Path to Better Adherence

The MMAS-8 is an 8-item self-report questionnaire (7 yes/no items, 1 Likert-scale) designed to measure medication adherence in chronic diseases. It’s split into two domains: unintentional nonadherence (e.g., “Do you ever forget to take your medicine?”) and intentional nonadherence (e.g., “When you feel better, do you sometimes stop taking your medicine?”). Scored from 0 to 8, lower scores (<6) indicate poor adherence. Its reliability (Cronbach’s α=0.83) and correlation with clinical outcomes like blood pressure control (r≈0.47) make it a go-to tool for assessing adherence in conditions like rheumatoid arthritis, where consistent medication use is critical to prevent flares (AlGhurair et al., 2012).
As a lagging metric, MMAS-8 looks backward, capturing behaviors that have already occurred. For example, in a study of hypertension patients, over 50% reported forgetting doses, and many skipped medications when feeling better, reflecting past issues with forgetfulness and low motivation (AlGhurair et al., 2012). These align with WHO patient-related barriers:
• Forgetfulness: Questions about missed doses identify unintentional lapses.
• Lack of Motivation: Items on stopping medications due to feeling better or worse highlight deliberate choices driven by low motivation or negative beliefs.
• Lack of Knowledge: Difficulty remembering all pills may signal past misunderstanding of regimens.
The MMAS-8 can confirm if patients have skipped doses due to asymptomatic periods or complex regimens, providing a snapshot of adherence challenges. However, its retrospective nature means it diagnoses problems after they’ve impacted health, limiting its ability to prevent future nonadherence or explain underlying causes like low confidence.

SEAMS: A Leading Metric to Predict and Prevent Nonadherence
Enter SEAMS, a 13-item tool that measures patients’ confidence (self-efficacy) in managing medications, using a 3-point Likert scale (1 = not confident, 3 = very confident). Its two subscales--Medication Use (7 items, e.g., “How confident are you that you can follow the instructions on your medication label?”) and Setbacks (6 items, e.g., “How confident are you that you can take your medicines correctly when they cause some side effects?”)—assess routine and challenging scenarios, respectively. Scores range from 13 to 39, with lower scores (<25) predicting nonadherence risk (Shi et al., 2023). Validated in low-literacy populations (α=0.89, sensitivity 81% against pill counts), SEAMS is ideal for diverse settings like Sudan (Risser et al., 2007).
As a leading metric, SEAMS looks forward, predicting adherence challenges by assessing confidence before issues arise. For example, low scores on remembering doses when busy (Setbacks item) predict future forgetfulness, while low confidence in managing side effects signals potential motivational barriers (Wang et al., 2024). SEAMS maps WHO patient-related barriers proactively:
• Forgetfulness: Items like “How confident are you that you can remember to take all your medicines?” predict memory lapses.
• Lack of Motivation: Questions about persisting despite side effects or feeling unwell forecast motivational deficits.
• Lack of Knowledge: Confidence in following instructions or filling prescriptions highlights knowledge gaps.
• Low Self-Efficacy: The core focus, with low scores (<25) linked to higher nonadherence risk (OR=1.15; Shi et al., 2023).

The SEAMS could identify patients at risk of missing doses during flares (low Setbacks scores) or struggling with complex regimens due to low literacy (low Medication Use scores), enabling early interventions like education or reminders.

Complementary Power: Lagging and Leading Together
MMAS-8 and SEAMS are a dynamic duo for tackling adherence. MMAS-8 diagnoses past nonadherence, confirming the extent of barriers like forgetfulness or low motivation. For instance, a patient scoring 4/8 on MMAS-8 might have frequently forgotten doses or skipped them due to feeling better, indicating established issues. SEAMS then digs deeper, predicting why these barriers persist by assessing confidence. A low SEAMS score on remembering doses when busy (e.g., score of 1) suggests future forgetfulness, while low confidence in handling side effects predicts intentional nonadherence. This was demonstrated in a myasthenia gravis study, where MMAS-8 identified poor adherence (52% prevalence), and SEAMS’ high self-efficacy scores predicted better outcomes (OR=1.194; Wang et al., 2024).