Translation, cultural adaptation and validation of general medication adherence scale (Gmas) into the nepalese language

Rajeev Shrestha, Binaya Sapkota, Asmita Priyadarshini Khatiwada, Sunil Shrestha, Saval Khanal, K. C. Bhuvan, Vibhu Paudyal

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Background: The General Medication Adherence Scale (GMAS) evaluates intentional and unintentional behaviour of patients, disease and medication burden and cost-related burden associated with non-adherence. GMAS was developed and validated among Urdu-speaking patients with chronic diseases. However, validated tool in Nepalese language to measure medication adherence among chronic illness patients currently does not exist. Aim: To translate, culturally adapt, and validate the English version of GMAS into the Nepalese language to measure medication adherence among chronic illness patients. Methods: The study was conducted among patients with chronic diseases in both hospital and community pharmacies of Nepal. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Good Practice Guideline for linguistic translation and cultural adaptation was used to translate and culturally adapt the English version of GMAS into the Nepalese version. The translated version was validated amongst patients with chronic diseases in Nepal. Exploratory factor analysis was carried out using principal component analysis with varimax rotation. Test–retest reliability and internal consistency were analysed. Results: A total of 220 (53.6% females, and 51.4% of 51 to 70 aged patients) patients with chronic diseases participated in the study. The majority of patients took two medications (27.3%) from six months to five and half years (68.2%). Kaiser Meyer Olkin was found to be 0.83. A principal axis factor analysis was conducted on the 3 items of GMAS without and with orthogonal rotation (varimax). The scree plot showed an inflexion on the third item that meant three components were present. The overall Cronbach’s alpha value of the full-phase study was 0.82. Conclusion: The General Medication Adherence Scale was successfully translated into the Nepalese language, culturally adapted, and validated amongst chronic diseases patients of Nepal. Therefore, the GMAS-Nepalese version can be used to evaluate medication adherence among Nepalese-speaking patients with chronic disease.

Original languageEnglish
Pages (from-to)1873-1885
Number of pages13
JournalPatient Preference and Adherence
Publication statusPublished - 27 Aug 2021


  • Adherence
  • Chronic disease
  • General medication adherence scale
  • GMAS
  • Nepal
  • Psychometric validation

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