{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:11:51Z","timestamp":1758931911261,"version":"3.44.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Medication adherence is essential for managing chronic kidney disease (CKD) and preventing its progression. In Malaysia, adherence is commonly assessed using the 12-item Likert scale Malaysia Medication Adherence Assessment Tool (MyMAAT-12), but it has not been validated for CKD patients. Thus, this study aimed to validate and explore its potential for item reduction among non-dialysis CKD patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>A cross-sectional, multi-center study was conducted across eight health facilities in Pahang state from December 2023 to August 2024. Non-dialysis CKD patients aged 18 years and above, with or without diabetes, attending outpatient clinics, were given the 12-item self-administered MyMAAT-12 and items from the Beliefs about Medicines Questionnaire (BMQ). Patient demographics, HbA1c levels, and serum phosphate changes within three months preceding MyMAAT-12 completion were collected.<\/jats:p>\n<jats:p>The dimensionality of the scale was explored through exploratory factor analysis (EFA), and its reliability and criterion validity were evaluated to ensure robust measurement properties. A simulation test was conducted to explore the feasibility of reducing MyMAAT-12 to a shorter version.<\/jats:p>\n<jats:p>A total of 246 respondents participated, predominantly female (54.5%) and Malay (91.5%), with a mean age of 59.5\u2009\u00b1\u200912.5 years and an average CKD duration of 5.0\u2009\u00b1\u20095.4 years. The average medication adherence score was poor to moderate (&lt;54\/60). MyMAAT-12 demonstrated excellent internal consistency (Cronbach\u2019s alpha\u2009=\u20090.90) and significant association with BMQ categories (\u03c7\u00b2(2) = 16.8, p\u2009&lt;\u20090.01). EFA identified a two-factor structure. MyMAAT-12 adherence categorization was significantly associated with HbA1c% (&lt;8% vs.\u2009\u2265\u20098%) (\u03c7<jats:sup>2<\/jats:sup>(2) = 4.7, p\u2009=\u20090.03) and phosphate level changes (\u03c7<jats:sup>2<\/jats:sup>(2) = 5.48, p\u2009=\u20090.02). Results indicated that reducing MyMAAT-12 to a 7-item scale was feasible, while maintaining strong psychometric properties (Cronbach\u2019s alpha\u2009=\u20090.87) and a significant association with HbA1c% (\u03c1\u2009=\u2009\u22120.22, p\u2009=\u20090.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>MyMAAT-12 demonstrated strong reliability and validity, making it a valuable tool for clinicians to accurately assess medication adherence in non-dialysis CKD patients. The shortened MyMAAT-7 offers a streamlined alternative with strong psychometric properties, enhancing clinical practicality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0332236","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T17:24:32Z","timestamp":1758907472000},"page":"e0332236","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Validation and potential refinement of the Malaysia Medication Adherence Assessment Tool (MyMAAT) among patients with non-dialysis chronic kidney disease"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9517-1627","authenticated-orcid":true,"given":"Ming Chiang","family":"Lim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6300-2965","authenticated-orcid":true,"given":"Ernieda","family":"Hatah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia Ean","family":"Goh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad Ramdani","family":"Abd Manan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joyce Chu Yee","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"pone.0332236.ref001","unstructured":"Ministry of Health (MOH) Malaysia. 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Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of chronic kidney disease\u2013mineral and bone disorder (CKD-MBD). 2017. Available from: http:\/\/kdigo.org\/guidelines\/ckd-mbd\/"},{"issue":"5","key":"pone.0332236.ref038","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.3390\/nu13051670","article-title":"The Importance of Phosphate Control in Chronic Kidney Disease","volume":"13","author":"K Tsuchiya","year":"2021","journal-title":"Nutrients"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332236","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T17:24:39Z","timestamp":1758907479000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0332236"}},"subtitle":[],"editor":[{"given":"Muhammad Junaid","family":"Farrukh","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,26]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0332236","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]}}}