Translation and cultural adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale to Portuguese

Abstract

Introduction: Hypertension is an extremely prevalent disease worldwide and hypertension control rates remain low. Lack of adherence contributes to poor control and to cardiovascular events. No questionnaire in Portuguese is readily available for the assessment of adherence to antihypertensive drugs. We aimed to perform a translation and cultural adaptation to Portuguese of the Hill-Bone Compliance to High Blood Pressure Therapy Scale, a validated instrument to measure adherence in hypertensive patients.

Methods: A formal process was employed, consisting of a forward translation by two independent translators and a back translation by a third translator. Discrepancies were resolved after each step. Hypertensive patients were involved to identify and resolve phrasing and wording difficulties and misunderstandings.

Results: The forward and back translation did not produce significant discrepancies. However, important issues were identified when the questionnaire was presented to patients, which led to changes in the wording of the questions and in the format of the questionnaire.

Conclusion: Questionnaires are important instruments to assess adherence to therapy, particularly in hypertension. A formal translation and cultural adaptation process ensures that the new version maintains the same concepts as the original. After translation, several changes were necessary to ensure that the questionnaire was understandable by elderly, low literacy patients, such as the majority of hypertensive patients. We propose a Portuguese version of the Hill-Bone Compliance Scale, which will require validation in further studies.

Keywords: Adesão à terapêutica; Hipertensão arterial; Hypertension; Medication adherence; Patient-reported outcomes; Questionnaires; Questionários; Tradução e adaptação cultural; Translation and cultural adaptation.