopia.

Methods

A hospital-based cross-sectional study design was conducted. Participants were selected through systematic random sampling. Data were collected using structured, interviewer-administered questionnaires. The perceived dietary adherence questionnaire was used to assess the level of dietary adherence. A simple binary logistic regression was used to identify candidate variables, while a multivariable logistic regression assessed factors associated with adherence to the recommended diet. A p-value <0.05 were considered as statistically significant. All analyses were performed using SPSS and R programming software.

Result

A total of 405 participants were included in the study, with a response rate of 96.2%. The magnitude of non-adherence to the recommended diet was 64.2% (95% confidence interval [CI]: 59.8, 68.6). In the multivariable logistic regression model, patients with low and middle income (AOR = 8.0; 95% CI: 3.4, 19.2) and (AOR = 2.75; 95% CI: 1.49, 5.55) respectively, high glycemic level (AOR = 2.15; 95% CI: 1.17, 3.94), food insecure (AOR = 12.7; 95% CI: 5.79, 28.2), poor diabetic knowledge (AOR = 2.88; 95% CI: 1.49, 5.55) and low perceived susceptibility (AOR = 2.97; 95% CI: 1.62, 5.45) were significantly associated factors for non-adherence to recommended diet among patients with diabetes mellitus type 2.

Conclusion

This study revealed that approximately two-thirds of patients with type 2 diabetes mellitus experienced non-adherence to the recommended diet. Key factors linked to dietary non-adherence among T2DM patients include low to middle income, elevated glycemic levels, household food insecurity, limited diabetes knowledge, and low perceived susceptibility. An integrated approach that combines socioeconomic support, nutritional guidance, and risk awareness may greatly enhance dietary adherence and optimize diabetes management.

Medication Adherence of Children with Congenital Hypothyroidism in Iran: A National Cross-Sectional Study

Background

Congenital hypothyroidism is the most common preventable and treatable cause of intellectual disability in children. A key component of the surveillance system for congenital hypothyroidism is ensuring a regular treatment program for affected children. Despite nearly 20 years since the successful implementation of the newborn screening program for hypothyroidism in Iran, a comprehensive evaluation of patients' adherence to treatment has not been conducted.

Objectives

The aim of this study was to investigate the adherence to treatment among patients with congenital hypothyroidism in Iran.

Methods

In this national cross-sectional study conducted in 2024, the adherence to treatment of 400 children with congenital hypothyroidism born between 2019 and 2023 in Iran was examined using the Morisky Medication Adherence Scale. The patients were randomly selected from national registry data. Data were analyzed using chi-squared tests, Fisher's exact test, and logistic regression in Stata software version 16.

Results

The mean and standard deviation of medication adherence was 6.35 ± 1.41. Overall, adherence was good (≥ 6) in 284 (71.0%) of the study participants. In the univariate analysis, the most significant factors influencing adherence were place of residence, higher maternal education, lower paternal education, and type of congenital hypothyroidism (CH). In the multivariate analysis, children with permanent CH had good adherence, and parental education was not statistically significant (P > 0.05).

Conclusions

The results of this study showed that medication compliance in more than two-thirds of hypothyroid children diagnosed by national newborn screening is good. Given the importance of treatment in these patients, it is recommended that intervention plans be implemented, including educational programs and active follow-up of patients to increase compliance.

Levels of adherence to treatment, illness perception and acceptance of illness in patients with coronary artery disease - descriptive and correlational study

BACKGROUND

Understanding the disease and its acceptance significantly influence adherence to prescribed medications, a critical aspect in managing coronary artery disease (CAD). This study is designed to explore the multifaceted factors influencing medication adherence specifically in CAD patients. Of particular interest is investigating the interconnectedness between medication adherence, the perception of illness, and the level of acceptance of the illness itself among these individuals.

METHODS

This cross-sectional study involved 280 confirmed CAD patients who were selected through a convenience sampling method adhering to predefined inclusion criteria. The study was conducted between March and September 2023. Three primary parameters-medication adherence, illness perception, and acceptance of illness-were evaluated using standardized tools: The Morisky Medication Adherence Scale-8, Illness Perception Questionnaire-Brief, and Acceptance of Illness Scale. Statistical analyses using SPSS (version 25) were used to analyze the data.

RESULTS

Patients had moderate illness perception (51.82 ± 7.58) and low acceptance to illness (16.98 ± 4.75), and 61.8 of them adhered to their medication regimen. A positive relationship between acceptance of illness and medication adherence (r = 0.435, p-value < 0.01) was found. Level of education, type of drug and marital status had significantly impact on medication adherence, and gender, level of education, intention to stop drug and marital status were associated with acceptance of illness (p < 0.05).

CONCLUSION

These results underscore the pivotal role of medication adherence in CAD management. Future interventions should target improving illness perception and acceptance of illness among CAD patients to enhance their overall adherence to prescribed medications and ultimately improve disease management.

Quality of measurement properties of medication adherence instruments in cardiovascular diseases and type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Medication adherence has a major impact on reducing mortality and healthcare costs related to the treatment of cardiovascular diseases and diabetes mellitus. Selecting the best patient-reported outcome measure (PROM) among the many available for this kind of patient is extremely important. This study aims to critically assess, compare and synthesize the quality of the measurement properties of patient-reported outcome measures to assess medication adherence among patients with cardiovascular diseases and/or type 2 diabetes mellitus.

METHODS

This review followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). The searches were performed in Web of Science, SCOPUS, PubMed, CINAHL, EMBASE, LILACS, PsycINFO, and ProQuest (gray literature).

RESULTS

A total of 110 records encompassing 27 different PROMs were included in the review. The included records were published between 1986 and 2023, most of which reported studies conducted in the United States and were published in English. None of the PROMs were classified in the category "a", thus being recommended for use due to the quality of its measurement properties. The PROMs that should not be recommended for use (category "c") are the MTA, GMAS, DMAS-7, MALMAS, ARMS-D, and 5-item questionnaire. The remaining PROMs, e.g., MMAS-8, SMAQ, MEDS, MNPS, ARMS-12, MGT, MTA-OA, MTA-Insulin, LMAS-14, MARS-5, A-14, ARMS-10, IADMAS, MAQ, MMAS-5, ProMAS, ARMS-7, 3-item questionnaire, AS, 12-item questionnaire, and Mascard were considered as having the potential to be recommended for use (category "b").

CONCLUSION

None of the included PROMs met the criteria for being classified as trusted and recommended for use for patients with cardiovascular diseases and/or type 2 diabetes mellitus. However, 21 PROMs have the potential to be recommended for use, but further studies are needed to ensure their quality based on the COSMIN guideline for systematic reviews of PROMs.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019129109.

Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial

BACKGROUND

Comorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities.

METHODS

In this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge.

RESULTS

Both groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P < 0.001) at other time points. A significant increase in medication adherence (P < 0.001) and a significant reduction in the burden of all symptoms were observed in the intervention group compared to the control group from Time 1 to Time 3.

CONCLUSIONS

The MMP (targeting comorbidity) is a promising strategy for managing symptoms and medication adherence in HF patients with comorbidities.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India

BACKGROUND

Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India.

OBJECTIVES

To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication.

METHODOLOGY

A hospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA).

RESULTS

The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days.

CONCLUSION

The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

Reliability and validity of the Chinese version of the eight-item Morisky Medication Adherence Scale in Chinese patients with systemic lupus erythematosus

OBJECTIVE

To evaluate the reliability and validity of the Chinese version of the eight-item Morisky Medication Adherence Scale (MMAS-8) in Chinese patients with systemic lupus erythematosus (SLE).

METHODS

The survey was conducted with a consecutive sampling of 158 Chinese SLE patients attending public hospitals from January to March 2021. We used the translated Chinese version of the MMAS-8 to collect related data. Reliability, item, and factor analyses were used to test the reliability and validity of the MMAS-8 scale in the selected patients. The internal consistency reliability was evaluated using Cronbach's α coefficient. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs) in a subset of 30 participants. Construct validity was evaluated using confirmatory factor analysis and correlations between the Self-efficacy for Appropriate Medication Use Scale (SEAMS) and related measures.

RESULTS

The internal consistency reliability of the Chinese version of the MMAS-8 was high (Cronbach's α = 0.817), and the test-retest reliability was excellent (intraclass correlation = 0.947; P < 0.001). There were significant differences in the F test and t test between the two extreme groups before and after the ranking of 27% of the questionnaire scores (P < 0.001). The Kaiser-Meyer-Olkin (KMO) value of construct validity was 0.860. The spherical test value of Bartlettgers was 417.8822. Factor analysis yielded three components that accounted for 69.375% of the total variance. Exploratory factor analysis identified three dimensions of the Chinese version of the MMAS-8. In terms of criterion validity, the correlation of the MMAS-8 score in SEAMS indicated that the convergent validity was good (r = 0.926; P < 0.001).

CONCLUSIONS

This study shows that the Chinese version of the Medication Adherence Scale-8 is a reliable and valid tool for assessing medication adherence in Chinese SLE patients. Key Points • Many factors affect medication adherence in SLE patients. • Many questionnaires measure medication adherence levels. • There is a lack of reliable validation of medication adherence questionnaires specifically for SLE patients.

Medication Adherence Among Hypertensive Patients Attending Different Primary Health Centers in Abha, Saudi Arabia: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Optimal blood pressure control is achieved by medication adherence. This will reduce the risk of associated morbidities and mortalities. The present study aimed to determine medication adherence and its associated factors among hypertensive patients attending different primary health centers (PHC) in Abha, Saudi Arabia (KSA).

METHODS

A cross-sectional study was conducted among ten different PHCs in Abha, KSA. Simple random sampling procedure was utilized to choose 400 participants. A structured anonymous questionnaire was used in the present study. Analysis of the data was done using the SPSS program, version 23. A logistic regression statistical test was applied to identify the independent associated factors of medication adherence. Furthermore, we have applied Spearman's test to find the correlation between overall B-IPQ score and medication adherence score.

RESULTS

A total of 400 hypertensive patients responded in the present survey. More than one-third of the participants (36.3%) were in the high adherence category group, while the remaining participants (63.7%) were either low or medium adherence category. The binary logistic regression analysis revealed that low and medium adherence category is significantly associated with age (adjusted odds ratio [AOR] = 0.96, 95% CI =0.93-0.99, p = 0.021), married participants (AOR = 0.42, 95% CI =0.33-0.58, p = 0.001), residing at village (AOR = 1.49, 95% CI =1.14-1.73, p = 0.038), and participants with monthly family income of 5000 to 7000 SAR (AOR = 3.06, 95% CI =1.62-5.79, p = 0.001). A negligible positive correlation was revealed between illness perception and medication adherence.

CONCLUSION

The present study revealed that hypertensive patients poorly adhere to their antihypertensive medications. This low adherence is significantly associated with the age, monthly income, people living in rural areas, and married participants. The present study results recommend sustained efforts to implement health education programs and awareness-raising interventions targeted at hypertensive patients.