Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.

In Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients' medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu...

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Main Authors: Sohail Riaz, Fazli Khuda, Nadia Shamshad Malik, Nitasha Gohar, Ayesha Rashid, Abuzar Khan, Abdur Rahman, Sajid Ali, Asif Jan, Aqeel Nasim
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0320258
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author Sohail Riaz
Fazli Khuda
Nadia Shamshad Malik
Nitasha Gohar
Ayesha Rashid
Abuzar Khan
Abdur Rahman
Sajid Ali
Asif Jan
Aqeel Nasim
author_facet Sohail Riaz
Fazli Khuda
Nadia Shamshad Malik
Nitasha Gohar
Ayesha Rashid
Abuzar Khan
Abdur Rahman
Sajid Ali
Asif Jan
Aqeel Nasim
author_sort Sohail Riaz
collection DOAJ
description In Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients' medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu language is required. The Morisky, Greene, and Levine Medication Adherence Scale (MGLS-4) is a reliable, valid and straightforward instrument to assess medication-taking behavior. The valid and reliable Urdu translation of MGLS-4 can fill this gap within the local context. Therefore, the present study aims to validate the Urdu Morisky, Green and Levine Adherence Scale (UMGLS-4) for MDD patients. This was a quantitative, cross-sectional validation study for Pakistani MDD patients. Reliability was measured using Cronbach's α and for test-retest reliability intraclass correlation coefficient (ICC) was calculated. Validity was assessed through face validity, content validity, construct validity, and convergent validity with the Drug Attitude Inventory (DAI-10). Descriptive and inferential statistical analyses were carried out to demonstrate adherence level and statistical significance, respectively. Linear regression was applied to find the association between the UGMLS-4 score and demographic characteristics. The UMGLS-4 demonstrated high reliability (Cronbach's α = 0.829) and a significant strong ICC (x = 0.601, p < 0.01) was detected. Exploratory factor analysis (EFA) revealed a single-factor structure explaining 66.084% of the variance. Confirmatory factor analysis (CFA) confirmed good model fit (GFI = 0.950, AGFI = 0.920, NFI = 0.930, RMSEA = 0.050, SRMSR = 0.055). Medication adherence was observed to be high in 39.1% of patients, moderate in 28.6%, and poor in 32.3%. Significant associations were found between adherence scores and gender, educational attainment, and occupational status (p < 0.005) with education predicting adherence (B = 0.301, p < 0.000), indicating the scale's robustness in detecting adherence variations among Urdu-speaking MDD patients. The UMGLS-4 is a reliable and valid tool for assessing medication adherence in Pakistani MDD patients, effectively capturing adherence variations across demographic variables.
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spelling doaj-art-0e1686229f064b89ac5d5b00a08401042025-08-20T03:52:06ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01204e032025810.1371/journal.pone.0320258Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.Sohail RiazFazli KhudaNadia Shamshad MalikNitasha GoharAyesha RashidAbuzar KhanAbdur RahmanSajid AliAsif JanAqeel NasimIn Pakistan, Major depressive disorder (MDD) contributes significantly to the mental health burden. It is crucial to understand patients' medication adherence status for developing a strategy for improving adherence and treatment outcomes. Therefore, a valid and reliable tool in the local Urdu language is required. The Morisky, Greene, and Levine Medication Adherence Scale (MGLS-4) is a reliable, valid and straightforward instrument to assess medication-taking behavior. The valid and reliable Urdu translation of MGLS-4 can fill this gap within the local context. Therefore, the present study aims to validate the Urdu Morisky, Green and Levine Adherence Scale (UMGLS-4) for MDD patients. This was a quantitative, cross-sectional validation study for Pakistani MDD patients. Reliability was measured using Cronbach's α and for test-retest reliability intraclass correlation coefficient (ICC) was calculated. Validity was assessed through face validity, content validity, construct validity, and convergent validity with the Drug Attitude Inventory (DAI-10). Descriptive and inferential statistical analyses were carried out to demonstrate adherence level and statistical significance, respectively. Linear regression was applied to find the association between the UGMLS-4 score and demographic characteristics. The UMGLS-4 demonstrated high reliability (Cronbach's α = 0.829) and a significant strong ICC (x = 0.601, p < 0.01) was detected. Exploratory factor analysis (EFA) revealed a single-factor structure explaining 66.084% of the variance. Confirmatory factor analysis (CFA) confirmed good model fit (GFI = 0.950, AGFI = 0.920, NFI = 0.930, RMSEA = 0.050, SRMSR = 0.055). Medication adherence was observed to be high in 39.1% of patients, moderate in 28.6%, and poor in 32.3%. Significant associations were found between adherence scores and gender, educational attainment, and occupational status (p < 0.005) with education predicting adherence (B = 0.301, p < 0.000), indicating the scale's robustness in detecting adherence variations among Urdu-speaking MDD patients. The UMGLS-4 is a reliable and valid tool for assessing medication adherence in Pakistani MDD patients, effectively capturing adherence variations across demographic variables.https://doi.org/10.1371/journal.pone.0320258
spellingShingle Sohail Riaz
Fazli Khuda
Nadia Shamshad Malik
Nitasha Gohar
Ayesha Rashid
Abuzar Khan
Abdur Rahman
Sajid Ali
Asif Jan
Aqeel Nasim
Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
PLoS ONE
title Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
title_full Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
title_fullStr Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
title_full_unstemmed Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
title_short Cross-cultural adaptation and psychometric evaluation of the urdu version of the morisky, greene, and levine medication adherence scale (MGLS-4) for major depressive disorder patients.
title_sort cross cultural adaptation and psychometric evaluation of the urdu version of the morisky greene and levine medication adherence scale mgls 4 for major depressive disorder patients
url https://doi.org/10.1371/journal.pone.0320258
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