How to properly use the MMAS4

The Morisky 4 item Scale is unique because it doesn’t treat non-adherence as a monolithic concept. It consist of two subscales, unintentional and intentional non-adherence, that are coded as four dichotomous (yes/no) variables in the MMAS-4.

Understanding the MMAS-4

Question 1: Do you ever forget to take your(name of health condition) medicine?

Focus: This question explicitly asks about forgetfulness, emphasizing whether the patient unintentionally misses doses.

• Nature of Issue: It identifies lapses in adherence relative to memory.
• Directness: The phrasing is straightforward and specific, making it easier for patients to recall specific instances of forgetting.

Question 2: Do you ever have problems remembering to take your (name of health condition) medicine?

Focus: This question addresses unintentional problem the patient has with difficulty remembering, which may include systemic or situational barriers (e.g., unpredictable schedules, lack of routines).

• Nature of Issue: It can encompass both habitual forgetfulness and challenges related to adherence systems, like not having reminders.
• Directness: This phrasing is less direct, eliciting a more honest response about their overall problems with adherence.

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Question 3: When you feel better, do you sometimes stop taking your (name of health condition) medicine?

Focus: This question addresses intentional non-adherence based on the patient’s perception of health improvement.

• Nature of Issue: It identifies whether patients discontinue their medication prematurely because they believe it is no longer necessary after feeling better.

Question 4: Sometimes if you feel worse when you take your (name of health condition) medicine, do you stop taking it?

Focus: This question addresses intentional non-adherence driven by negative side effects or perceived worsening of symptoms after taking medication.

• Nature of Issue: It explores whether patients choose to discontinue medication because they associate it with feeling worse, whether due to actual side effects or psychosomatic perceptions.

​The Morisky Protocol assesses the differential impact of unintentional (forgetfulness and polypharmacy) and intentional (stopping use of medication if feeling better or worse) medication non-adherence. Using the Morisky Scale platform will score and recode your data with intentional and unintentional medication non-adherence. The Morisky Protocol training will guide you through a process to tailor educational counceling focused on patient beneficence in the decision making about prescribed medicines.