Psychometric properties of modified 10-item Medication Adherence Scale for cancer patients receiving chemotherapy: Self-report scale validation study

Abstract

Purpose

The 10-item Medication Adherence Rating Scale (MARS-10) is a validated, self-report tool used to assess adherence to chronic illnesses due to its applicability. However, its psychometric properties have not been evaluated among cancer patients receiving chemotherapy. This study aimed to determine the psychometric properties of the modified MARS-10 in this population.

Methods

A cross-sectional analytic study was conducted on adults receiving cancer chemotherapy from April to May 2022. Confirmatory factor analysis was used to validate the scale. The internal consistency was determined using composite reliability. Convergent and discriminant validity of the constructs were measured by the average variance extracted and the Heterotrait-Monotrait correlation ratio, respectively. Statistical significance was declared as p-value < 0.05.

Results

Three hundred (n = 300) adults receiving cancer chemotherapy were enrolled in the study. There was a significant difference between the higher and lower adherence scores, t (299) = 95.84, p < 0.001. The four constructs explained 66.6% of the total variance. The composite reliability of constructs one (0.79), two (0.66), three (0.66), and four (0.66) was in the acceptable to good range. The extracted mean-variance was more than 0.50, and the Heterotrait-Monotrait correlation ratio ranged from 0.31–0.83 for all constructs.

Conclusion

This study has established the internal psychometric properties of the modified 10-item Medication Adherence Rating Scale. Therefore, this modified scale is a valuable tool for researchers and has important implications for oncology health promotion, and policymakers where direct adherence measurement to cancer chemotherapy is challenging.

Keywords

Reliability validity mMARS-10 cancer chemotherapy adult patients

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References

Kazibwe

Tran

Annerstedt

. The household financial burden of non-communicable diseases in low- and middle-income countries: a systematic review. Health Res Policy Syst 2021; 19: 96.

World Health Organiazation. Noncommunicable diseases. 2024.

World Health Organization. Key prevention and control interventions for reducing cancer burden in the WHO African region. 2012.

Gebrezgi

Trepka

Kidane

. Barriers to and facilitators of hypertension management in Asmara, Eritrea: patients’ perspectives. J Health Popul Nutr 2017; 36: 11.

Shobana

Semere

Sied

, et al. Prescribing pattern of anti-hypertensive drugs among hypertension patients with cardiac complications in Eritrea. Lat Am J Pharm 2013; 32: 745–748.

Mufunda

Mebrahtu

Usman

, et al. The prevalence of hypertension and its relationship with obesity: results from a national blood pressure survey in Eritrea. J Hum Hypertens 2006; 20: 59–65.

World Health Ranking. Live longer live better; country profile: Eritrea. 2020.

Abdu

Bakrey

Hamed

, et al. Non-communicable diseases in Eritrea: a review of challenges, risk factors and public health strategies. Discov Public Health 2025; 22: 71.

Brown

Bussell

. Medication adherence: WHO cares? Mayo Clin Proc 2011; 86: 304–314.

10.

Sabaté

. Adherence to long-term therapies: evidence for action. Geneva, Switzerland: World Health Organization, 2003.

11.

Kalemkerian

Loo

Akerley

, et al. NCCN Guidelines insights: small cell lung cancer, version 2.2018. J Natl Compr Canc Netw 2018; 16: 1171–1182.

12.

Brito

Portela

de Vasconcellos

. Adherence to hormone therapy among women with breast cancer. BMC Cancer 2014; 14: 397.

13.

Bouwman

Eeltink

Visser

, et al. Prevalence and associated factors of medication non-adherence in hematological-oncological patients in their home situation. BMC Cancer 2017; 17: 739.

14.

Col

Fanale

Kronholm

. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med 1990; 150: 841–845.

15.

Inotai

Ágh

Maris

, et al. Systematic review of real-world studies evaluating the impact of medication non-adherence to endocrine therapies on hard clinical endpoints in patients with non-metastatic breast cancer. Cancer Treat Rev 2021; 100: 102264.

16.

Cheung

. Difficult to swallow: issues affecting optimal adherence to oral anticancer agents. Am Soc Clin Oncol Educ Book 2013; 33: 265–270.

17.

Jin

Sklar

Min Sen Oh

, et al. Factors affecting therapeutic compliance: a review from the patient's perspective. Ther Clin Risk Manag 2008; 4: 269–286.

18.

Anand

Dey

Chandel

AKS

, et al. Cancer chemotherapy and beyond: current status, drug candidates, associated risks and progress in targeted therapeutics. Genes Dis 2023; 10: 1367–1401.

19.

Gatenby

Brown

. The evolution and ecology of resistance in cancer therapy. Cold Spring Harbor Perspect Med 2020; 10: a040261.

20.

Qin

Jiang

, et al. Emerging role of tumor cell plasticity in modifying therapeutic response. Signal Transduct Target Ther 2020; 5: 228.

21.

Chirgwin

Giobbie-Hurder

Coates

, et al. Treatment adherence and its impact on disease-free survival in the breast international group 1-98 trial of tamoxifen and letrozole, alone and in sequence. J Clin Oncol 2016; 34: 2452–2459.

22.

Puts

MTE

Tourangeau

, et al. Factors influencing adherence to cancer treatment in older adults with cancer: a systematic review. Ann Oncol 2014; 25: 564–577.

23.

Bell

Airaksinen

Lyles

, et al. Concordance is not synonymous with compliance or adherence. Br J Clin Pharmacol 2007; 64: 710–711.

24.

Osterberg

Blaschke

. Adherence to medication. N Engl J Med 2005; 353: 487–497.

25.

Spoelstra

Given

. Assessment and measurement of adherence to oral antineoplastic agents. Semin Oncol Nurs 2011; 27: 116–132.

26.

Cameron

Ross

Clayman

, et al. Measuring patients’ self-efficacy in understanding and using prescription medication. Patient Educ Couns 2010; 80: 372–376.

27.

Moharamzad

Saadat

Nakhjavan Shahraki

, et al. Validation of the Persian version of the 8-item Morisky Medication Adherence Scale (MMAS-8) in Iranian hypertensive patients. Glob J Health Sci 2015; 7: 173–183.

28.

Morisky

DiMatteo

. Improving the measurement of self-reported medication nonadherence: response to authors. J Clin Epidemiol 2011; 64: 255–257; discussion 8-63.

29.

Lavsa

Holzworth

Ansani

. Selection of a validated scale for measuring medication adherence. J Am Pharm Assoc 2011; 51: 90–94.

30.

Zemmour

Tinland

Boucekine

, et al. Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: results from the French Housing First experience. Sci Rep 2016; 6: 31598.

31.

Cohen

Mann

Wisnivesky

, et al. Assessing the validity of self-reported medication adherence among inner-city asthmatic adults: the Medication Adherence Report Scale for Asthma. Ann Allergy Asthma Immunol 2009; 103: 325–331.

32.

Stirratt

Dunbar-Jacob

Crane

, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med 2015; 5: 470–482.

33.

Thompson

Kulkarni

Sergejew

. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 2000; 42: 241–247.

34.

Demyttenaere

Bruffaerts

Albert

, et al. Development of an antidepressant compliance questionnaire. Acta Psychiatr Scand 2004; 110: 201–207.

35.

Achieng

Bunani

Kagaayi

, et al. Adherence to antiretroviral and cancer chemotherapy, and associated factors among patients with HIV–cancer co-morbidity at the Uganda Cancer Institute: a cross sectional study. BMC Public Health 2023; 23: 1451.

36.

Morisky

Green

Levine

. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67–74.

37.

Hogan

Awad

Eastwood

. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983; 13: 177–183.

38.

Lord

. Applications of item response theory to practical testing problems. New York: Routledge, 1980.

39.

Nguyen

La Caze

Cottrell

. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol 2014; 77: 427–445.

40.

Fialko

Garety

Kuipers

, et al. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophr Res 2008; 100: 53–59.

41.

Sowunmi

Onifade

. Psychometric evaluation of Medication Adherence Rating Scale (MARS) among Nigerian patients with schizophrenia. Niger J Clin Pract 2019; 22: 1281.

42.

Owie

Olotu

James

. Reliability and validity of the Medication Adherence Rating Scale in a cohort of patients with schizophrenia from Nigeria. Trends Psychiatry Psychother 2018; 40: 85–92.

43.

Diamantopoulos

Sarstedt

Fuchs

, et al. Guidelines for choosing between multi-item and single-item scales for construct measurement: a predictive validity perspective. J Acad Mark Sci 2012; 40: 434–449.

44.

Hair

Hult

GTM

Ringle

, et al. A primer on partial least squares structural equation modeling (PLS-SEM). 3rd ed. Thousand Oaks: Sage, 2022.

45.

Sarstedt

Ringle

Hair

. Partial least squares structural equation modeling. In: Homburg C, Klarmann M and Vomberg A (eds) Handbook of market research. Cham: Springer, 2021, pp.587–632.

46.

Hair

JHG

Ringle

Sarstedt

. Primer on partial least squares structural equation modeling (PLS-SEM). Los Angeles: Sage Publications, Incorporated, 2014.

47.

Leech

Barrett

Morgan

. SPSS for intermediate statistics; use and interpretation. 2nd ed. Mahwah, New Jersey, London: Lawrence Erlbaum Associates, Inc., 2005.

48.

Akpolat

Arici

Sengul

, et al. Home sphygmomanometers can help in the control of blood pressure: a nationwide field survey. Hypertens Res 2018; 41: 460–468.

49.

Sarstedt

Ringle

Hair

. Partial least squares structural equation modeling . In: Homburg C, Klarmann M and Vomberg, A (eds) Handbook of market research. Springer, 2011.

50.

Bagozzi

. On the evaluation of structural equation models. J Acad Mark Sci 1988; 16: 74–94.

51.

Henseler

Ringle

Sarstedt

. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci 2015; 43: 115–135.

52.

Pednekar

Ágh

Malmenäs

, et al. Methods for measuring multiple medication adherence: a systematic review–report of the ISPOR medication adherence and persistence special interest group. Value Health 2019; 22: 139–156.

53.

Cross

Elliott

Petrie

, et al. Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications. Cochrane Database Syst Rev 2020; 5: Cd012419.

54.

Bekalu

Wudu

Gashu

. Adherence to chemotherapy and associated factors among patients with cancer in Amhara Region, Northeastern Ethiopia, 2022. A cross-sectional study. Cancer Control 2023; 30: 10732748231185010.

55.

Reshma

Chacko

Abdulla

, et al. Medication adherence in cancer patients: a comprehensive review. Cureus 2024; 16: e52721.

56.

Jimmy

Jose

. Patient medication adherence: measures in daily practice. Oman Med J 2011; 26: 155–159.

57.

Jacobs

Pensak

Sporn

, et al. Treatment satisfaction and adherence to oral chemotherapy in patients with cancer. J Oncol Pract 2017; 13: e474–e485.

58.

Lam

Fresco

. Medication adherence measures: an overview. BioMed Res Int 2015; 2015: 217047.

59.

Düsing

Lottermoser

Mengden

. Compliance with drug therapy-new answers to an old question. Nephrol Dial Transplant 2001; 16: 1317–1321.

60.

Talens

LÓpez-Pintor

Guilabert

, et al. Validation of a scale to assess adherence to oral chemotherapy based on the experiences of patients and healthcare professionals (EXPAD-ANEO). Front Pharmacol 2023; 14: 1113898.

61.

Claros

Messa

CVM

García-Perdomo

. Adherence to oral pharmacological treatment in cancer patients: systematic review. Oncol Rev 2019; 13: 402.

62.

Chan

AHY

Horne

Hankins

, et al. The Medication Adherence Report Scale: a measurement tool for eliciting patients’ reports of nonadherence. Br J Clin Pharmacol 2020; 86: 1281–1288.

63.

Cao

Zhang

, et al. Continuous improvement of quality management in the fall prevention process for inpatients: a historically controlled study. 2021.

64.

Mishra

Sharma

Verma

, et al. Medication adherence and quality of life among type-2 diabetes mellitus patients in India. World J Diabetes 2021; 12: 1740–1749.

65.

World Health Organization. Adherence to long-term therapies, Evidence for action. Geneva, Switzerland: World Health Organization, 2003.

66.

Irwin

. Factors influencing oral adherence: qualitative metasummary and triangulation with quantitative evidence. Clin J Oncol Nurs 2013; 19: 6–30.

67.

Ruddy

Mayer

Partridge

. Patient adherence and persistence with oral anticancer treatment. CA Cancer J Clin 2009; 59: 56–66.

68.

Weingart

Brown

Bach

, et al. NCCN Task force report: oral chemotherapy. J Natl Compr Cancer Netw 2008; 6: S‐8–S‐10.

69.

Seretny

Currie

Sena

, et al. Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Pain 2014; 155: 2461–2470.

70.

Das

Ranadive

Kinra

, et al. An overview on chemotherapy-induced cognitive impairment and potential role of antidepressants. Curr Neuropharmacol 2020; 18: 838–851.

71.

Aluise

Sultana

Tangpong

, et al. Chemo brain (chemo fog) as a potential side effect of doxorubicin administration: role of cytokine-induced, oxidative/nitrosative stress in cognitive dysfunction. Adv Exp Med Biol 2010; 678: 147–156.

72.

Bernstein

Edelstein

Sharma

, et al. Chemo-brain: an activation likelihood estimation meta-analysis of functional magnetic resonance imaging studies. Neurosci Biobehav Rev 2021; 130: 314–325.

73.

Lewandowska

Rudzki

. Quality of life of cancer patients treated with chemotherapy. Int J Environ Res Public Health 2020; 17: 6938.

74.

Gopalan

Karunakaran

Prabhakaran

, et al. Prevalence of psychiatric morbidity among cancer patients - hospital-based, cross-sectional survey. Indian J Psychiatry 2016; 58: 275–280.