There are two Hill-Bone Scales. The original scale is the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP). It was developed in English. To our knowledge, it has been translated into nine other languages by users. HB-HBP is a 14-item scale that assesses patient behaviors for three important behavioral domains of high blood pressure treatment (i.e. the three (3) sub-scales):
Appointment Keeping (3-items)
Medication Adherence (9-items)
The second scale is the Hill-Bone Medication Adherence Scale (HB-MAS), formerly the medication sub-scale of HB-HBP. This 9-item scale has broad application across various chronic diseases and conditions for self-assessment of medication adherence. It is a useful tool for conditions like hypertension, diabetes, COPD, and stroke.
These brief scales provide a simple method for clinicians in various settings to assess patients’ self-reported adherence and to plan appropriate interventions. Each can be self-administered or interviewer-administered in less than 5 minutes, thus making each clinically useful.
Use of the HB-HBP Scale at every visit is beneficial in planning and implementing effective individualized HBP care. Nurses, physicians, and community health personnel working in both office, clinic and community settings will find the instrument useful as a teaching tool to guide behavior modification that will lead to improved HBP control.
The scales were developed with National Institutes of Health (NIH) funds; therefore, they are available for use at no cost>; the scales are free.
High Blood Pressure Compliance
High blood pressure (HBP) is among the most prevalent and important risk factors for cardiovascular, cerebrovascular, and renal disease. Effective care and control of HBP cannot be achieved without compliance to treatment regimen guidelines and recommendations by patients, providers, and organizations.[i]
Researchers and clinicians interested in improving health outcomes for patients with HBP need reliable, valid, efficient, and cost-effective assessment tools to assess the critical domains of HBP care during the screening, diagnosis, monitoring, and feedback processes.
Estimates of controlled blood pressure (BP) among identified HBP patients typically ranges from 20%-30%[ii],[iii]in the U.S., in large part, because only one half of the individuals diagnosed with hypertension are in treatment and one half of these are not receiving treatment adequate to control BP. In a critical review, Rogers and Bullman[iv]found that noncompliance rates with prescribed therapeutic regimens range from 30%-60%, and at least 50% of patients for whom drugs are prescribed failed to receive full benefit through inadequate compliance. The high noncompliance rates in HBP treatment have multiple implications at the individual and societal levels. These rates jeopardize patients’’ health and well-being, result in suboptimal health outcomes, lead to inefficient use of health resources, and incur costly treatment for the complications of untreated or inadequately treated HBP.[i],[v],[vi]In spite of the critical role played by compliance in the treatment of HBP, clinicians are not routinely assessing patients’ compliance level and patients rarely volunteer this information to their clinician.[v],[vii]
The Original Scale
The original scale is the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP). It was developed in English. To our knowledge, it has been translated into nine other languages by users. HB-HBP is a 14-item scale that assesses patient behaviors for three important behavioral domains of high blood pressure treatment (i.e. the three (3) sub-scales):
Appointment Keeping (3-items)
Diet (e.g. reduced sodium intake) (2-items)
Medication Adherence (9-items)
This brief instrument provides a simple method for clinicians in various settings to assess patients’ self-reported adherence and to plan appropriate interventions.
The HB-HBP Scale assesses HBP behaviors more comprehensively in comparison to other existing tools. It was analyzed for reliability and validity. The scale proved useful in measuring three aspects of HBP treatment in two samples of hypertensive urban African American adults. In its current form, it can be self-administered or done by interview in less than 5 minutes, thus making it a clinically useful tool for diagnosing problems with compliance. For clinicians wishing to use a briefer form, one of the subscales, such as the 8-item medication taking behavior subscale, may be useful.
Validity of the Scale
The content validity of the scale originally was assessed by a relevant literature review and an expert panel, which focused on cultural sensitivity and appropriateness of the instrument for low literacy. Internal consistency reliability and predictive validity of the scale were evaluated using two community-based samples of hypertensive adults enrolled in clinical trials of high blood pressure care and control. The standardized a for the total scale were 0.74 and 0.84, and the average interitem correlations of the 14 items were 0.18 and 0.28, respectively. The construct and predictive validity of the scale was assessed by factor analysis and by testing of theoretically derived hypotheses regarding whether the scale demonstrated consistent and expected relationships with related variables. (See references).
Utility of the Scale
In the initial study, high compliance scale scores predicted significantly lower levels of blood pressure and blood pressure control. Moreover, high compliance scale scores at the baseline were significantly associated with blood pressure control at both baseline and at follow up in the two independent samples.
Subsequent studies have generated similar results.
This patient-oriented tool enables clinicians to assess patients’ self-reported compliance levels and to plan appropriate interventions.
[i]Miller, N.N., Hill, M.N., Kottke, T., et al. The multilevel compliance challenge: Recommendations for a call to action. American Heart Association. Circulation. 1997;95:1085-1090.
[ii]Burt, V.L., Cutler, J.A., Higgins, M. Trends in awareness, treatment and control of hypertension in the adult U.S. population. Data from the health Examination Surveys, 1960-1991. Hypertension. 1995.26;1:60-69.
[iii]American Heart Association. Heart and Stroke Facts, 1997. Dallas, TX: 1997.
[iv]Rogers, P.G., Bullman, W.R. Prescription medication compliance: A review of the baseline of knowledge. A report for the National Council on Patient Information and Education. J Pharm Epidemiol. 1995;2:3.
[v]Rotar, D., Hall, J., Merisca, R., et al. Effectiveness of interventions to improve patient compliance: A meta-analysis. Med Care. 1998;36(8):1138-1161.
[vi]Dunbar-Jacob, J., Dqyer, K., Dunning, E.J. Compliance with anti-hypertensive regimens: A review of the research in the 1980’s. Ann Behav Med. 1991;13(3):31-39.
[vii]Steele, D.T., Jackson, T.C., Gutmann, M.C. Have you been taking your pills? The adherence monitoring sequence in the medical interview. J Fam Pract. 1990;30:294.