title: The Malaysian Medication Adherence Scale (MALMAS): Concurrent Validity Using a Clinical Measure among People with Type 2 Diabetes in Malaysia.
abstract: Medication non-adherence is a prevalent problem worldwide but up to today, no gold standard is available to assess such behavior. This study was to evaluate the psychometric properties, particularly the concurrent validity of the English version of the Malaysian Medication Adherence Scale (MALMAS) among people with type 2 diabetes in Malaysia. Individuals with type 2 diabetes, aged 21 years and above, using at least one anti-diabetes agent and could communicate in English were recruited. The MALMAS was compared with the 8-item Morisky Medication Adherence Scale (MMAS-8) to assess its convergent validity while concurrent validity was evaluated based on the levels of glycated hemoglobin (HbA1C). Participants answered the MALMAS twice: at baseline and 4 weeks later. The study involved 136 participants. The MALMAS achieved acceptable internal consistency (Cronbach's alpha=0.565) and stable reliability as the test-retest scores showed fair correlation (Spearman's rho=0.412). The MALMAS has good correlation with the MMAS-8 (Spearman's rho=0.715). Participants who were adherent to their anti-diabetes medications had significantly lower median HbA1C values than those who were non-adherence (7.90 versus 8.55%, p=0.032). The odds of participants who were adherent to their medications achieving good glycemic control was 3.36 times (95% confidence interval: 1.09-10.37) of those who were non-adherence. This confirms the concurrent validity of the MALMAS. The sensitivity of the MALMAS was 88.9% while its specificity was 29.6%. The findings of this study further substantiates the reliability and validity of the MALMAS, in particular its concurrent validity and sensitivity for assessing medication adherence of people with type 2 diabetes in Malaysia.
authors.affiliation: Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Wen Wei
authors.initials: WW
authors.lastname: Chung
authors.affiliation: Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Siew Siang
authors.initials: SS
authors.lastname: Chua
authors.affiliation: Department of Primary Care Medicine, University Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Pauline Siew Mei
authors.initials: PS
authors.lastname: Lai
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008296:Malaysia / Q000453:epidemiology / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance; D015203:Reproducibility of Results; D012307:Risk Factors; D016903:Drug Monitoring