Self-reported questionnaires have frequently been used because they are low in both cost and time expenditure. Early studies found that the self-report method was underestimating non-adherence when compared with pill counts or biological assays. However, subsequent research suggests that the self-report method may provide a reasonably accurate estimate of adherence. Among structured, self-reported scales, a four-item self-reported questionnaire (the Morisky Medication Adherence Scale-MMAS-4) to assess medication adherence was developed by Prof. Morisky.  Recently, an eight-item self-reported scale has been developed (MMAS-8) and widely use in different kind of studies. The MMAS-4 and MMAS-8 are not in the public domain and a license agreement may be obtained from Prof. Morisky.

    The original Morisky, Green and Levine adherence scale appeared in Medical Care in 1986¹ , but subsequent research on this scale identified one of the scale constructs to be perceived as pejorative and victim blaming (careless at times regarding medication taking-behavior), so another item addressing unintentional determinants was substituted.  Subsequent articles using the MMAS-4 and a recent article publishing the 4-item scale appear below ²³. The original article of the MMAS-8 appeared in the Journal of Clinical Hypertension, 2008 and is noted below⁴.


Morisky Medication Adherence Scale

Reference :

1. Morisky DE, Green LW, Levine DM.  Concurrent and Predictive Validity of a Self-Reported Measure of Medication Adherence and Long-Term Predictive Validity of Blood Pressure Control.  Med Care 1986; 24:67-74.

2. Morisky DE, Malotte CK, Choi P, et al.  A Patient Education Program to Improve  Adherence Rate with Antituberculosis Drug Regimens. Health Education Quarterly 1990; 17:253-268.

3. Morisky DE, Ang A, Krousel-Wood M, Ward H. Predictive validity of a medication adherence measure for hypertension control. J Clin Hypertens 2008;10: 348–354.

4, Morisky DE, DiMatteo MR. Improving the measurement of self-reported medication nonadherence: Final response. J Clin Epidemio 2011; 64:262-263.

The following footnote should appear on all tables which present the MMAS.

Use of the ©MMAS is protected by US copyright laws. Permission for use is required.  A Licensure agreement is available from: Donald E. Morisky, ScD, ScM, MSPH, Professor, Department of Community Health Sciences, UCLA School of Public Health, 650 Charles E. Young Drive South, Los Angeles, CA 90095-1772,

Please press the document on the top of this page and it will link to obtain the the application for a copyright agreement and copy of license agreement for use of the copyrighted MMAS-4 and MMAS-8.