Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8

• Published in: PloS one Vol. 12; no. 11; p. e0187139
• Main Authors: Moon, Sun Jae, Lee, Weon-Young, Hwang, Jin Seub, Hong, Yeon Pyo, Morisky, Donald E
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-11-2017; Public Library of Science (PLoS)
• Subjects: Accuracy; Adhesion; Analysis; Biocompatibility; Biomedical materials; Bivariate analysis; Chronic illnesses; Confidence intervals; Correlation (Statistics); Correlation coefficient; Correlation coefficients; Criteria; Cut-off; Diabetes; Diabetes mellitus; Disease prevention; Drug Therapy; Drugs; Health care; Humans; Identification methods; Medical practices; Medical research; Medical screening; Medication adherence; Medicine and Health Sciences; Meta-analysis; Methods; Osteoporosis; Patient Compliance; Patients; Physical Sciences; Prescriptions (Drugs); Preventive medicine; Reliability analysis; Reproducibility; Reproducibility of Results; Research and Analysis Methods; Sensitivity; Sensitivity analysis; Studies; Transformation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0187139

This systematic review examined the reliability and validity of the Morisky Medication Adherence Scale-8 (MMAS-8), which has been widely used to assess patient medication adherence in clinical research and medical practice.
Of 418 studies identified through searching 4 electronic databases, we finally analyzed 28 studies meeting the selection criteria of this study regarding the reliability and validity of MMAS-8 including sensitivity and specificity. Meta-analysis for Cronbach's α, intraclass correlation coefficient (ICC), sensitivity and specificity to detect a patient with nonadherence to medication were performed. The pooled estimates for Cronbach's α and ICC were calculated using the random-effects weighted T transformation. A bivariate random-effects model was used to estimate pooled sensitivity and specificity.
The pooled Cronbach's α estimate for type 2 diabetes group in 7 studies and osteoporosis group in 3 studies were 0.67 (95% Confidence Interval(CI), 0.65 to 0.69) and 0.77 (95% CI, 0.72 to 0.83), respectively. With regard to test-retest, the pooled ICC for type 2 diabetes group in 3 studies and osteoporosis group in 2 studies were 0.81 (95% CI, 0.75 to 0.85) and 0.80 (95% CI, 0.74 to 0.85). For a cut-off value of 6, the pooled sensitivity and specificity in 12 studies were 0.43 (95% CI, 0.33 to 0.53) and 0.73 (95% CI, 0.68 to 0.78), respectively.
The MMAS-8 had acceptable internal consistency and reproducibility in a few diseases like type 2 diabetes. Using the cut-off value of 6, criterion validity was not enough good to validly screen a patient with nonadherence to medication. However, this study did not calculated a pooled estimate for criterion validity using the higher values than 6 as a cut-off value since most of included individual studies did not report criterion validity based on those values.