Okello Samson, Nasasira Benson, Muiru Anthony Ndichu Wa, Muyingo Anthony
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2016 Jul 1;11(7):e0158499. doi: 10.1371/journal.pone.0158499. eCollection 2016.
The Morisky Medication Adherence scale (MMAS-8) is a widely used self-reported measure of adherence to antihypertensive medications that has not been validated in hypertensive patients in sub-Saharan Africa.
We carried out a cross-sectional study to examine psychometric properties of a translated MMAS-8 (MMAS-U) in a tertiary care hypertension clinic in Uganda. We administered the MMAS-U to consecutively selected hypertensive adults and used principal factor analysis and Cronbach's alpha to determine its validity and internal consistency respectively. Then we randomly selected one-sixth of participants for a 2-week test-retest telephone interview. Lastly, we used ordinal logistic regression modeling to explore factors associated with levels of medication adherence.
Of the 329 participants, 228 (69%) were females, median age of 55 years [Interquartile range (IQR) (46-66)], and median duration of hypertension of 4 years [IQR (2-8)]. The adherence levels were low (MMAS-U score ≤ 5) in 85%, moderate (MMAS-U score 6-7) in 12% and high (MMAS-U score ≥8) in 3%. The factor analysis of construct validity was good (overall Kaiser's measure of sampling adequacy for residuals of 0.72) and identified unidimensionality of MMAS-U. The internal consistency of MMAS-U was moderate (Cronbach α = 0.65), and test-retest reliability was low (weighted kappa = 0.36; 95% CI -0.01, 0.73). Age of 40 years or greater was associated with low medication adherence (p = 0.02) whereas a family member buying medication for participants (p = 0.02) and purchasing medication from a private clinic (p = 0.02) were associated with high adherence.
The Ugandan version of the MMAS-8 (MMAS-U) is a valid and reliable measure of adherence to antihypertensive medication among Ugandan outpatients receiving care at a public tertiary facility. Though the limited supply of medication affected adherence, this easy to use tool can be adapted to assess medication adherence among adults with hypertension in Uganda.
莫利斯基药物依从性量表（MMAS - 8）是一种广泛使用的自我报告的抗高血压药物依从性测量工具，尚未在撒哈拉以南非洲的高血压患者中得到验证。
我们在乌干达的一家三级护理高血压诊所开展了一项横断面研究，以检验翻译后的MMAS - 8（MMAS - U）的心理测量特性。我们对连续入选的高血压成年患者进行MMAS - U测试，并分别使用主因子分析和克朗巴哈系数来确定其效度和内部一致性。然后，我们随机选择六分之一的参与者进行为期2周的重测电话访谈。最后，我们使用有序逻辑回归模型来探索与药物依从性水平相关的因素。
在329名参与者中，228名（69%）为女性，中位年龄55岁[四分位间距（IQR）（46 - 66）]，高血压中位病程4年[IQR（2 - 8）]。依从性水平低（MMAS - U评分≤5）的占85%，中等（MMAS - U评分6 - 7）的占12%，高（MMAS - U评分≥8）的占3%。结构效度的因子分析良好（总体凯泽残差抽样适当性度量为0.72），并确定了MMAS - U的单维度性。MMAS - U的内部一致性中等（克朗巴哈α = 0.65）且重测信度较低（加权kappa = 0.36；95%可信区间 - 0.01，0.73）。40岁及以上与低药物依从性相关（p = 0.02），而有家庭成员为参与者购买药物（p = 0.02）以及从私人诊所购买药物（p = 0.02）与高依从性相关。
乌干达版的MMAS - 8（MMAS - U）是在一家公立三级医疗机构接受治疗的乌干达门诊患者中抗高血压药物依从性的有效且可靠的测量工具。尽管药物供应有限影响了依从性，但这个易于使用的工具可用于评估乌干达成年高血压患者的药物依从性。
