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Meta-Analysis
. 2017 Nov 2;12(11):e0187139.
doi: 10.1371/journal.pone.0187139. eCollection 2017.

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

Sun Jae Moon  1 , Weon-Young Lee  1 , Jin Seub Hwang  2 , Yeon Pyo Hong  1 , Donald E Morisky  3
Affiliations
Meta-Analysis

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

Sun Jae Moon et al. PLoS One. .

Erratum in

Abstract

Background: 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.

Methods: 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.

Findings: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of evidence selection.
Fig 2
Fig 2. Assessment of methodological quality by QUADAS-2.
Fig 3
Fig 3. Subgroup analysis of Cronbach's α by disease.
Fig 4
Fig 4. Subgroup analysis of ICC by disease.
Fig 5
Fig 5. SROC plots of sensitivity and specificity based on cut-off of 6 using bivariate model.
Fig 6
Fig 6. SROC plots of sensitivity and specificity based on cut-off of 6 using bivariate model in the subgroup of hypertension and Type2DM.
See this image and copyright information in PMC

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