A SYSTEMATIC REVIEW ON SELF-REPORTED QUESTIONNAIRES TO ASSESS MEDICATION ADHERENCE IN DIABETIC PATIENTS
Adherence to pharmacological therapies are keys to effective treatments in diabetic patients. Previous reviews found that most adherence measurement studies on chronic diseases used a self-reported scale. However, there is no consensus on the best scale to measure adherence in diabetic patients. The purpose of this systematic review was to identify the potential self-reported scale that could be considered for measuring medication adherence in diabetic patients and to provide recommendations for researchers or clinicians to determine appropriate adherence self-reported scales in diabetic patients. This review follows general guidelines in the implementation of systematic reviews. After further review, it was found that 33 studies met all inclusion criteria from 4 databases (Wiley, Science Direct, Scopus, and PubMed). The articles were done by the PRISMA, while the keywords were determined by the PICO method. Most research was conducted in Asia (69.7%) and America (18.2%) on patients with type 2 diabetes (81.3%), patients in hospitals (54.5%), suffering for 1–6 months (54.5%), and using a cross-sectional study design (78.8%). HbA1c clinic data (57.6%) were used in most studies as biological markers of adherence. The measurement scales of medication adherence in diabetic patients are MMAS-8 (57,.5%), MMAS-4 (12.1%), BMQ (9%), MCQ (6%), ARMS (3%), ARMS-D (3%), GMAS (3%), LMAS-14 (3%), and MARS-5 (3%). This review provides information on the different self-reported scales most widely used in diabetic medication adherence research. Various aspects need to be considered before choosing the scale of adherence.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Research and Clinical Practice. 2019 Nov;157:107843.
Verhulst MJL, Loos BG, Gerdes VEA, Teeuw WJ. Evaluating all potential oral complications of diabetes mellitus. Frontiers in Endocrinology. 2019;10(56).
Seuring T, Archangelidi O, Suhrcke M. The Economic Costs of Type 2 Diabetes: A Global Systematic Review. PharmacoEconomics. 2015;33(8):811–31.
Khunti K, Seidu S, Kunutsor S, Davies M. Association between adherence to pharmacotherapy and outcomes in type 2 diabetes: A meta-analysis. Diabetes Care. 2017;40(11):1588–96.
Al-lela OQB, Abdulkareem RA, AL-Mufti L, Kamal N, Qasim S, Sagvan R. Medication Adherence Among Diabetic Patients in Developing Countries: Review of Studies. Systematic Reviews in Pharmacy. 2020;11(8):6.
Odegard PS, Capoccia K. Medication Taking and Diabetes A Systematic Review of the Literature. Diabetes Educ. 2007 Nov;33(6):1014–29.
Meddings J, Kerr EA, Heisler M, Hofer TP. Physician assessments of medication adherence and decisions to intensify medications for patients with uncontrolled blood pressure: Still no better than a coin toss. BMC Health Services Research. 2012;12(1):1.
Clifford S, Perez-Nieves M, Skalicky AM, Reaney M, Coyne KS. A systematic literature review of methodologies used to assess medication adherence in patients with diabetes. Current Medical Research and Opinion. 2014 Jun 1;30(6):1071–85.
Gonzalez JS, Schneider HE. Methodological Issues in the Assessment of Diabetes Treatment Adherence. Curr Diab Rep. 2011 Dec;11(6):472–9.
Kristina SA, Wulandari GP. Medication adherence using self-report measures among chronic disease patients: A review. International Journal Of Pharmaceutical Research. 2020 Jan 1;12.
Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017 Dec;6(1):245.
Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. jmla [Internet]. 2018 Oct 4 [cited 2020 Dec 21];106(4). Available from: http://jmla.pitt.edu/ojs/jmla/article/view/345
National Institutes of Health. Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies [Internet]. National Heart, Lung, and Blood Institute. 2014. Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools
WHO. Process of translation and adaptation of instruments. World Health Organization. 2015.
Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: Report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in Health. 2005 Mar;8(2):94–104.
Agency for Healthcare Research and Quality. Translation Guidelines for the AHRQ Surveys on Patient Safety Culture [Internet]. The Agency for Healthcare Research and Quality’s (AHRQ). 2015. Available from: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/resources/transguide.pdf
Moher D, Liberati A, etzlaff JT, Altman DG. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009 Jul;6(7):1–6.
Al-Qazaz HK, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. International Journal of Clinical Pharmacy. 2011;33(6):1028–35.
Sweileh WM, Zyoud SH, Abu Nab’A RJ, Deleq MI, Enaia MI, Nassar SM, et al. Influence of patients’ disease knowledge and beliefs about medicines on medication adherence: Findings from a cross-sectional survey among patients with type 2 diabetes mellitus in Palestine. BMC Public Health. 2014;14(1):1–8.
Farsaei S, Radfar M, Heydari Z, Abbasi F, Qorbani M. Insulin adherence in patients with diabetes: Risk factors for injection omission. Primary Care Diabetes. 2014;8(4):338–45.
Wong MCS, Wu CHM, Wang HHX, Li HW, Hui EMT, Lam AT, et al. Association between the 8-item Morisky medication adherence scale (MMAS-8) score and glycaemic control among Chinese diabetes patients. Journal of Clinical Pharmacology. 2015;55(3):279–87.
Shams N, Amjad S, Kumar N, Ahmed W, Saleem F. Drug Non-Adherence In Type 2 Diabetes Mellitus; Predictors And Associations. Journal of Ayub Medical College, Abbottabad : JAMC. 2016;28(2):302–7.
Acharya AS, Gupta E, Prakash N, Singhal N. Self-reported adherence to medication among patients with type II diabetes mellitus attending a tertiary care hospital of delhi. Journal of Association of Physicians of India. 2019;67:26–9.
Hernandez-Tejada MA, Campbell JA, Walker RJ, Smalls BL, Davis KS, Egede LE. Diabetes empowerment, medication adherence and self-care behaviors in adults with type 2 diabetes. Diabetes Technology and Therapeutics. 2012;14(7):630–4.
Bailey GR, Barner JC, Weems JK, Leckbee G, Solis R, Montemayor D, et al. Assessing Barriers to Medication Adherence in Underserved Patients With Diabetes in Texas. The Diabetes Educator. 2012;38(2):271–9.
Sankar U V., Lipska K, Mini GK, Sarma PS, Thankappan KR. The adherence to medications in diabetic patients in rural Kerala, India. Asia-Pacific Journal of Public Health. 2015;27(2):NP513–23.
Jackson IL, Adibe MO, Okonta MJ, Ukwe C V. Medication adherence in type 2 diabetes patients in Nigeria. Diabetes Technology and Therapeutics. 2015;17(6):398–404.
Alfian SD, Sukandar H, Lestari K, Abdulah R. Medication Adherence Contributes to an Improved Quality of Life in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study. Diabetes Therapy. 2016;7(4):755–64.
Samu AM, Amirthalingam PS, Mohammed OS. Assessment of patient medication adherence among the type 2 diabetes mellitus population with peripheral diabetic neuropathy in South India. Journal of Taibah University Medical Sciences. 2017;12(2):164–8.
Olorunfemi O, Ojewole F. Medication belief as correlate of medication adherence among patients with diabetes in Edo State, Nigeria. Nursing Open. 2019;6(1):197–202.
Balasubramaniam S, Lim SL, Goh LH, Subramaniam S, Tangiisuran B. Evaluation of illness perceptions and their associations with glycaemic control, medication adherence and chronic kidney disease in type 2 diabetes mellitus patients in Malaysia. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2019;13(4):2585–91.
Jannoo Z, Mamode Khan N. Medication Adherence and Diabetes Self-Care Activities among Patients with Type 2 Diabetes Mellitus. Value in Health Regional Issues. 2019;18(18):30–5.
Khotkar K, Chaudhari S, Jadhav PR, Deshmukh YA. Assessment of Medication Adherence in Type II Diabetic Patients: A Cross-sectional Study. MGM Journal of Medical Sciences. 2017 Jun;4(2):65–9.
Butt M, Mhd Ali A, Bakry MM, Mustafa N. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study. Saudi Pharmaceutical Journal. 2016;24(1):40–8.
Waari G, Mutai J, Gikunju J. Medication adherence and factors associated with poor adherence among type 2 diabetes mellitus patients on follow-up at Kenyatta National Hospital, Kenya. PAMJ [Internet]. 2018 [cited 2021 Feb 14];29. Available from: http://www.panafrican-med-journal.com/content/article/29/82/full/
Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: The role of disease and medication beliefs. Journal of Behavioral Medicine. 2009;32(3):278–84.
Aikens JE, Piette JD. Longitudinal association between medication adherence and glycaemic control in Type 2 diabetes. Vol. 30, Diabetic Medicine. 2013. p. 338–44.
Grandy S, Fox KM, Hardy E, Bays H, Bazata DD, Gavin JR, et al. Association of Weight Loss and Medication Adherence Among Adults With Type 2 Diabetes Mellitus: SHIELD (Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes). Current Therapeutic Research - Clinical and Experimental. 2013;75:77–82.
AlQarni K, AlQarni EA, Naqvi AA, AlShayban DM, Ghori SA, Haseeb A, et al. Assessment of medication adherence in Saudi patients with type II diabetes mellitus in Khobar city, Saudi Arabia. Frontiers in Pharmacology. 2019;10(November):1–9.
Alqarni AM, Alrahbeni T, Al Qarni A, Al Qarni HM. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. PPA. 2018 Dec;Volume 13:63–71.
Al-Qazaz HKh, Sulaiman SA, Hassali MA, Shafie AA, Sundram S, Al-Nuri R, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011 Dec;33(6):1028–35.
Balasubramaniam S, Lim SL, Goh LH, Subramaniam S, Tangiisuran B. Evaluation of illness perceptions and their associations with glycaemic control, medication adherence and chronic kidney disease in type 2 diabetes mellitus patients in Malaysia. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2019 Jul;13(4):2585–91.
Butt M, Mhd Ali A, Bakry MM, Mustafa N. Impact of a pharmacist led diabetes mellitus intervention on HbA1c, medication adherence and quality of life: A randomised controlled study. Saudi Pharmaceutical Journal. 2016 Jan;24(1):40–8.
Jannoo Z, Mamode Khan N. Medication Adherence and Diabetes Self-Care Activities Among Patients With Type 2 Diabetes Mellitus. Value in Health Regional Issues. 2019 May;18:30–5.
Sankar UV, Lipska K, Mini GK, Sarma PS, Thankappan KR. The Adherence to Medications in Diabetic Patients in Rural Kerala, India. Asia Pac J Public Health. 2015 Mar;27(2):513–23.
Sakthong P, Chabunthom R, Charoenvisuthiwongs R. Psychometric Properties of the Thai Version of the 8-item Morisky Medication Adherence Scale in Patients with Type 2 Diabetes. Ann Pharmacother. 2009 May;43(5):950–7.
Lee W-Y, Ahn J, Kim J-H, Hong Y-P, Hong SK, Kim YT, et al. Reliability and validity of a self-reported measure of medication adherence in patients with type 2 diabetes mellitus in Korea. J Int Med Res. 2013 Aug;41(4):1098–110.
Al-Qazaz HKh, Hassali MA, Shafie AA, Sulaiman SA, Sundram S, Morisky DE. The eight-item Morisky Medication Adherence Scale MMAS: Translation and validation of the Malaysian version. Diabetes Research and Clinical Practice. 2010 Nov;90(2):216–21.
Tandon S, Chew M, Eklu-Gadegbeku CK, Shermock KM, Morisky DE. Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Type 2 diabetes patients in sub-Saharan Africa. Diabetes Research and Clinical Practice. 2015 Nov;110(2):129–36.
Ashur ST, Shamsuddin K, Shah SA, Bosseri S, Morisky DE. Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients. Easter Mediterr Health J. 2015 Oct 1;21(10):722–8.
Martinez-Perez P, Orozco-Beltrán D, Pomares-Gomez F, Hernández-Rizo JL, Borras-Gallen A, Gil-Guillen VF, et al. Validation and psychometric properties of the 8-item Morisky Medication Adherence Scale (MMAS-8) in type 2 diabetes patients in Spain. Atención Primaria. 2021 Feb;53(2):101942.
Wang Y, Lee J, Toh MPHS, Tang WE, Ko Y. Validity and reliability of a self-reported measure of medication adherence in patients with Type 2 diabetes mellitus in Singapore: Validation of a medication adherence measure in Singapore. Diabetic Medicine. 2012 Sep;29(9):e338–44.
DiBonaventura M, Wintfeld N, Huang J, Goren A. The association between nonadherence and glycated hemoglobin among type 2 diabetes patients using basal insulin analogs. PPA. 2014 Jun;873.
Kreyenbuhl J, Leith J, Medoff DR, Fang LJ, Dickerson FB, Brown CH, et al. A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness. Psychiatry Research. 2011;188(1):109–14.
Perwitasari DA, Urbayatun S. Treatment Adherence and Quality of Life in Diabetes Mellitus Patients in Indonesia. SAGE Open. 2016;6(2).
Istilli PT, Pereira MCA, Teixeira CR de S, Zanetti ML, Becker TAC, Marques JVP. Treatment adherence to oral glucose-lowering agents in people with diabetes: Using the Brief Medication Questionnaire. Journal of Diabetes Nursing. 2015;19(9):340–8.
Perwitasari DA, Urbayatun S. Treatment Adherence and Quality of Life in Diabetes Mellitus Patients in Indonesia. SAGE Open. 2016 Apr 20;6(2):215824401664374.
Ranasinghe P, Jayawardena R, Katulanda P, Constantine GR, Ramanayake V, Galappatthy P. Translation and Validation of the Sinhalese Version of the Brief Medication Questionnaire in Patients with Diabetes Mellitus. Journal of Diabetes Research. 2018;2018:1–7.
Ben AJ, Neumann CR, Mengue SS. The Brief Medication Questionnaire and Morisky-Green Test to evaluate medication adherence. Rev Saúde Pública. 2012 Apr;46(2):279–89.
Sufiza Ahmad N, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Preference and Adherence. 2013;7:525–30.
Aminde LN, Tindong M, Ngwasiri CA, Aminde JA, Njim T, Fondong AA, et al. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocrine Disorders. 2019;19(1).
Andanalusia M, Athiyah U, Nita Y. Medication adherence in diabetes mellitus patients at Tanjung Karang Primary Health Care Center, Mataram. Journal of Basic and Clinical Physiology and Pharmacology. 2019;0(0).
Jaam M, Mohamed Ibrahim MI, Kheir N, Hadi MA, Diab MI, Awaisu A. Assessing prevalence of and barriers to medication adherence in patients with uncontrolled diabetes attending primary healthcare clinics in Qatar. Primary Care Diabetes. 2018;12(2):116–25.
Naqvi AA, Hassali MA, Rizvi M, Zehra A, Iffat W, Haseeb A, et al. Development and Validation of a Novel General Medication Adherence Scale (GMAS) for Chronic Illness Patients in Pakistan. Front Pharmacol. 2018 Oct 9;9:1124.
Naqvi AA, Mahmoud MA, AlShayban DM, Alharbi FA, Alolayan SO, Althagfan S, et al. Translation and validation of the Arabic version of the General Medication Adherence Scale (GMAS) in Saudi patients with chronic illnesses. Saudi Pharmaceutical Journal. 2020 Sep;28(9):1055–61.
Naqvi AA, Hassali MA, Jahangir A, Nadir MN, Kachela B. Translation and validation of the English version of the general medication adherence scale (GMAS) in patients with chronic illnesses. Journal of Drug Assessment. 2019 Jan 1;8(1):36–42.
Assi SA, Slaybi Y, Salameh P, Saleh N. Development of A Scoring System to Measure Drug Compliance Among Patients With Chronic Diseases In Lebanon. Journal of Hypertension. 2015 Jun;33:e281.
Bou Serhal R, Salameh P, Wakim N, Issa C, Kassem B, Abou Jaoude L, et al. A New Lebanese Medication Adherence Scale: Validation in Lebanese Hypertensive Adults. International Journal of Hypertension. 2018;2018:1–7.
Hallit S, Haddad C, Sacre H, Rahme C, Akel M, Saleh N, et al. Medication adherence among Lebanese adult patients with hypothyroidism: Validation of the Lebanese Medication Adherence Scale and correlates. Clinical Epidemiology and Global Health. 2021 Jan;9.
Ibrahim L, Ibrahim L, Hallit S, Salameh P, Sacre H, Akel M, et al. Validation of the Lebanese Medication Adherence Scale among Lebanese diabetic patients. Int J Clin Pharm. 2020 Nov;
Mroueh L, Ayoub D, El-Hajj M, Awada S, Rachidi S, Zein S, et al. Evaluation of medication adherence among lebanese diabetic patients. Pharmacy Practice. 2018;16(4):1–8.
Nazir SUR, Hassali MA, Saleem F, Bashir S, Aljadhey H. Disease related knowledge, medication adherence and glycaemic control among patients with type 2 diabetes mellitus in Pakistan. Primary Care Diabetes. 2016 Apr;10(2):136–41.
Mann DM, Ponieman D, Leventhal H, Halm EA. Predictors of adherence to diabetes medications: the role of disease and medication beliefs. J Behav Med. 2009 Jun;32(3).
Alqarni AM, Alrahbeni T, Al Qarni A, Al Qarni HM. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. Patient Preference and Adherence. 2019;13:63–71.
Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: a cross-sectional study. BMJ Open. 2017 Sep;7(9):e016317.
Horne R, Weinman J. Self-regulation and Self-management in Asthma: Exploring The Role of Illness Perceptions and Treatment Beliefs in Explaining Non-adherence to Preventer Medication. Psychology & Health. 2002 Jan;17(1):17–32.
Lee CS, Tan JHM, Sankari U, Koh YLE, Tan NC. Assessing oral medication adherence among patients with type 2 diabetes mellitus treated with polytherapy in a developed Asian community: A cross-sectional study. BMJ Open. 2017;7(9):1–7.
Ladova K, Matoulkova P, Zadak Z, Macek K, Vyroubal P, Vlcek J, et al. Self-reported adherence by MARS-CZ reflects LDL cholesterol goal achievement among statin users: validation study in the Czech Republic: Self-reported and objective adherence. J Eval Clin Pract. 2014 Oct;20(5):671–7.
Brooks TL, Leventhal H, Wolf MS, O’Conor R, Morillo J, Martynenko M, et al. Strategies Used by Older Adults with Asthma for Adherence to Inhaled Corticosteroids. J GEN INTERN MED. 2014 Nov;29(11):1506–12.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich). 2008 May;10(5):348–54.
Morisky DE, Green LW, Levine DM. Concurrent and Predictive Validity of a Self-reported Measure of Medication Adherence. Med Care. 1986 Jan;24(1):67–74.
Elsous A, Radwan M, Al-Sharif H, Abu Mustafa A. Medications Adherence and Associated Factors among Patients with Type 2 Diabetes Mellitus in the Gaza Strip, Palestine. Front Endocrinol. 2017 Jun 9;8:100.
Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. PPA. 2013 Jun;525.
Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and Evaluation of the Adherence to Refills and Medications Scale (ARMS) among Low-Literacy Patients with Chronic Disease. Value in Health. 2009 Jan;12(1):118–23.
Nita Y, Saputra FM, Damayanti S, Pratiwi PI, Zukhairah R, Sulistyarini A, et al. Medication adherence in the elderly with chronic diseases using the Adherence to Refill and Medication Scale (ARMS). In: Zairina E, Khotib J, Ardianto C, Sulaiman SAS, Sands CD, Welty TE, editors. Unity in Diversity and the Standardisation of Clinical Pharmacy Services [Internet]. 1st ed. CRC Press; 2017 [cited 2021 Feb 20]. p. 175–8. Available from: https://www.taylorfrancis.com/books/9781351622981/chapters/10.1201/9781315112756-30
Mayberry LS, Gonzalez JS, Wallston KA, Kripalani S, Osborn CY. The ARMS-D out performs the SDSCA, but both are reliable, valid, and predict glycemic control. Diabetes Research and Clinical Practice. 2013 Nov;102(2):96–104.
Chan EKH, Zumbo BD, editors. Validity and Validation in Social, Behavioral, and Health Sciences. 1st ed. 2014. Cham: Springer International Publishing : Imprint: Springer; 2014. 1 p. (Social Indicators Research Series).
Basu S, Garg S, Sharma N, Singh Mm. Improving the assessment of medication adherence: Challenges and considerations with a focus on low-resource settings. Tzu Chi Med J. 2019;31(2):73.
Zongo A, Guénette L, Moisan J, Grégoire J-P. Predictive Validity of Self-Reported Measures of Adherence to Noninsulin Antidiabetes Medication against Control of Glycated Hemoglobin Levels. Canadian Journal of Diabetes. 2016 Feb;40(1):58–65.
Forbes CA, Deshpande S, Sorio-Vilela F, Kutikova L, Duffy S, Gouni-Berthold I, et al. A systematic literature review comparing methods for the measurement of patient persistence and adherence. null. 2018 Sep 2;34(9):1613–25.
Anghel LA, Farcas AM, Oprean RN. An overview of the common methods used to measure treatment adherence. Medicine and Pharmacy Reports [Internet]. 2019 Apr 22 [cited 2021 Mar 22]; Available from: https://medpharmareports.com/index.php/mpr/article/view/1201