The Morisky Medication Adherence Scale (MMAS) addresses social desirability bias—the tendency of respondents to answer questions in a way that presents themselves in a favorable light—through its design and structure in several ways:
1. Indirect Questioning • The MMAS uses indirect and non-judgmental phrasing to reduce the likelihood that respondents feel pressured to provide “socially acceptable” answers. • For example, instead of directly asking, “Do you always take your medication as prescribed?” the scale uses questions like: • “Do you sometimes forget to take your medication?” • “When you feel better, do you sometimes stop taking your medicine?” • These phrasing strategies encourage honest self-reporting by normalizing less-than-perfect adherence. 2. Neutral Framing • Questions avoid accusatory or leading language, making it less likely that patients feel the need to provide “ideal” responses. • This approach helps respondents focus on their actual behaviors rather than what they believe is expected of them. 3. Emphasis on Common Behavior • Some items on the scale are designed to acknowledge that non-adherence is common (e.g., forgetting medication), reducing the stigma or guilt that might lead to biased responses. 4. Multiple Behavioral Dimensions • The scale assesses adherence across multiple scenarios (e.g., forgetfulness, changes in routine, and intentional non-adherence). This comprehensive approach allows it to capture a range of non-adherence behaviors that might not be apparent if only one type of adherence issue were assessed. 5. Scoring System • The MMAS uses a weighted scoring system that categorizes adherence into levels (low, medium, or high). This approach accommodates variability in responses and reduces the influence of any single socially desirable answer on the overall adherence assessment. 6. Validation in Diverse Populations • The scale has been validated in various cultural and clinical settings, demonstrating its ability to account for and minimize biases, including social desirability bias, across different populations. Despite these features, no self-reported tool can entirely eliminate social desirability bias. Researchers often complement the MMAS with objective measures (e.g., pill counts or pharmacy refill records) for a more comprehensive assessment of medication adherence.
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AuthorDr Donald Morisky. Archives
January 2025
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