Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0077
Trends in Psychiatry and Psychotherapy
Original Article

Reliability and validity of the Medication Adherence Rating Scale in a cohort of patients with schizophrenia from Nigeria

Confiabilidade e validade da Medication Adherence Rating Scale em uma coorte de pacientes com esquizofrenia na Nigéria

Godspower O. Owie; Sunday O. Olotu; Bawo O. James

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Abstract

Abstract Introduction Assessing adherence in schizophrenia facilitates interventions that optimize outcomes. Adherence rating questionnaires are feasible and non-intrusive; however, no validated measure exists in sub-Saharan Africa. We aimed to assess the psychometric properties of the 10-item Medication Adherence Rating Scale (MARS). Methods This was a cross-sectional study of a cohort of patients with schizophrenia (n=230). A sociodemographic questionnaire, the Mini International Neuropsychiatric Interview (MINI), Positive and Negative Syndrome Scale (PANSS), Scale for the Unawareness of Mental Disorder (SUMD) and the MARS were all administered by an interviewer. Results The MARS demonstrated good reliability (Cronbach’s alpha: 0.76). The scale was reducible to a 3-factor construct (1 – medication adherence behavior, 2 – attitude to taking medications, and 3 – negative side effects and attitude to psychotropics), with significant though weak external validity in relation to psychopathology (p<0.001) and insight (p<0.001). The first factor showed good internal consistency (α=0.80), comprising six items that could serve as a reliable proxy measure of adherence in place of the MARS Conclusion The MARS demonstrated fair psychometric characteristics in assessing adherence in patients with schizophrenia in this cohort. The scale may be useful in the dimensional assessment of medication adherence for schizophrenia in sub-Saharan African settings.

Keywords

Medication adherence, schizophrenia, rating scale, reliability, validity

Resumo

Resumo Introdução Avaliar adesão ao tratamento na esquizofrenia facilita intervenções que otimizam desfechos. Questionários de avaliação da adesão são factíveis e não intrusivos; no entanto, não há uma medida validada na África subsaariana. O objetivo deste estudo foi avaliar as propriedades psicométricas da escala de 10 itens intitulada Medication Adherence Rating Scale (MARS). Métodos Este foi um estudo transversal de uma coorte de pacientes com esquizofrenia (n=230). Um questionário sociodemográfico e os instrumentos Mini International Neuropsychiatric Interview (MINI), Positive and Negative Syndrome Scale (PANSS), Scale for the Unawareness of Mental Disorder (SUMD) e a MARS foram todos administrados por um entrevistador. Resultados A MARS demonstrou boa confiabilidade (alfa de Cronbach: 0,76). Foi possível reduzir a escala a um construto de 3 fatores (1 – comportamento de adesão à medicação, 2 – atitude em relação a tomar medicação, e 3 – efeitos colaterais negativos e atitude em relação aos psicotrópicos), com validade externa significativa, embora fraca, em relação à psicopatologia (p<0,001) e ao insight (p<0,001). O primeiro fator mostrou boa consistência interna (α=0,80), incluindo seis itens que poderiam servir como uma medida substituta confiável de adesão no lugar da MARS Conclusão A MARS demonstrou características psicométricas satisfatórias ao avaliar adesão em pacientes com esquizofrenia nesta coorte. A escala pode ser útil na avaliação dimensional da adesão ao tratamento para esquizofrenia em contextos africanos subsaarianos.

Palavras-chave

Adesão à medicação, esquizofrenia, escala, confiabilidade, validade

References

Czobor P, Van Dorn RA, Citrome L, Kahn RS, Fleischhacker WW, Volavka J. Treatment adherence in schizophrenia: A patient-level meta-analysis of combined CATIE and EUFEST studies. Eur Neuropsychopharmacol. 2015;25:1158-66.

Adewuya AO, Owoeye OA, Erinfolami AR, Coker AO, Ogun OC, Okewole AO. Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria. Gen Hosp Psychiatry. 2009;31:167-74.

Borras L, Mohr S, Brandt P-Y, Gilliéron C, Eytan A, Huguelet P. Religious beliefs in schizophrenia: their relevance for adherence to treatment. Schizophr Bull. 2007;33:1238-46.

Okpataku CI, Kwanashie HO, Ejiofor JI, Olisah VO. Medication compliance behavior in psychiatric out - patients with psychoactive substance use comorbidity in a Nigerian tertiary hospital. Niger J Clin Pract. 2015;18:371-6.

Mak KY, Lo WTL, Yeung WS, Wong M, Chung WSD, Chui E. Consensus statements on adherence issues in schizophrenia for Hong Kong. Asian J Psychiatr. 2014;12:163-9.

Sendt K-V, Tracy DK, Bhattacharyya S. A systematic review of factors influencing adherence to antipsychotic medication in schizophrenia-spectrum disorders. Psychiatry Res. 2015;225:14-30.

Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42:241-7.

Alcaide ML, Ramlagan S, Rodriguez VJ, Cook R, Peltzer K, Weiss SM. Self-report and dry blood spot measurement of antiretroviral medications as markers of adherence in pregnant women in rural South Africa. AIDS Behav. 2017:1-6.

Nguyen TMU, Caze AL, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol. 2014;77:427-45.

Arute JE, Eniojukan JF, Eboigbe N. Adherence to psychotropic medications by outpatients in psychiatric hospital, Uselu Benin City, Nigeria. Value Heal. 2014;17:A460-1.

Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med. 1983;13:177.

Fialko L, Garety PA, Kuipers E, Dunn G, Bebbington PE, Fowler D. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophr Res. 2008;100:53-9.

Zemmour K, Tinland A, Boucekine M, Girard V, Loubière S, Resseguier N. Validation of the Medication Adherence Rating Scale in homeless patients with schizophrenia: results from the French housing first experience. Sci Rep. 2016;6:31598.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry.. 1998;59.

Adewuya AO. Validation of the Alcohol Use Disorders Identification Test (AUDIT) as a screening tool for alcohol-related problems among Nigerian university students. Alcohol. 2005;40:575-7.

Adewuya AO, Makanjuola ROA. Subjective quality of life of Nigerian schizophrenia patients: sociodemographic and clinical correlates. Acta Psychiatr Scand. 2009;120:160-4.

Iteke O, Bakare MO, Agomoh AO, Uwakwe R, Onwukwe JU. Road traffic accidents and posttraumatic stress disorder in an orthopedic setting in south-eastern Nigeria: a controlled study. Scand J Trauma Resusc Emerg Med. 2011;19:39.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261-76.

Adewuya AO, Ola BA, Mosaku SK, Fatoye FO, Eegunranti AB. Attitude towards antipsychotics among out-patients with schizophrenia in Nigeria. Acta Psychiatr Scand. 2006;113:207-11.

Igberase OO, Morakinyo O, Lawani AO, James BO, Omoaregba JO. Burden of care among relatives of patients with schizophrenia in midwestern Nigeria. Int J Soc Psychiatry. 2012;58:131-7.

Moreira IC, Bandeira M, Pollo TC, Oliveira MS de. Cross-cultural adaptation to Brazil of Medication Adherence Rating Scale for psychiatric patients. J Bras Psiquiatr. 2014;63(4):273-80.

Thompson K, Kulkarni J, Sergejew A. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res. 2000;42:241-7.

Jaeger S, Pfiffner C, Weiser P, Kilian R, Becker T, Längle G. Adherence styles of schizophrenia patients identified by a latent class analysis of the Medication Adherence Rating Scale (MARS): A six-month follow-up study. Psychiatry Res. 2012;200:83-8.

Vanelli I, Chendo I, Gois C, Santos J, Levy P. Medication adherence rating scale. Acta Med Port. ;24:17-20.

Fialko L, Garety P, Kuipers E, Dunn G, Bebbington P, Fowler D. A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophr Res. 2008;100:53-9.

James BO, Omoaregba JO, Okonoda KM, Otefe EU, Patel MX. The knowledge and attitudes of psychiatrists towards antipsychotic long-acting injections in Nigeria. Ther Adv Psychopharmacol. 2012;2:169-77.

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