This scoping review aimed to map instruments used to assess medication adherence among African populations living with chronic diseases, and to describe instruments’ methodological features. Specific objectives included reporting the instruments used, their validation status and cultural adaptation, modes of administration, disease-specific applicability, use of supplementary adherence measures, and observed adherence rates. The review followed the PRISMA-ScR framework.
Three bibliographic databases—PubMed, Scopus and Web of Science—were searched on 25 June 2026. Eligible studies were those conducted in African countries that assessed medication adherence among people with chronic diseases using any adherence measurement tool. Excluded were studies limited to acute conditions, non-medication adherence behaviours, reviews, editorials, protocols and conference abstracts.
Data were extracted with a standardised charting form and summarised descriptively. The review synthesized study characteristics, the adherence measurement tools used, procedures for validation and cultural adaptation, administration methods, disease-specific application of tools, supplementary adherence assessment methods, and the reported adherence rates. Findings were presented narratively.
Ninety-eight studies met inclusion criteria and were conducted across 27 African countries. The largest numbers of included studies originated from Ethiopia (n=36) and Nigeria (n=22). The review did not report the full list of all countries in this summary text beyond the count of 27.
The chronic conditions most frequently investigated were type 2 diabetes (n=29), hypertension (n=18) and HIV (n=13). Other chronic diseases were included across the remaining studies, but condition-specific counts beyond those listed were not presented in the source summary.
The review identified a broad array of tools, with a strong predominance of interviewer-administered, generic self-report instruments. The 8-item Morisky Medication Adherence Scale was the most commonly used instrument, appearing in 50 studies. Overall, most studies relied on self-report measures rather than objective measures.
Only 15 studies (15.3%) reported local validation and/or cultural adaptation of the adherence instruments they used. Supplementary, more objective adherence-assessment methods were relatively uncommon: some studies incorporated pharmacy refill records, pill counts, electronic monitoring, viral load assessment or biological markers, but these approaches were the exception rather than the norm.
Reported medication adherence rates varied substantially across diseases and studies. Observed adherence spanned the full reported range from 0% up to 96.8%. The source summary did not provide pooled adherence estimates, meta-analysis, or condition-specific central tendency measures.
Medication adherence assessment across African settings, as captured by the included studies, is marked by considerable methodological variability and limited evidence of context-specific validation and cultural adaptation. The widespread use of generic self-report instruments administered by interviewers, combined with the scarcity of objective adherence measures, underscores a need for greater standardisation and for validation of adherence tools tailored to local contexts and healthcare settings in Africa.
When selecting adherence instruments for research or program evaluation in African settings, stakeholders should prioritise tools with documented local validation or plan for cultural adaptation and psychometric testing.
Combining self-report instruments with supplementary objective measures (for example, pharmacy refill data, pill counts or biological markers where feasible) would strengthen the reliability of adherence assessment.
Standardised reporting of adherence measurement methods and explicit documentation of validation or adaptation procedures would improve comparability across studies and support evidence synthesis.
The summary highlights the heterogeneity of methods and limited reporting on validation/adaptation, which constrain interpretation and comparability of adherence estimates across studies. The source did not present additional methodological limitations or risk-of-bias assessments in this summary.
This scoping review of studies up to the search date identified an overreliance on interviewer-administered self-report adherence tools, limited local validation, and wide variability in reported adherence rates (0%–96.8%). These findings point to a clear need for context-specific validation and more routine use of objective supplementary adherence measures in African chronic disease research and monitoring.