Open Access Research article

Developing the Diagnostic Adherence to Medication Scale (the DAMS) for use in clinical practice

Sara Garfield1*, Lina Eliasson12, Sarah Clifford1, Alan Willson3 and Nick Barber1

Author Affiliations

1 The Centre for Medication Safety and Service Quality, UCL School of pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK

2 Centre for Haematology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0NN, UK

3 National Leadership and Innovation Agency for Healthcare, Bridgend Road, Llanharan, Glamorgan, UK

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BMC Health Services Research 2012, 12:350  doi:10.1186/1472-6963-12-350

Published: 8 October 2012



There is a need for an adherence measure, to monitor adherence services in clinical practice, which can distinguish between different types of non-adherence and measure changes over time. In order to be inclusive of all patients it needs to be able to be administered to both patients and carers and to be suitable for patients taking multiple medications for a range of clinical conditions. A systematic review found that no adherence measure met all these criteria. We therefore wished to develop a theory based adherence scale (the DAMS) and establish its content, face and preliminary construct validity in a primary care population.


The DAMS (consisting of 6 questions) was developed from theory by a multidisciplinary team and the questions were initially tested in small patient populations. Further to this, patients were recruited when attending a General Practice and interviewed using the DAMS and two other validated self-reported adherence measures, theMorisky-8 and Lu questionnaires. A semi-structured interview was used to explore acceptability and reasons for differences in responses between the DAMS and the other measures. Descriptive data were generated and Spearman rank correlation tests were used to identify associations between the DAMS and the other adherence measures.


One hundred patients completed the DAMS in an average of 1 minute 28 seconds and reported finding it straightforward to complete. An adherence score could not be calculated for the 4(4%) patients only taking ‘when required’ medication. Thirty six(37.5%) of the remaining patients reported some non-adherence. Adherence ratings of the DAMS were significantly associated with levels of self reported adherence on all other measures Spearman Rho 0.348-0.719, (p < 0.01). Differences in trends could generally be explained by qualitative data.


The DAMS has been developed for routine monitoring of adherence in clinical practice. It was acceptable to patients taking single or multiple medication and valid when tested against other adherence measures. However, ‘when required’ medication needs to be excluded. Further tests of the DAMS against objective measures such as MEMS are in progress and reliability needs to be established. Further investigation of the carers’ version of the DAMS is required.

Adherence; Compliance; Medication; Medicine; Measure; DAMS; Development; Validity