Cross-cultural adaptation of the Morisky Green Levine medication adherence scale for use in patients with Ischaemic Heart Disease in Sri Lanka

Abstract

Background  Ischaemic Heart Disease (IHD) is a major constituent of cardiovascular disease in the world at present and has become the leading cause of death in Sri Lanka. Poor adherence to medication in IHD is related to increased re-hospitalisation and mortality. Therefore, continuous assessment of medication adherence is extremely important among these patients. The Morisky Green Levine Medication Adherence Scale (MGLS) is a widely used instrument to evaluate medication adherence in the clinical setting. The study aimed to translate the MGLS into Sinhala and cross-culturally adapt it to the Sri Lankan setting. Methods A Delphi process was conducted with a panel of experts where content and consensual validity of the scale was assessed after translation, back translation and pre-testing of the original scale. The ratings received from the first round of the Delphi process were noted and the amended translation re-sent for a second round. The re-ratings were evaluated for the degree of consensus and Items for the MGLS 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, (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. Results No items were removed from the original scale. Some items were reworded according to the experts’ suggestions to retain the conceptual meaning when translated into Sinhala. The Sinhala version of the MGLS exhibited adequate content and consensual validity. Conclusion The Sinhala version of the MGLS can be used in research, medication adherence evaluations and IHD prevention programmes in Sri Lanka.