Medication Understanding and Use Self-Efficacy Scale (MUSE-S)
Also known as: MUSE-S
The Medication Understanding and Use Self-Efficacy Scale (MUSE-S) is a brief, patient-centered self-report measure assessing both knowledge and confidence regarding medication use. Developed by Kripalani and colleagues at Emory University in 2009, the MUSE-S evaluates whether patients understand their medications (what they are for, how to take them, important side effects) and feel confident managing them in daily life. This dual focus on knowledge and self-efficacy makes the MUSE-S particularly valuable for identifying education gaps, assessing health literacy barriers to medication adherence, and evaluating outcomes of medication counseling or education interventions.
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When to use it
The MUSE-S is appropriate for any patient on medication, particularly those at high risk for knowledge gaps: low health literacy, non-English-speaking, elderly, cognitively impaired, or new to medication regimen. It is valuable at medication initiation to assess baseline understanding and guide counseling, during follow-up to monitor whether education was effective, and after medication changes to ensure patient understanding. The MUSE-S is also used in research evaluating medication education interventions or in health systems screening for patients needing intensive counseling. It is particularly useful in primary care, emergency departments, hospital discharge, and specialty clinics where medication education is critical.
Strengths & limitations
- Captures dual components: Measures both knowledge (understanding) and confidence (self-efficacy), addressing two distinct barriers to adherence; more comprehensive than knowledge-only or efficacy-only measures.
- Patient-centered: Focuses on what matters to patients—understanding their medication and feeling capable of managing it—rather than clinical jargon or provider assessment.
- Identifies education targets: Low understanding scores pinpoint gaps (e.g., 'patient doesn't know medication purpose' or 'doesn't recognize side effects') guiding specific education.
- Predicts adherence and outcomes: Multiple studies show MUSE-S correlates with medication adherence, medication errors, and clinical outcomes.
- Brief and practical: 8–10 items completed in 5 minutes; suitable for routine clinical use.
- Self-report bias: Patients may overestimate understanding or confidence; actual knowledge may be less than reported (particularly in low-literacy populations).
- Does not assess actual medication knowledge: MUSE-S asks if patients feel they understand medication; objectively testing knowledge (open-ended questions, recall tests) would be more precise.
- Limited to medications currently taking: Cannot assess understanding of new medications before initiation; useful for current regimen assessment only.
- Does not capture other adherence barriers: Measures understanding and confidence but not beliefs, side effects, cost, access, or complexity; requires supplementary assessment.
- Variation in instrument versions: Different versions (8-item, 10-item, adapted) complicate comparability across studies and settings.
Frequently asked
A patient scores high on MUSE-S but still doesn't take medication as prescribed. What's going on?
The patient understands the medication and feels confident in their ability to take it, but is still not adhering. This suggests non-knowledge-based barriers: side effects, cost, access problems, attitudinal barriers (doesn't believe they need it), or practical challenges (forgetfulness, complexity, life disruption). Explore: 'You understand your medication, but I notice you haven't been taking it as prescribed. What's getting in the way?' Investigate side effects (use TSQM), beliefs (use BMQ), cost/access (social work referral), or memory aids (reminders, simplified regimen). High MUSE-S eliminates education as the main barrier; address other barriers.
How do I improve low MUSE-S scores?
Use multi-method education: (1) Verbal counseling—explain medication purpose, benefits, side effects in plain language; avoid jargon. (2) Written materials—provide simple written instructions or diagrams. (3) Teach-back method—ask patient to explain back what you've taught; correct misunderstandings. (4) Demonstration—show how to administer (inhaler technique, injection, eye drops) and have patient demonstrate back. (5) Frequent follow-up—reassess understanding at next visit; reinforce key points. (6) Simplification—if instructions are complex, work with provider to simplify (fewer medications, once-daily dosing, etc.). (7) Family/caregiver involvement—include family members in education if appropriate.
Should I use MUSE-S or objective knowledge testing?
Ideally, use both. MUSE-S is a practical, brief screening tool for busy clinical settings to identify patients needing education. Objective knowledge testing (asking open-ended questions like 'Why are you taking this medication?' or 'What side effects should you watch for?') provides more precise assessment of actual knowledge. In clinical practice, MUSE-S is sufficient for initial screening and reassessment; objective testing is more useful in research or when detailed knowledge assessment is needed.
Is MUSE-S appropriate for patients on multiple medications?
MUSE-S is typically administered for a specific medication or medication class (e.g., 'This set of questions is about your blood pressure medications'). For patients on multiple medications, either administer MUSE-S for each medication of concern or focus on the most critical/complex medication. Alternatively, ask generic questions about the medication regimen as a whole, but this is less specific. Most commonly, MUSE-S is used for one medication at a time.
Sources
- Kripalani, S., Risser, J., Gatti, M. E., & Jacobson, T. A. (2009). Development and validation of a simple questionnaire to measure medication understanding. Medical Care, 47(3), 340-348. link ↗
How to cite this page
ScholarGate. (2026, June 3). Medication Understanding and Use Self-Efficacy Scale (MUSE-S). ScholarGate. https://scholargate.app/en/pharmacology/medication-understanding-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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