Using the Medication Adherence Reasons Scale (MAR-Scale) to identify the reasons for non-adherence across multiple disease conditions

Figures & data

Table 1 Respondent demographics

Variable (and categories)	% (of N=15,672 in total)
Gender
Male	42.7
Female	57.3
Race/Ethnicity
White	71.7
Hispanic	10.1
African American	9.2
Asian	4.5
Other	4.6
Education
Less than high school/completed some high school	2.2
High school graduate or equivalent	16.3
Completed some college/Associate degree	37.9
College graduate/completed some grad school	28.7
Completed graduate school	14.9
Health Insurance
Yes	94.2
No	5.8
Prescription coverage through insurance
Yes	92.5
No	7.5

Table 2 Proportion non-adherent to medications

Condition^c	Overall rate of non-adherence^a,b based on the 19 items on the MAR-Scale (N)
	Daily orals	Daily injections	Daily topicals	Weekly orals	Weekly injections	Weekly topicals
Diabetes	25.2% (2746)	20.8% (1078)			36.7% (120)
Arthritis	37.6% (2480)	66.7% (48)	37.4% (163)	45.1% (244)	50.8% (126)	62.3% (53)
Lupus	44.5% (119)			41.7% (12)
Migraine	49.9% (1055)			58.1% (413)
Osteoporosis	39.4% (307)			27.3% (330)
Pain	42.5% (4056)		45.3% (172)	59.5% (603)	59.6% (52)	62.3% (53)
IBD	49.2% (254)				67.7% (31)
GERD/Heartburn	35.9% (4442)			60.3% (406)
Chronic constipation	47.3% (393)			52.4% (84)
IBS	44.2% (659)			53.8% (117)
Psoriasis	61.3% (137)	63.6% (22)	46% (328)	41.2% (34)	58.7% (46)	57.6% (66)
Eczema	63.7% (171)		53.8% (979)	76.5% (51)	96.9% (32)	50.2% (201)
Multiple sclerosis	34.8% (89)	50.0% (14)			33.3% (21)
Epilepsy	35.0% (294)
Sleep condition	43.9% (2812)			65.4% (379)	90% (40)
Depression	40.1% (4798)			76.1% (113)
Overactive bladder	41.3% (953)			72.2% (54)

Notes: ^aAny respondent who checked a response other than 0 days across any of the 19 items was considered non-adherent with that medicine for that specific reason. ^bFor medicines, the non-adherence rate was calculated only if the sample size was more than 30 or at least 10% of the patients taking oral medicines for that condition. For example, in multiple sclerosis, there were only 89 patients on oral medicines. Thus, where there were at least nine patients on the other modes of administration, data for those other modes were included. ^cEczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults.

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, irritable bowel syndrome.

Table 3 Mean non-adherence scores

Condition^c	Mean (standard deviation) MAR-Scale score^a, b for the 19 items
	Daily oral	Daily injections	Daily topicals	Weekly orals	Weekly injections	Weekly topical
Diabetes	1.78 (7.30)	2.00 (9.08)			6.12 (14.41)
Arthritis	3.92 (11.15)	17.52 (31.26)	4.93 (13.00)	4.61 (10.08)	7.08 (12.20)	6.94 (9.72)
Lupus	7.18 (18.81)			6.25 (12.61)
Migraine	5.41 (12.44)			4.28 (8.65)
Osteoporosis	4.70 (12.93)			1.84 (6.03)
Pain	3.81 (10.11)		6.42 (14.03)	4.55 (8.58)	11.08 (15.54)	6.06 (10.00)
IBD	5.82 (12.48)				17.23 (17.87)
GERD/Heartburn	2.79 (8.96)			5.07 (10.66)
Chronic constipation	5.48 (14.09)			3.31 (6.52)
IBS	4.31 (10.33)			4.57 (8.69)
Psoriasis	14.07 (21.76)	10.55 (16.74) (22)	3.63 (10.23)	4.38 (9.97)	11.24 (18.01)	4.36 (7.98)
Eczema	11.05 (18.60)		4.01 (8.64)	12.69 (16.11)	23.69 (16.55)	3.84 (9.38)
Multiple sclerosis	3.54 (8.05)	3.00 (5.80) (14)			5.67 (12.92)
Epilepsy	3.89 (11.47)
Sleep condition	4.34 (10.88)			5.44 (9.39)	15.43 (13.29)
Depression	3.53 (10.14)			8.54 (12.37)
Overactive bladder	4.43 (11.51)			7.09 (10.93)

Notes: ^aThe MAR-Scale score can range from 0 to 133 for medicines taken daily and 0–76 for medicines taken weekly. Higher scores indicate more complex non-adherence with more reasons and days. ^bFor medicines, the mean MAR-Scale scores were calculated only if the sample size was more than 30 or at least 10% of the patients taking oral medicines for that condition. For example, in multiple sclerosis, there were only 89 patients on oral medicines. Thus, if there were at least nine patients on the other modes of administration, it was included. ^cEczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults.

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, irritable bowel syndrome.

Table 4 Top three reasons for non-adherence with medicines taken daily and orally across all the 17 disease conditions

Disease condition^a	Sample size	1st reason	2nd reason	3rd reason
Diabetes	2,746	Simply missed it (11.4%)	Busy schedule (6.4%)	Side effects (5.6%)
Arthritis	2,480	Long-term effects (12.7%)	Skip to see if medicine is still needed (12.0%)	Simply missed it (11.9%)
IBD	254	Side effects (20.9%)	Simply missed it (20.5%)	Long-term effects (19.3%)
GERD/Heartburn	4,442	Simply missed it (13.1%)	Skip to see if still needed (11.1%)	Long-term effects (8.0%)
Chronic constipation	393	Skip to see if still needed (19.1%)	Simply missed it (16.5%)	Long-term effects (14%)
IBS	659	Skip to see if it is still needed (15.0%)	Simply missed it (14.6%)	Long-term effects (11.7%)
Psoriasis	137	Side effects (44.5%)	Long-term effects (38.0%)	Skip to see if still needed (36.5%)
Eczema	171	Side effects (39.2%)	Long-term effects/Skip to see if still needed (35.1%)	Simply missed it (33.3%)
Lupus	119	Long-term effects (21.0%)	Possible side effects (19.3%)	Side effects/Simply missed it (17.7%)
Multiple sclerosis	89	Simply missed it/Side effects (14.6%)	Long-term effects/Medicine not working (12.4%)	Personal Reasons/Cost (11.2%)
Epilepsy	294	Simply missed it (14.3%)	Side effects (12.6%)	Long-term effects/Possible side effects (11.2%)
Sleep condition	2,812	Skip to see if still needed (14.9%)	Simply missed it (13.6%)	Side effects (13.1%)
Depression	4,798	Simply missed it (16.4%)	Side effects (9.5%)	Busy schedule (9.1%)
Migraine	1,055	Side effects (16.6%)	Skip to see if it is still needed/Long term effects (16.4%)	Possible side effects (15.0%)
Pain	4,056	Skip to see if still needed (13.1%)	Long-term effects (12.1%)	Simply missed it (11.6%)
Osteoporosis	307	Simply missed it (17.0%)	Possible side effects (13.7%)	Long-term effects (13.0%)
Overactive bladder	953	Simply missed it (15.5%)	Side effects (12.5%)	Skip to see if still needed (12.0%)

Notes: ^aEczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults.

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, irritable bowel syndrome.

Figure 1 Comparison of proportion of respondents non-adherent (%) to daily oral medications for the 17 disease conditions based on the global item and the 19 items on the MAR-Scale. Eczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults.

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, Irritable Bowel Syndrome.

Table 5 Reliability statistics for the MAR-scale across disease conditions and modes and frequencies of administration

Condition^b	Reliability statistics based on Cronbach’s alpha/Guttman Split-half coefficient^a (sample size)
	Daily orals	Daily injections	Daily topicals	Weekly orals	Weekly injections	Weekly topicals
Diabetes	0.911/0.807 (2746)	0.954/0.918 (1078)			0.993/0.984 (120)
Arthritis	0.915/0.826 (2480)		0.944/0.925 (163)	0.962/0.917 (244)	0.979/0.965 (126)
Lupus	0.966/0.930 (119)
Migraine	0.914/0.849 (1055)			0.950/0.875 (413)
Osteoporosis	0.937/0.895 (307)			0.924/0.824 (330)
Pain	0.887/0.766 (4056)		0.933/0.851 (172)	0.934/0.880 (603)
IBD	0.931/0.855 (254)
GERD/Heartburn	0.912/0.828 (4442)			0.959/0.917 (406)
Chronic constipation	0.941/0.900 (393)
IBS	0.884/0.782 (659)			0.940/0.900 (117)
Psoriasis	0.973/0.949 (137)		0.899/0.791 (328)
Eczema	0.966/0.898 (171)		0.842/0.770 (979)			0.957/0.917 (201)
Epilepsy	0.920/0.792 (294)
Sleep condition	0.903/0.834 (2812)			0.943/0.901 (379)
Depression	0.893/0.775 (4798)			0.957/0.897 (113)
Overactive bladder	0.912/0.830 (953)

Notes: ^aFor medicines, Cronbach’s alpha/Guttman split-half coefficient was calculated only if the sample size was greater than 100. ^bEczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults.

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, irritable bowel syndrome.

Table 6 Overall prevalence^a of non-adherence due to each specific reason in the MAR-scale for daily orals for the 17 disease conditions^b

Notes: ^aColor shading indicates increasing non-adherence going from darkest blue (most adherent) to darkest red (most non-adherent); the shading is calibrated differently for overall adherence and the individual reasons, in order to better highlight the variance across conditions. ^bEczema = Eczema/Atopic Dermatitis/Dermatitis; Sleep condition = Sleep difficulties/Insomnia/Narcolepsy/Sleep Apnea; Pain = Pain/Fibromyalgia/Diabetic Neuropathic Pain; Overactive bladder = Wet/Dry/Stress Urinary Incontinence; Osteoporosis = Osteoporosis/Osteopenia; Arthritis = Rheumatoid Arthritis/Psoriatic Arthritis/Osteoarthritis/Ankylosing Spondylitis; Diabetes = Type 1/Type 2/Latent Autoimmune Diabetes in Adults

Abbreviations: GERD, GastroEsophageal Reflux Disease; IBD, Inflammatory Bowel Disease; IBS, Irritable Bowel Syndrome.