title: Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Type 2 diabetes patients in sub-Saharan Africa.
abstract: OBJECTIVE
  Research 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.
  
  
  METHODS
  154 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.
  
  
  RESULTS
  Internal 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 (χ(2)) tests of proportions showed a significant relationship between blood glucose control and MMAS-8 (χ(2)=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.
  
  
  CONCLUSIONS
  Psychometric 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.
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: sangeeta@jhmi.edu.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Tandon
authors.affiliation: Bloomberg School of Public Health, The Johns Hopkins Medical Institutions, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Chew
authors.affiliation: Laboratory of Physiology and Pharmacology, University of Lomé, Lomé, Togo.
authors.forename: Christophe Kwashie
authors.initials: CK
authors.lastname: Eklu-Gadegbeku
authors.affiliation: Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA; Center for Pharmaceutical Outcomes, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Shermock
authors.affiliation: Department of Community Health Sciences, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D016903:Drug Monitoring
keywords: Adherence; Diabetic medications; Morisky Scale; Sub-Saharan Africa; Togo