Avoid This Adherence Scale for Health Surveys
Here’s an unfortunate reality in the world of survey research: Survey questions can sometimes be copyrighted. When certain questions (no matter how obvious and common) are asked together as a set, and then scaled into a single measure (no matter how obvious and simple), and then validated in a study as being a solid tool … that scale can be considered intellectual property. And then the owners of that property can stop you from using it in your research.
This issue has been in recent news as a professor at UCLA has been demanding payments or retractions in publications from other researchers (usually academic) who have used versions of the Morisky Medication Adherence Scales without permission.
Here are the exceedingly simple questions on the four-item scale:
- Do you ever forget to take your medicine?
- Are you careless at times about taking your medicine?
- Sometimes if you feel worse when you take the medicine, do you stop taking it?
- When you feel better do you sometimes stop taking your medicine?
Score 0 for each “yes” and 1 for each “no” and voila, high scores indicate greater adherence.
To be fair, true validation of self-reported measures like these is no simple task. The authors deserve credit and recognition for having done so. Indeed, they have gotten life-long credit and recognition including highly coveted jobs at fancy universities.
So why do they want to stop you from using it? They say it’s because if you don’t license it, they can’t confirm that you’re using it correctly, and they are “trying to save lives.”
Our advice? Make up your own scale, or use one of many other validated adherence scales. The fact that these simple self-report measures have been validated means that similar self-report questions would almost certainly be valid as well. A good researcher with a bit of know-how and experience constructing decent healthcare survey questions can do it for you.