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Development and testing of the Hill-Bone Compliance to High Blood Pressure Therapy Scale
1John Hopkins University, School of Nursing, Baltimore, MD 21205-2110, USA.
Insights
The Hill-Bone Compliance Scale effectively measures patient adherence to high blood pressure therapy, including diet, appointments, and medication. Higher scores on this scale predict better blood pressure control.
Area of Science:
- Cardiology
- Health Behavior Research
- Psychometrics
Background:
- High blood pressure (hypertension) management requires consistent patient adherence to therapeutic recommendations.
- Assessing patient compliance is crucial for effective hypertension treatment and control.
- Existing tools may lack cultural sensitivity or be unsuitable for low-literacy populations.
Purpose of the Study:
- To introduce and validate the Hill-Bone Compliance to High Blood Pressure Therapy Scale.
- To evaluate the scale's reliability and validity in assessing patient adherence behaviors.
- To determine if the scale can predict blood pressure control.
Main Methods:
- Developed a 14-item scale across three subscales: sodium intake, appointment keeping, and medication adherence.
- Assessed content validity through literature review and expert consensus, focusing on cultural sensitivity and low-literacy appropriateness.
- Evaluated internal consistency reliability (Cronbach's alpha) and predictive validity in two independent samples of hypertensive adults.
Main Results:
- The scale demonstrated good internal consistency reliability (standardized alpha 0.74 and 0.84).
- High compliance scale scores were significantly associated with lower blood pressure levels and better blood pressure control.
- Scores at baseline predicted blood pressure control at both baseline and follow-up.
Conclusions:
- The Hill-Bone Compliance to High Blood Pressure Therapy Scale is a reliable and valid instrument for assessing patient adherence.
- The scale is suitable for diverse clinical settings and populations, including those with low literacy.
- Clinicians can use this scale to identify non-adherence and tailor interventions for improved hypertension management.
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.