Translation, Cultural Adaptation and Validation of General Medication Adherence Scale (GMAS) into the Nepalese Language

Figures & data

Figure 1 Stepwise translation procedure.

Table 1 Demographic Characteristics of Study Population (N = 220)

Variables	Frequency (%)
Age of the participants (in years)
Below 30	12 (5.5)
30 to 50	47 (21.4)
51 to 70	113 (51.4)
> 70	48 (21.8)
Gender
Male	102 (46.4)
Female	118 (53.6)
Education
Uneducated	71 (32.3)
Primary (5 year of formal schooling)	54 (24.5)
Secondary (10 years of formal schooling)	43 (19.5)
Higher secondary (12 years of formal schooling)	22 (10.0)
Undergraduate	23 (10.5)
Post-Graduate	7 (3.2)
Employment status
Employed	35 (15.9)
Unemployed	13 (5.9)
Retired	37 (16.8)
Household	115 (52.3)
Self-employed	20 (9.1)
Monthly Income (NPR)
< 20,000	74 (33.6)
20,000 to 40,000	103 (46.8)
40,001 to 60,000	32 (14.5)
> 60,000	11 (5.0)

Abbreviation: NPR, Nepalese Rupees (1 United States Dollar = 115 NPR approximately on 22 Jan 2021).

Table 2 Treatment-Related Characteristics Among the Study Participants

Variables	Frequency (%)
Treatment length (in years) (Mean ± SD: 5.26±4.41)
</= 0.5	2 (0.9)
0.6–5.5	150 (68.2)
5.6–10.5	45 (20.5)
10.6–15.5	13 (5.9)
15.6+	10 (4.5)
Medication number: (Mean ± SD: 2.65±1.53)
1	63 (28.6)
2	60 (27.3)
3	32 (14.5)
4	33 (15.0)
5	23 (10.5)
6	6 (2.7)
7	3 (1.4)
Number of Chronic Illness (Mean ± SD: 1.9 ± 0.7)
1	49 (22.3)
2	128 (58.2)
3	43 (19.5)

Table 3 GMAS Related Characteristics Among the Study Participants

Construct	Study Items	Frequency (%)				Total
		Always	Mostly	Sometimes	Never
PBNA	GMAS1	20 (9.1)	9 (4.1)	101 (45.9)	90 (40.9)	220 (100)
	GMAS2	3 (1.4)	14 (6.4)	118 (53.6)	85 (38.6)	220 (100)
	GMAS3	7 (3.2)	23 (10.5)	36 (16.4)	154 (70)	220 (100)
	GMAS4	3 (1.4)	19 (8.6)	45 (20.5)	153 (69.5)	220 (100)
	GMAS5	3 (1.4)	8 (3.6)	42 (19.1)	167 (75.9)	220 (100)
ADPB	GMAS6	1 (0.5)	4 (1.8)	34 (15.5)	181 (82.3)	220 (100)
	GMAS7	2 (0.9)	14 (6.4)	65 (29.5)	139 (63.2)	220 (100)
	GMAS8	2 (0.9)	13 (5.9)	30 (13.6)	175 (79.5)	220 (100)
	GMAS9	3 (1.4)	6 (2.7)	49 (22.3)	162 (73.6)	220 (100)
CRNA	GMAS10	4 (1.8)	4 (1.8)	26 (11.8)	186 (84.5)	220 (100)
	GMAS11	2 (0.9)	13 (5.9)	54 (24.5)	151 (68.6)	220 (100)

Abbreviations: PBNA, Patient behaviour related non-adherence; ADPB, Additional disease and pill burden; CRNA, Cost related non-adherence.

Table 4 Principal Components Analysis Before Factor Retention on the Unrotated Condition

Items	PC1	PC2	PC3	PC4	PC5	PC6	PC7	PC8	PC9	PC10	PC11	h2	u2 (ie, 1-h2)
GMAS1	0.56	0.10	0.60	0.07	0.11	0.18	0.16	−0.42	0.09	0.22	−0.08	1	−4.4X10-16
GMAS2	0.51	−0.08	0.62	−0.33	0.01	−0.12	0.17	0.41	0.06	−0.14	0.09	1	−1.6X10-15
GMAS3	0.48	0.47	−0.23	−0.01	0.27	−0.62	0.16	−0.05	0.03	0.09	0.03	1	7.8X10-16
GMAS4	0.51	0.41	−0.33	−0.42	0.08	0.41	−0.10	0.17	0.18	0.22	0.05	1	3.3X10-16
GMAS5	0.58	0.52	0.01	0.33	0.13	0.27	0.05	0.07	−0.30	−0.30	−0.07	1	3.3X10-16
GMAS6	0.70	−0.24	−0.29	−0.17	−0.01	0.04	0.10	−0.27	0.31	−0.38	0.00	1	4.4X10-16
GMAS7	0.72	0.04	0.19	0.13	−0.12	−0.13	−0.58	−0.09	0.00	−0.02	0.24	1	1
GMAS8	0.77	−0.07	−0.05	−0.13	−0.41	−0.16	−0.12	0.07	−0.10	0.07	−0.41	1	1.1X10-16
GMAS9	0.56	−0.15	−0.14	0.64	−0.19	0.06	0.19	0.25	0.26	0.14	0.06	1	1.1X10-16
GMAS10	0.69	−0.33	−0.22	−0.16	−0.15	0.05	0.25	−0.10	−0.41	0.13	0.23	1	5.6X10-16
GMAS11	0.46	−0.53	−0.08	0.08	0.66	0.03	−0.16	0.12	−0.06	0.07	−0.13	1	1
SS loadings (Initial)	4.01	1.15	1.10	0.90	0.78	0.72	0.57	0.55	0.48	0.41	0.32
Proportion of Variance	0.36	0.10	0.10	0.08	0.07	0.07	0.05	0.05	0.04	0.04	0.03
% of variance	36%	10%	10%	8%	7%	7%	5%	5%	4%	4%	3%
Cumulative Variance and proportion	0.36	0.47	0.57	0.65	0.72	0.79	0.84	0.89	0.93	0.97	1.00
Cumulative variance %	36%	47%	57%	65%	72%	79%	84%	89%	93%	97%	100%

Notes: SS loadings: Eigenvalues (ie, variance explained by that component); h2: Communalities (ie, proportion of common variance among the variables); u2: Uniqueness (ie, the variance that is specific to a particular variable and is not shared with other ones).

Table 5 Principal Components Analysis After Factors (Components) Retention on the Unrotated and Rotated Conditions

Items	Without Rotation					With Varimax Rotation
	PC1	PC2	PC3	h2	u2	RC1	RC2	RC3	h2	u2
GMAS1	0.56	0.10	0.60	0.69	0.31	0.11	0.17	0.80	0.69	0.31
GMAS2	0.51	−0.08	0.62	0.65	0.35	0.18	−0.01	0.78	0.65	0.35
GMAS3	0.48	0.47	−0.23	0.50	0.50	0.12	0.70	0.06	0.50	0.50
GMAS4	0.51	0.41	−0.33	0.53	0.47	0.21	0.70	−0.01	0.53	0.47
GMAS5	0.58	0.52	0.01	0.61	0.39	0.08	0.70	0.32	0.61	0.39
GMAS6	0.70	−0.24	−0.29	0.64	0.36	0.74	0.28	0.08	0.64	0.36
GMAS7	0.72	0.04	0.19	0.55	0.45	0.41	0.35	0.52	0.55	0.45
GMAS8	0.77	−0.07	−0.05	0.60	0.40	0.60	0.37	0.33	0.60	0.40
GMAS9	0.56	−0.15	−0.14	0.36	0.64	0.54	0.23	0.14	0.36	0.64
GMAS10	0.69	−0.33	−0.22	0.64	0.36	0.77	0.18	0.13	0.64	0.36
GMAS11	0.46	−0.53	−0.08	0.50	0.50	0.68	−0.14	0.13	0.50	0.50
SS loadings	4.01	1.15	1.10			2.53	1.94	1.80
Proportion of Variance	0.36	0.10	0.10			0.23	0.18	0.16
% of variance	36%	10%	10%			23%	18%	16%
Cumulative Variance	0.36	0.47	0.57			0.23	0.41	0.57
Cumulative Variance %	36%	47%	57%			23%	41%	57%
Cumulative Proportion	0.64	0.82	1.00			0.40	0.71	1.00

Abbreviations: PC, Principal component matrix; RC, Rotated component (factor) matrix; h2, Communalities; u2, Uniqueness.

Table 6 Test–Retest Reliability Analysis of Pilot Test Study

	Scale Mean If Item Deleted	Scale Variance If Item Deleted	Corrected Item-Total Correlation	Cronbach’s Alpha If Item Deleted
GMAS1_test	54.83	53.937	0.632	0.885
GMAS1_retest	54.93	54.202	0.597	0.886
GMAS2_test	54.73	58.340	0.441	0.891
GMAS2_retest	54.90	58.921	0.322	0.894
GMAS3_test	54.47	56.051	0.682	0.885
GMAS3_retest	54.50	56.948	0.565	0.887
GMAS4_test	54.47	60.740	0.150	0.897*
GMAS4_retest	54.40	60.524	0.186	0.896*
GMAS5_test	54.50	54.948	0.667	0.884
GMAS5_retest	54.47	54.809	0.691	0.883
GMAS6_test	54.43	60.599	0.200	0.896*
GMAS6_retest	54.30	59.941	0.453	0.891
GMAS7_test	54.63	53.964	0.745	0.882
GMAS7_retest	54.77	54.254	0.723	0.882
GMAS8_test	54.43	58.047	0.461	0.890
GMAS8_retest	54.40	57.834	0.574	0.888
GMAS9_test	54.50	55.569	0.605	0.886
GMAS9_retest	54.47	54.947	0.677	0.884
GMAS10_test	54.33	59.264	0.528	0.890
GMAS10_retest	54.33	59.747	0.443	0.891
GMAS10_retest	54.33	59.747	0.443	0.891
GMAS11_test	54.87	57.913	0.285	0.897*
GMAS11_retest	54.83	57.454	0.420	0.891

Notes: Composite Cronbach’s alpha: 0.894; number of items: 22. *Items with Cronbach’s alpha values greater than the composite alpha value.

Table 7 Reliability Analysis of Full Test Study

Items	Cronbach’s Alpha If Item Not Included or Deleted (Raw_Alpha)	Correlation Between Each Item (r)	Corrected Item–Total Correlation (r.Drop)
GMAS1	0.81	0.57	0.46
GMAS2	0.81	0.52	0.40
GMAS3	0.81	0.51	0.38
GMAS4	0.81	0.52	0.40
GMAS5	0.80	0.60	0.49
GMAS6	0.79	0.69	0.59
GMAS7	0.79	0.70	0.61
GMAS8	0.79	0.74	0.65
GMAS9	0.81	0.56	0.45
GMAS10	0.80	0.67	0.57
GMAS11	0.82	0.49	0.36

Notes: Overall alpha: 0.82; r.drop: correlation of the item with the scale if that item is not included (aka item–rest correlation).