Validity and Reliability of Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) in Type 1 Diabetic Patients

Background: Assessing medication adherence is crucial for patients with type 1 diabetes (T1DM), as it is a primary obstacle to achieving optimal glycemic control in this population. However, none of the currently available tools to assess medication adherence are specific to Iraqi patients with T1DM. Objective: To assess the reliability and validity of the Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS) among Iraqi patients with T1DM. Methods: This cross-sectional study was conducted from January 29 to May 29, 2025, at the Faiha Specialized Diabetes, Endocrine, and Metabolism Center in Basrah, Iraq. It involved 100 Iraqi T1D patients aged≥12 years diagnosed for at least 12 months and on stable treatment for at least 3 months. Participants completed a paper-based IADMAS questionnaire at baseline. Reliability was assessed using Cronbach’s alpha. For test-retest reliability, 24 participants completed the questionnaire again after two weeks, and their scores were correlated using Spearman’s rho. Concurrent validity was examined by comparing IADMAS scores with HbA1c levels. Results: The internal consistency of IADMAS, assessed using Cronbach's alpha (0.217). It can be slightly elevated to 0.266 if item 4 is removed. Regarding the test-retest results, the correlation for the total IADMAS scores was 0.458(p=0.024). By inspecting individual items within IADMAS, two items showed significant differences between test and retest values. There was a non-significant association between IADMAS score and HbA1c (Spearman's ρ = −0.087, p=0.391). Conclusions: IADMAS has poor validity and reliability and hence it is not suitable to assess medication adherence among T1DM patients.