New Fall/Winter Issue – Johns Hopkins Nursing Magazine

The Fall/Winter 2024 issue of Johns Hopkins Nursing is now live online at nursing.jhu.edu/magazine. Watch your mailbox for printed issues to arrive this month.

Homepage
Home / Faculty & Research / Research / Research Projects & Funding / Frequently Asked Questions (FAQs) Hill-Bone Scales

Frequently Asked Questions (FAQs) Hill-Bone Scales

About the Hill-Bone Scales

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)

  • Diet (2-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.

Although the original Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP) was developed and validated for use in patients diagnosed with hypertension, the Hill-Bone Medication Adherence Scale (HB-MAS) has broad application across various diseases and conditions:

  • Hypertension

  • Diabetes Mellitus

  • Stroke

  • Human Immunodeficiency Virus (HIV)

Obtaining and Using the Hill-Bone Scales

The scales were developed with National Institutes of Health (NIH) funds; therefore, they are available for use at no cost. There are no license fees. We do require that the Hill-Bone Scales be properly cited/referenced in publications and/or presentations.

We do require that you receive permission to use the Hill-Bone Scales, whether for research or clinical use. Obtaining permission to use the scales is a simple, automated process. To receive permission to use the scale(s), please go to the Obtain the Scales section of this website.

There are three steps to obtain the scales:

  • Click Obtain the Scales, answer and submit the Permission Request Form online

  • Return the User Permission Agreement via email

  • Receive the User Manual and Scoring Guide via email

To receive permission to use the scale(s), Complete and Submit the Permission Request Form. You may request to use one or both scales. Please note that you will need to designate which scale(s) you would like to use, so that we may provide you with the associated User Manual. We will then email you the User Permission Agreement, which further describes terms of use. The User Permission Agreement specifies that the scale must be referenced in your research and subsequent publications and presentations. To improve scale utility and adoption, please notify us of any resulting publication and/or presentation for inclusion in our dynamic, public databases and provide us with scale-translations for public dissemination (if applicable). Once the User Permission Agreement has been completed and returned to us, we will promptly send the scale(s) and respective User Manual(s) and Scoring Guide(s)to you.

The investigative team created and validated the original Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP) in English. Subsequently, the scale has been translated by other researchers and/or practitioners and applied in practice in several other languages including Arabic, Chinese, German, Korean, Malay, Persian, Polish, Portuguese, and Turkish.

Unfortunately, we cannot vouch for the validity of any of these translated scales.

Please feel free to utilize our dynamic list of publications/presentations to contact other researchers for permission to use their translated versions. In addition, the authors of these translated scales may be willing to share psychometric data with you. Should you require assistance in finding a scale translation or contacting the authors/researchers of said studies, please reach out to us; we may be able to assist you in your efforts.

We do require that the Hill-Bone Scales be properly cited/referenced in publications and/or presentations. The original article may be referenced as follows (APA format, 6th edition):

Kim, M. T., Hill, M. N., Bone, L. R., & Levine, D. M. (2000). Development and testing of the Hill-Bone compliance to high blood pressure therapy scale. Progress in Cardiovascular Nursing, 15(3), 90-96.

Please reference other articles/publications/presentations accordingly.

Administering and Scoring the Hill-Bone Scales

Yes, you may translate the Hill-Bone Scales. We recommend that you translate and back-translate to improve accuracy of the translation. If you do decide to perform your own translation of a scale, we ask that you provide us with the final translation of the scale for public dissemination on our webpage.

We will credit your work and provide reference to any affiliated publications that accompany the translated scale.

The scales may be self-administered or interviewer-administered.

Hill, M. N., & Berk, R. A.  (1995). Psychological barriers to hypertension therapy adherence: Instrument development and preliminary psychometric evidence.  Cardiovascular Nursing, 31. 37-43.

[Abstract] This paper is a report of the results of a literature review conducted with the goal of identifying the nursing process components: assessment, diagnoses, interventions and outcomes related to health promotion in adults with hypertension in primary settings. A total of 39 nursing process components (nursing diagnoses outcomes and interventions) related to health promotion with adults with high blood pressure were identified in primary healthcare settings. Research-based evidence material provides an evidence-based nursing practice guideline with specific nursing process components on the topic. The evidence-based nursing practice guideline developed from this referential study for promoting health of adults with hypertension should be reflected in nursing practice in primary healthcare settings.

Kim, M. T., Hill, M. N., Bone, L. R., & Levine, D. M. (2000). Development and testing of the Hill-Bone compliance to high blood pressure therapy scale. Progress in Cardiovascular Nursing, 15(3), 90-96.

[Abstract] The Hill-Bone Compliance to High Blood Pressure Therapy Scale assesses patient behaviors for three important behavioral domains of high blood pressure treatment: 1) reduced sodium intake; 2) appointment keeping; and 3) medication taking. This scale is comprised of 14 items in three subscales. Each item is a four point Likert type scale. The content validity of the scale 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 alpha 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. In this 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. This brief instrument provides a simple method for clinicians in various settings to use to assess patients’ self-reported compliance levels and to plan appropriate interventions.

Lambert, E. V., Steyn, K., Stender, S., Everage, N., Fourie, J. M., & Hill, M. (2006). Cross-cultural validation of the Hill-Bone compliance to high blood pressure therapy scale in a South African, primary health care setting. Ethnicity & Disease, 16:286-291.

[Abstract] Hypertension is prevalent, under-diagnosed, and inadequately treated in Black South Africans. However, few studies have addressed barriers to hypertension care and control in this community. The aim of this study was to validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale for use in a South African primary healthcare setting. This instrument consists of three subscales, medications-compliance, appointment making, and salt intake. A demographic questionnaire and the HB scale were translated into the first language of the subjects and then back-translated into English. Hypertensive patients (N=98) were recruited from primary healthcare clinics in Cape Town. We demonstrated criterion validity and internal consistency for a modified Hill-Bone Compliance Scale, in Black, urban, hypertensive, South African patients. Results compare favorably with those from an urban African-American setting (standardized Cronbach alpha was .74-.84).

We do not prescribe any cut-offs, for example for low/moderate/high noncompliance. Please examine the distribution of the scores from your data set(s) and create cut-offs (for instance tertiles) that fit your data. You may examine the association between these cut-offs and other clinical measures, such as blood pressure control, to establish the validity of your cut-offs.