Validation of diabetes medication adherence scale in the Lebanese population Zahraa Mallah a,e , Yasmin Hammoud a,e , Sanaa Awada b,e , Samar Rachidi c,e , Salam Zein c,e , Hajar Ballout d,e , Amal Al-Hajje c,e, * a Research Clinical Pharmacy and Pharmaco-epidemiology, Lebanon b Pharmacokinetics, Lebanon c Clinical Pharmacy, Lebanon d Saint Georges Hospital, Lebanon e Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon ARTICLE INFO Article history: Received 27 June 2019 Received in revised form 25 July 2019 Accepted 30 August 2019 Available online 31 August 2019 Keywords: Type 2 diabetes mellitus Adherence Oral anti-diabetics Diabetes Medication Adherence Scale (DMAS-7) Validation Glycemic control ABSTRACT Aim: To validate the Diabetes Medication Adherence Scale (DMAS-7), determine its concor- dance with another validated scales and to assess factors affecting medication adherence. Methods: A cross-sectional study was conducted on a sample of Lebanese patients with dia- betes using a questionnaire. The level of adherence was measured using the DMAS-7 and the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted, and the scale was validated in terms of reliability, predictive ability, and construct validity using SPSS version 19. Results: Out of 300 eligible patients, the rate of adherence was 33.7%. Measures of validity showed good reliability (Cronbach alpha = 0.627), and good construct validity with LMAS-14 (Spearman’s rho = 0.846; Cohen’s kappa = 0.711). DMAS-7 was found to be both correlated with LMAS-14 (ICC average measure = 0.675; p-value <0.001) in addition to possessing a bet- ter predictive value. Thus, DMAS-7 showed to have good concordance and increased valid- ity compared to LMAS-14. Having an optimal glycated hemoglobin (HbA1C) (OR = 0.779; p = 0.001) and performing regular physical activity (OR 2.328; p = 0.002) increased medica- tion adherence. Conclusion: The DMAS-7 showed to be reliable and valid instrument superior to LMAS-14 in predicting adherence levels to oral anti-diabetic medications, and thus can be used to achieve better glycemic outcomes. Ó 2019 Published by Elsevier B.V. 1. Introduction The global burden of diabetes is rapidly emerging throughout the 21th century with increasing prevalence and long lasting complications [1]. This disease remains the 7th leading cause of premature mortality and the most expensive condition in 2017 in the United States [2]. According to the International Diabetes Federation’s latest report, the global prevalence of diabetes is estimated to be 8.8% [3]. Lebanon showed to have a higher prevalence of this disease (14.6%) in 2017 [4]. https://doi.org/10.1016/j.diabres.2019.107837 0168-8227/Ó 2019 Published by Elsevier B.V. * Corresponding author at: Clinical Pharmacy, Lebanese University, Campus Hadath, Beirut, Lebanon. E-mail address: amalkeh@hotmail.com (A. Al-Hajje). diabetes research and clinical practice 156 (2019) 107837 Contents available at ScienceDirect Diabetes Research and Clinical Practice journal homepage: www.elsevier.com/locate/diabres