Translation, Cultural Adaptation and Validation of the Medication Adherence Report Scale (MARS-5) in Nepalese Cancer Patients Experiencing Pain

Sunil Shrestha; Simit Sapkota; Vibhu Paudyal; Zoe Moon; Rob Horne; Siew Hua Gan

doi:10.2147/JPR.S455852

Translation, Cultural Adaptation and Validation of the Medication Adherence Report Scale (MARS-5) in Nepalese Cancer Patients Experiencing Pain

J Pain Res. 2024 Nov 14:17:3741-3753. doi: 10.2147/JPR.S455852. eCollection 2024.

Authors

Sunil Shrestha¹, Simit Sapkota^{2

3}, Vibhu Paudyal^{4

5}, Zoe Moon⁶, Rob Horne⁶, Siew Hua Gan¹

Affiliations

¹ School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia.
² Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal.
³ Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal.
⁴ Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, London, UK.
⁵ School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, UK.
⁶ Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UK.

Abstract

Background: Adherence to pain medication is crucial for cancer patients, since non-adherence can lead to increased suffering, reduced quality of life and increased healthcare costs. Although the five-item Medication Adherence Report Scale (MARS-5) is a validated tool for assessing medication adherence, but it has not been translated and validated into the Nepalese language. This study aimed to translate, culturally adapt and validate the MARS-5 in Nepalese language for Nepalese cancer patients who were experiencing pain.

Materials and methods: The cross-sectional validation study utilized a convenience sampling method. Initially, a pre-test was conducted with 25 patients. The MARS-5 was then forward and backward translated following the EORTC QLG translation procedure. The final translated version was reviewed by experts and subjected to a second pre-test. Construct validity was assessed through principal component analysis, and internal consistency was measured using Cronbach's alpha coefficient. Inter-rater reliability was evaluated using the Intra-Class Correlation coefficient (ICC).

Results: The study included 204 cancer patients (ages 18-86, 55% female). The Nepalese version of the MARS-5 was translated without significant issues and underwent pre-testing with participants. Participants discussed the scale during these pre-tests, providing feedback on its clarity and comprehensibility. While formal assessment tools were not employed, the iterative nature of the pre-testing process allowed for the refinement of the translation based on participant feedback, indicating a robust understanding of the scale among participants. The ICC of test-retest reliability was found to be 0.860. The Kaiser Meyer Olkin's value was 0.690, and Cronbach's alpha was 0.72, indicating good construct validity and high internal consistency. The medication non-adherence rate was 11.3%.

Conclusion: The MARS-5 was successfully translated, culturally adapted, and validated in Nepalese for use among Nepalese cancer patients experiencing pain. The Nepalese version of MARS-5 is a reliable tool for evaluating medication adherence in this population.

Keywords: MARS-5; Nepalese patients; cancer pain; cultural adaptation; medication adherence; validation.

Grants and funding

The authors received no funding for this work.