The cross-cultural adaptation of Morisky Green Levine Medication Adherence Scale for use with diagnosed patients of Ischemic Heart Disease in Sri Lanka

Abstract

Ischemic Heart Disease (IHD) has been classified as one of the major cardiovascular diseases in the world and it has become the main cause of death in Sri Lanka. Medication adherence is defined as the level to which the client's behaviour complies with the established endorsements from a health care professional. Poor medication adherence to IHD is related to increased re-hospitalization and mortality and continuous assessment of medication adherence is extremely important among these patients. Morisky Green Levine Medication Adherence Scale is a medication adherence tool comprised of four items with yes/no response which results in a score ranging from 0 to 4. The study aim was to translate Morisky Green Levine Medication Adherence Scale into Sinhala and cross-culturally adapt it to the Sri Lankan setting. Translation, back translation, and pretest were conducted prior to a Delphi process which assessed the content and consensual validity of the scale. The Delphi process included two consultant physicians, a cardiologist, a clinical psychologist, and a registered pharmacist. In consensual validity, each item was rated, on a scale of 0(total disagreement) to 9(total agreement) (i) if its conceptual meaning was retained after translation, (ii) if it was appropriate to be used with IHD patients, and (iii) if it was culturally relevant to Sri Lanka. For content validity, each item was rated on a scale of 0 to 9 (i) if each item was an appropriate indicator of its scale, and (ii) if the composite of items was adequate to measure medication adherence. The ratings received from stage one were listed and re-sent for a second round and the re-ratings were evaluated for the degree of consensus. Items for this Medication Adherence Scale’s Sinhala version were chosen based on the following criteria: (i) the item was reworded or removed if 70% or more of the re-ratings were in category 0–3. If reworded, the Delphi Process was repeated for that item, and (ii) the item was kept with no change if 70% or more of the re-ratings were in categories of 4–6 and 7–9. No items were removed from the original scale and some items were reworded according to suggestions made by the experts to retain the conceptual meaning when translated into Sinhala. The Sinhala version of the Morisky Green Levine Medication Adherence Scale can be used in research, medication adherence evaluations and IHD preventive programmes in Sri Lankan setting with confidence.