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  1. Responds to Jeff Week 3 DQ 1 DNP-830 

    Medication non-adherence is one of the most important factors associated with poor management of chronic diseases such as hypertension (De las Cuevas & Peñate, 2015). The prevalence of the lack of medication adherence is even greater in the vulnerable populations such as African Americans, Hispanics and native Americans (Jankowska-Polańska, Uchmanowicz, Dudek, & Mazur, 2016). Some other contributing factors that may contribute to the lack of compliance may be lack of resources to healthcare, socioeconomic resource, and lack of education regarding available resources (Jankowska-Polańska et al., 2016). To determine and capture some of these barriers, a medication adherence scale such as Morisky Medication Adherence Scale (MMAS-8) with additional unvalidated questionnaires targeted on lack of resources would be utilized in the project to determine the relationship between medication adherence and hypertension in the adult African Americans.

    The MMAS 8 scale for measuring medication nonadherence has been utilized in many studies to understand and gain prospective of some of the commonly associated behaviors regarding medication with chronic disease management (Jankowska-Polańska et al., 2016). It consists of 8 items, 7 of which allows individuals to answer yes or no questions and the last question consist of a 5-point likert-scale rating. The reliability of the MMAS-8 has been questioned by many other studies with similar goals and have been found to be reliable when use appropriately (De las Cuevas & Peñate, 2015).

    De las Cuevas, C., & Peñate, W. (2015). ORIGINAL ARTICLE: Psychometric properties of the eight-item Morisky Medication Adherence Scale (MMAS-8) in a psychiatric outpatient setting. International Journal of Clinical and Health Psychology15, 121–129. https://doi-org.lopes.idm.oclc.org/10.1016/j.ijchp.2014.11.003

    Jankowska-Polańska, B., Uchmanowicz, I., Dudek, K., & Mazur, G. (2016). Relationship between patients’ knowledge and medication adherence among patients with hypertension. Patient Preference & Adherence10, 2437–2447. https://doi-org.lopes.idm.oclc.org/10.2147/PPA.S117269


    Respond to Paula, Week 3 DQ 1 DNP-830 


    Describe a survey, instrument, or tool that you plan to use in your project. Describe the tool in terms of name, number of items, how it is answered (Likert scale, yes/no, open answers, etc.), and the total score. Describe the level of measurement for this instrument. Support with references.

    The instrument planned to be used for my DPI project is a Likert scale. The Likert scale quantifies subjective attitudes, opinions and perceptions into objective data that can be measured. Validity of the Likert scale is dependent on the applicability of the topic to those surveyed. In the case of the patient’s surveyed using aromasticks to improve sleep, sleep deficit was an issue to those surveyed so applicable to their needs and concerns. In the Likert scale this writer plans to use to survey nurses, questions/statements will address knowledge of CAM, attitudes and use of CAM. The Likert scale may have 5-7 choices to ensure the best response ranging from absolutely agree to absolutely disagree. I know if I use a standardized Likert scale it will add to reliability, but have not found one with exactly the correct wording.


    Dyer, J., Cleary, L., McNeill, S., Ragsdale-Lowe, M. Osland,C. (2016)

    The use of aromasticks to help with sleep problems: A patient experience survey,

    Complementary Therapies in Clinical Practice, Vol 22, 51-58 Retrieved


    Joshi, A., Kale, S., Chandel, S., Pal, D. (2016) Likert Scale: Explored and Explained. British Journal of Applied Science & Technology 7(4) 396-403


Subject Nursing Pages 4 Style APA


Response 1

Hello Jeff, let me first acknowledge the importance of your discussion question in promoting the quality of patient outcome. Indeed, medication non-adherence is a major challenge that requires a comprehensive evaluation and the implementation of effective mitigation approaches. In chronic illnesses, as you have identified, they require strict adherence to the medication schedule. Failure to this adherence affects the rate of recovery of the individual (Vrijens et al., 2017). To contribute to your discussion, establishing the cause of non-adherence to medication should factor in the patient’s personal factors and other healthcare conditions. For patients with multiple chronic illnesses, polypharmacy may be a critical challenge affecting their medication adherence.

The MMAS 8 scale is indeed a reliable and valid instrument in examining medication non-adherence. Notably, the 5-point Likert scale reflects on a high level of measurement which promotes the instrument’s validity and reliability. To further contribute to your discussion, the MMAS-8 update is characterized by a higher sensitivity and is indeed the most used instrument to examine medication non-adherence. According to Wong et al. (2015), the closed dichotomous questions which require the respondent to either use yes or no is vital in preventing bias from the patients’ positive responses. Notably, the responses associated with the respondent’s adherence behavior are reversed. Every item in this scale examines a particular adherence behavior, and only the last question allows for using a scale (always, often, sometimes, almost never, and never). When using this instrument, the level of adherence is based on the total score of the correct responses. High adherence is described by eight points, average adherence (6 – <8), and poor adherence is described by (< 6 points).


Vrijens, B., Antoniou, S., Burnier, M., de la Sierra, A., & Volpe, M. (2017). Current situation of medication adherence in hypertension. Frontiers in pharmacology8, 100.

Wong, M. C., Wu, C. H., Wang, H. H., Li, H. W., Hui, E. M., Lam, A. T., … & Morisky, D. E. (2015). Association between the 8‐item Morisky medication adherence scale (MMAS‐8) score and glycaemic control among Chinese diabetes patients. The Journal of Clinical Pharmacology55(3), 279-287.


Response 2

Hello Paula, I concur with you on using the Likert scale to promote the study validity and reliability. The quantification of the perceptions, attitudes, and opinions into subjective data that can be numerically analyzed allows the researcher to establish the relationship between the study constituents or variables in the social world which is in line with the positivist philosophy in research. Besides the validity of the Likert scale being centered on the applicability of the survey to the topic, the interval and ratio scales are identified as high levels of measurements which also increases the study quality and reliability (Joshi, Kal, Chandel, & Pal, 2015).

To contribute to your discussion, establishing responses from various respondents including nurses and patients provide comprehensive data whose analysis may be used to improve one’s understanding of the topic. The 5-7 choices is also an essential approach in presenting the respondents with flexibility in choosing the most suitable response. To solve your challenge of selecting an instrument with the correct wording, I would suggest the consideration of adopting and adapting approaches to an instrument or developing your questions from literature and as guided by the research objectives. According to Aboshady et al. (2015), the adoption or adaption of a research instrument depends on the relationship between one’s study and others which have been done previously. However, there are situations where the research may not conform to the existing studies. At such a point, the individual has the option to develop an instrument although it must be guided by the research board and experts. Also, this approach is complex since validity and reliability issues have to be considered.


Aboshady, O. A., Radwan, A. E., Eltaweel, A. R., Azzam, A., Aboelnaga, A. A., Hashem, H. A., … & Noaman, A. M. (2015). Perception and use of massive open online courses among medical students in a developing country: multicentre cross-sectional study. BMJ open5(1), e006804.

Joshi, A., Kale, S., Chandel, S., & Pal, D. K. (2015). Likert scale: Explored and explained. British Journal of Applied Science & Technology7(4), 396.


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