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Scales for assessing medication adherence in patients with hypertension

28 November 2019
9 min read
Volume 28 · Issue 21



the choice of the appropriate tool for assessing level of medication adherence is a significant barrier in scientific research.


to translate into Greek and test the reliability of the Hill-Bone and A-14 scales among patients with hypertension. Also, to compare patients' responses in the Hill-Bone scale, A-14 scale and Morisky Medication Adherence Scale (MMAS).


data collection occurred between February 2016 and March 2016 at a general hospital in Athens, Greece. The sample consisted of hypertensive patients (n=34) and non-hypertensive patients (n=34).


the coefficient alpha in hypertensive patients was 0.76 for Hill-Bone, 0.64 for MMAS and 0.91 for the A-14 scale. In non-hypertensive patients, the Cronbach's alpha for MMAS was 0.81 and 0.78 for A-14. A statistically significant difference was found among the mean scores of the scales, whereas strong correlation was found only between two pairs of questions with similar meaning.


all tools are appropriate to assess the level of medication adherence in Greek hypertensive patients. However, careful translation of the scales is essential since items with the same meaning could be understudied in a different way.

Many terms are used to define the extent to which individuals take their medication as prescribed (Cramer et al, 2008). The most common of them are ‘adherence’ and ‘compliance’ (Osterberg and Blaschke, 2005; Aronson, 2007). Although the appropriate term has not been agreed, there is much research interest on the level of adherence to medication regimens, especially among patients with chronic diseases such as hypertension. The study of adherence is important since low levels of adherence are associated with high risks of mortality, deterioration in quality of life and increases in costs of health care (Cutler et al, 2018; Burns et al, 2019).

However, there are many tools for assessing the level of medication adherence and researchers must consider the validity and reliability of each scale to determine which is the most appropriate to be used in each study. In addition, researchers need to decide whether they want to use disease-specific or generic scales. For example, the Hill-Bone scale is a specific tool assessing adherence in treatment for hypertension (Kim et al, 2000), whereas the Morisky and A-14 scales are generic tools (Morisky et al, 1986; Jank et al, 2009). The choice of scale is further complicated by different tools using the same or similar questions.

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