Using MMAS-8 and SEAMS to Tackle Medication Adherence: Lagging and Leading Metrics for Better Outcomes

The Morisky Medication Adherence Scale (MMAS-8) and the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) are both validated self-report tools used to assess medication adherence in chronic diseases, but they serve different purposes. The MMAS-8 is considered a lagging metric because it measures past adherence behaviors and outcomes (e.g., whether patients have already missed doses or deliberately skipped medications), reflecting historical performance. In contrast, the SEAMS is a leading metric because it assesses patients’ confidence (self-efficacy) in managing future medication-taking tasks, predicting potential adherence challenges before they manifest.

As a lagging metric, MMAS-8 is diagnostic, confirming nonadherence after it occurs. It’s useful for assessing the extent of adherence problems and correlating them with clinical outcomes (e.g., poor blood pressure control in hypertension). However, it doesn’t predict future adherence or identify why barriers exist, limiting its proactive utility. For example, a patient scoring low on MMAS-8 (e.g., 4/8) has already exhibited nonadherence, but the tool doesn’t explain underlying confidence or capability issues.

As a leading metric, SEAMS is predictive, identifying patients at risk of nonadherence before it occurs. For example, a patient with low confidence in managing side effects (SEAMS item #11) is likely to skip doses in the future, allowing clinicians to intervene proactively with education or regimen adjustments. Its focus on self-efficacy makes it actionable for tailoring interventions to boost confidence.

Complementary Roles and WHO Barrier Mapping • Lagging vs. Leading Synergy: MMAS-8 and SEAMS complement each other in addressing WHO patient-related barriers:

• MMAS-8 (Lagging): Confirms past nonadherence, quantifying the extent of barriers like forgetfulness (e.g., >50% prevalence in hypertension, AlGhurair et al., 2012) or intentional nonadherence due to low motivation or beliefs. It’s reactive, identifying patients who have already struggled.
​
• SEAMS (Leading): Predicts future nonadherence by assessing confidence deficits that underpin these barriers. For instance, low SEAMS scores on remembering doses (#6) predict forgetfulness, while low scores on managing side effects (#11) predict motivational issues, as seen in myasthenia gravis patients (Wang et al., 2024, OR=1.194 for self-efficacy).

​A Path to Better Adherence
​For researchers and clinicians tackling medication adherence, MMAS-8 and SEAMS are a perfect pair. MMAS-8, the lagging metric, diagnoses past adherence failures, shining a light on barriers like forgetfulness and low motivation. SEAMS, the leading metric, predicts future risks by assessing self-efficacy, empowering proactive solutions. Together, they map WHO patient-related barriers comprehensively, offering actionable insights for your rheumatoid arthritis study in Sudan. By using MMAS-8 to identify nonadherent patients and SEAMS to target confidence deficits, you can design interventions—like education or simplified regimens—that improve outcomes despite economic challenges.

​Let’s leverage these tools to help patients stay on track and reduce flares worldwide! If you’re ready to integrate these into your study, check out the resources or reach out for support.
​


​

​

​