Student Name Nina Nguyen

Name of Measurement Tool Self-Reported Medication-Taking Scale

Source (Cite your article) Use APA to provide a reference for the article.
Morisky, D., Green, L., & Levine, D. (1986). Concurrent and predictive validity of a

self- reported measure of medication adherence. Medical Care, 24(1), 67–74.

1) Briefly describe the instrument/tool in terms the type of tool, number of items,
scoring, and meaning of the scores. (5)5
The study used four-item self-reported scale to measure medication-taking behavior. They
measured the theory of drug omission with several items: “forgetting, carelessness, stopping the
drug when feeling better, or starting the drug when feeling worse” (Morisky, 1986). The factors
where used as a questionnaire for patients to respond with “yes” and “no” with the following
questions:
1. Do you ever forget to take your medicine?
2. Are you careless at times about taking your medicine?
3. When you feel better do you sometimes stop taking your medicine?
4. Sometimes if you feel worse when you take medicine, do you stop taking it?
The score of zero is given to the response of “yes” and one is given for the response of “no”.
Total score of zero indicates high nonadherence, while total score of four equals to low
nonadherence. Therefore, the lower the total score, the lower the adherence and the higher the
score the higher levels of adherence.

2) Discuss the reliability of the tool. Be sure to describe each aspect of reliability
mentioned in the article. Include the evidence for determining reliability. (For
example, for the internal consistency, identify the value indicating the Cronbach
Alpha). (10)10
“The reliability of the scale is reflected in its relatively high (0.61) measure of internal
consistency” (Morisky, 1986). Although, the article stated the scale as relatively high, it is
considered as not acceptable and poor reliability. The Cronbach Alpha is considered acceptable
if it is above 0.70.

3) How is validity of the tool described? Does the paper discuss the various types of
validity discussed in class? Provided statistics as appropriate. (10)8
 “Individuals who scored high on the scale were more likely to have their blood pressure
under control than those individuals who scored low. The point biserial correlation was equal
to 0.43 (P < 0.01)” (Morisky, 1986). The value of 0.43 is considered as a moderate relationship
among the variables of medication adherence and blood pressure control. The P < 0.01
indicates significant probability that there is 1% chance that they made an error and 99%
chance they didn’t make an error.
The paper discussed that these “findings reconfirms the previously assessed concurrent
validity as noted in the baseline needs assessment” (Morisky, 1986). The meaning of the
concurrent validity states the higher the score for reported medication adherence, the higher the
score for blood pressure control.
The paper also states the scale’s predictive validity manifest as a linear relationship, which
examined in terms of future performance of medication adherence leads to better control with
blood pressure. “Individuals scoring high on the adherence scale were significantly more likely
to have their blood pressure under control compared with individuals who scored low (r=0.58;
P <0.01)”. The correlation value of 0.58 is a strong relationship between those variables and
significant probability states 1% chance of error.
4. What aspects of validity or reliability are missing in the discussion? (Use Bullet points)
(5)4
 No test-retest was mentioned in the article to the determine the stability of the instrument.
5. What is your overall assessment of the value of this instrument? (2-3 sentences) (5) 5
The instrument is ranked with a low Cronbach Alpha score of .61, which is considered as
a low internal consistency. The instrument is significant with concurrent and predictive validity
with moderate relationship among medication adherence and blood pressure control. The scale
has a moderate sensitivity of 81% for testing true positive and a low specificity of 44% for false
positive. 32/35=91.4%