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Rev Port Cardiol. 2018 Apr;37(4):297-303. doi: 10.1016/j.repc.2017.09.017. Epub 2018 Apr 5.

Cross-cultural adaptation and validation of a European Portuguese version of the 8-item Morisky medication adherence scale.

[Article in English, Portuguese]

Author information

Pharmacology and Pharmaceutical Care Laboratory, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
Cognitive and Behavioural Center for Research and Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
Institute for Biomedical Imaging and life Sciences, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal. Electronic address:



The 8-Item Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used instruments to assess medication adherence, but a validated European Portuguese version of MMAS-8 does not exist. Our aim was to develop and validate a European Portuguese version of the MMAS-8.


A process of translation and back-translation of the original MMAS-8 was performed. The questionnaire was administered in nine community pharmacies and one public hospital between March 2014 and September 2015. Adult patients taking at least one antihypertensive drug were invited to participate. A confirmatory factor analysis was performed and internal consistency, convergent validity and concurrent validity were examined.


A total of 472 patients were enrolled in the study. The mean MMAS-8 score obtained was 6.74±1.39. One hundred and thirty-two patients were classified as low adherers (28%), 181 (38.3%) as medium adherers and 159 (33.7%) as high adherers. For the factorial structure of the Portuguese version of the MMAS-8, the fit indices of the final model (chi-square [18] 48.465, p<0.001) are suggestive of very good fit, with comparative fit index 0.95, root mean square error of approximation 0.06 (90% confidence interval 0.04-0.08), and standardized root mean square residual 0.04, confirming that the construct tested was unidimensional. The Cronbach's alpha for all items was 0.60, and the translated version presents convergent validity and concurrent validity.


A European Portuguese version of the MMAS-8 was created that maintained a similar structure to the original MMAS-8 and good psychometric properties.


Adesão à medicação; Medication adherence; Questionnaires; Questionários; Validation; Validação

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