Adherence to Insulin Therapy Among Children with Type 1 Diabetes: Reliability and Validity of the Arabic Version of the 4-Item Morisky Medication Adherence Scale

Yasmine I Elhenawy,1 Reham I Abdelmageed,2 Dalia K Zaafar,3 Asmaa W Abdelaziz2 1Pediatric and Adolescent Diabetes Unit (PADU), Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 2Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 3Pharmacology Department, Faculty of Pharmacy, Modern University for Technology and Information, Cairo, EgyptCorrespondence: Yasmine I Elhenawy, Pediatric and Adolescent Diabetes Unit (PADU), Department of Pediatrics, Faculty of Medicine, Ain Shams University, 26 Hassan Ibrahim Hassan Street, Nasr City, Cairo, Egypt, Tel +201006714334, Email dr_yasmi@yahoo.comBackground: Inadequate adherence to insulin is a major concern, necessitating the use of reliable and valid metrics for assessing adherence. Up to date, there are no Arabic validated tools assessing adherence to insulin therapy among children with type 1 diabetes (T1DM). Thus, the aim of this study is to evaluate the psychometric properties of an Arabic version of the four-item Morisky Green Levine Medication Adherence Scale (MGLS-4) as a self-reported measure of adherence to insulin among a cohort of Egyptian children with T1DM.Methods: The MGLS-4 was translated using forward and backward translation. The Cronbach’s alpha was used to assess reliability. Criterion validity of the scale was tested by examining the correlation coefficients between the compliance score (level of adherence) and the HbA1c levels.Results: A total of 400 patients completed the Arabic version of MGLS-4. 26.25% of the studied cohort was found to be non-adherent to insulin therapy; non-adherent patients were significantly older (P=0.001). Decreased maternal education level, decreased frequency of blood glucose monitoring and prolonged disease duration best predicted the occurrence of non-adherence among the studied cohort. The internal consistency of the current version showed good reliability (Cronbach’s alpha = 0.857). The adherence score and