Cardiology

Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-HBP): A Full Guide for researchers and clinicians.

0.0

0.0 out of 5 stars (based on 0 reviews)

Introduction

The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB_HBP) serves as a crucial instrument for evaluating patient adherence to hypertension treatment regimens. In 2000, Miyong T. Kim, Martha N. Hill, Lee R. Bone, and David M. Levine developed the scale at the Johns Hopkins University School of Nursing. Since then, it has become a cornerstone in cardiovascular health research. Moreover, its widespread adoption—reflected in over 600 citations on Google Scholar—underscores its value in both clinical practice and academic studies. The creators specifically designed this self-administered questionnaire for adults aged 18 and older to assess patient behaviors across three critical domains: reduced sodium intake, appointment keeping, and medication taking.

This article offers a comprehensive overview of the Hill-Bone scale’s features, scoring, applications, and limitations, serving as an essential resource for cardiology and chronic disease management experts.

Key Features of the Hill-Bone Compliance to High Blood Pressure Therapy Scale

Purpose and Use

The primary purpose of the Hill-Bone scale is to measure patient behaviors related to hypertension therapy adherence. Unlike general adherence tools, it specifically targets three domains critical to managing high blood pressure:

Reduced Sodium Intake
Appointment Keeping
Medication Taking

Thanks to this targeted structure, healthcare providers can quickly identify specific barriers that hinder patient compliance. Consequently, they gain the insight needed to design tailored interventions that directly address each patient’s unique challenges. Ultimately, this makes the Hill-Bone scale a highly effective tool for improving treatment outcomes.

Target Population

The scale is designed for adults aged 18 and older who are undergoing treatment for hypertension. It is particularly effective for:

Middle-aged adults (25-44 years).
Older adults (45-64 years).
Seniors (65+).
Parents.

Moreover, its straightforward design was originally validated in low-literacy populations, which significantly enhances its applicability across diverse patient demographics with chronic diseases.

Structure

The Hill-Bone scale comprises of 14 items organized into three subscales:

Reduced Sodium Intake (2 items): Assesses dietary habits related to salty foods.
Appointment Keeping (3 items): Evaluates consistency in attending doctor visits and securing prescription refills.
Medication Taking (9 items): Measures medication adherence, including the frequency of missed or skipped doses.

Each item appears on a 4-point Likert scale, which enables clinicians to capture patient behavior with greater nuance.

Consequently, it offers both efficiency and depth, making it a preferred choice among healthcare professionals.

Scoring Method

The scale utilizes a 4-point Likert response format for each of its 14 items: (4) All the time, (3) Most of the time, (2) Some of the time, and (1) Never. The scoring process is straightforward:

Total Score: The scores for all 14 items are summed, yielding a total score that ranges from 14 to 56.
Score Interpretation: Crucially, higher scores indicate worse adherence to the prescribed therapy.
Cut-off Scores: There are no standardized cut-off scores; instead, the results are interpreted continuously, with lower scores consistently signifying better patient compliance.

Administration Format

The Hill-Bone scale offers exceptional flexibility in its administration, taking less than five minutes to complete. It is available in multiple formats, including:

Paper-based forms.
Digital (Online) platforms.
Mobile Apps.
Interviews (In-person).
Phone/Video calls.

The Hill-Bone scale self-administered nature means no specialized training is required, which further enhances its utility in various healthcare environments.

Applications of the Hill-Bone Scale in Clinical Practice

The Hill-Bone scale is a versatile tool with several key applications in the management of hypertension and chronic diseases:

Screening: The scale quickly identifies patients with poor adherence who may be at risk for treatment failure.
Monitoring: The scale tracks changes in patient adherence over time, allowing clinicians to assess the effectiveness of interventions.
Treatment Planning: The scale provides specific insights into non-adherence behaviors (e.g., diet vs. medication), enabling providers to develop targeted support plans.
Research: The scale serves as a reliable outcome measure in clinical trials evaluating the efficacy of new hypertension treatments and adherence strategies.

Languages and Availability

To support global research and clinical use, the Hill-Bone scale has been translated in over 15 languages. Available versions include:

Arabic
English
Mandarin Chinese
Spanish
French
Other.

The questionnaire is free for research purposes but requires permission for clinical use. It operates under an Open Access license, promoting widespread accessibility.

Reliability and Validity

The Hill-Bone scale is a moderately reliable and valid instrument for assessing treatment adherence in hypertensive patients, with a Cronbach’s alpha ranging from 0.74 to 0.84 in original studies, indicating good internal consistency.

Numerous validation studies have confirmed its utility across different cultural and demographic contexts.

Original Validation Study link.
Nepalese Validation Study link.
Romanian Validation Study link.
South African Validation Study link.
Croation Validation Study link.

Limitations and Considerations

Despite its strengths, the Hill-Bone scale has a few limitations:

Self-report Measure: As a self-report questionnaire, the results may be influenced by a patient’s subjective interpretation.
Cultural Bias: Certain items may be interpreted differently across cultures; for instance, the term “fast food” in one question was misunderstood in a Portuguese validation study.
Narrow Focus: The instrument is specifically designed for hypertension and may not capture adherence barriers related to other comorbidities.
Language Barriers: Although many translations exist, nuances can be lost, potentially affecting the validity of responses in some populations.
Social Desirability Bias: Crucially, respondents may be influenced by a desire to provide answers that they perceive as socially acceptable or compliant, potentially overestimating their adherence

Additional Resources

Access the Original Validation Study for detailed psychometric data.
You can access the questionnaire as a PDF through this link.
For inquiries, contact the Hill-Bone Scales Team at the Johns Hopkins School of Nursing.
For additional Hill-Bone scale resources, consult the Johns Hopkins School of Nursing website.

Frequently Asked Questions (FAQ)

Who can use the Hill-Bone scale?
Clinicians, researchers, and healthcare providers can use the scale for adult patients (18 years and older) with hypertension to assess treatment adherence.
How long does it take to complete the Hill-Bone scale?
Patients typically complete the questionnaire in less than 5 minutes, making it highly efficient for clinical and research settings.
How is the Hill-Bone scale administered?
Healthcare teams can administer the scale via paper-based forms, digital platforms, mobile apps, in-person interviews, or phone/video calls, offering significant flexibility.
Is there any cost to using the Hill-Bone scale?
The scale is free for research use, but permission from Johns Hopkins University is required for clinical applications.

A Word from ResRef About the Hill-Bone Compliance to High Blood Pressure Therapy Scale

The Hill-Bone Scale offers a clinically efficient and globally validated tool that helps clinicians phenotype adherence barriers in both hypertension and chronic diseases. Although self-reporting presents certain limitations, the developers specifically designed the scale to accommodate low-literacy populations and enable rapid administration. As a result, it has become indispensable for real-world clinical practice. Moreover, ongoing translations—such as Romanian and Tamil—not only expand its reach but also highlight its cross-cultural utility. Nevertheless, to maintain contextual accuracy and ensure effectiveness, researchers must consistently apply rigorous localization strategies.

References

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. Journal of Cardiovascular Nursing, 15(1), 60-70. Link.
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(1), 216-221. Link.
Karademir, M., & Kaşıkçı, M. K. (2022). The validity and reliability of the Turkish version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. The Journal of Cardiovascular Nursing, 37(3), E51-E58. Link.
Knezović, A., Bralić Lang, V., & Bergman Marković, B. (2014). Validation of the Croatian version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Collegium Antropologicum, 38(4), 1187-1191. Link.
Wang, W., & Lau, Y. (2024). A systematic review of the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Journal of Clinical Nursing, 33(5-6), 1438-1453. Link.