Reliability and Validity of the M-MALMAS Instrument to Assess Medication Adherence in Malay-Speaking Patients with...

The English Malaysian Medication Adherence Scale (MALMAS) has been validated for assessing medication adherence of people with type 2 diabetes. However, Malay is the national language of Malaysia.

The aim of this study was to cross-culturally adapt and validate the Malay MALMAS (M-MALMAS) in Malaysia.

Adults with type 2 diabetes, who could understand Malay, were recruited between May 2016 and February 2017 from a primary care clinic in Kuala Lumpur, Malaysia. The M-MALMAS and the Malay version of the Morisky Medication Adherence Scale (MMAS-8) were administered at baseline to test for convergent validity. Four weeks later, the M-MALMAS was re-administered. Predictive validity of the M-MALMAS was assessed by correlating the medication adherence scores with levels of glycated haemoglobin (HbA_1c).

In total, 100 of 104 people agreed to participate (response rate = 96.2%). The overall Cronbach's α and McDonald's Ω for the M-MALMAS was 0.654 and 0.676, respectively (mean = 0.665). At test-retest, no significant difference was found for all items. The median total score interquartile range (IQR) of the M-MALMAS was 7.0 (6.0-8.0) and this was significantly correlated to the median total score of the Malay MMAS-8 [median (IQR) = 7.0 (5.8-8.0), p < 0.001]. HbA_1c levels were significantly lower among participants who were adherent to their medications (score: 6-8) versus those who were non-adherent (score < 6, p = 0.018). The sensitivity and specificity of the M-MALMAS was 92% and 32.8%, respectively.

The M-MALMAS was found to be a valid and reliable instrument for assessing medication adherence of people with type 2 diabetes in Malaysia. The M-MALMAS had a high sensitivity but its specificity was not as good.