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

Abstract

Sunil Shrestha,1 Simit Sapkota,2,3 Vibhu Paudyal,4,5 Zoe Moon,6 Rob Horne,6 Siew Hua Gan1 1School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia; 2Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal; 3Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal; 4Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College, London, UK; 5School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, UK; 6Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UKCorrespondence: Sunil Shrestha, Email [email protected]: 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: cancer pain, cultural adaptation, MARS-5, medication adherence, Nepalese patients, validation

Keywords

• cancer pain
• cultural adaptation
• mars-5
• medication adherence
• nepalese patients
• validation