title: Translation and cultural adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale to Portuguese.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors: Serviço de Medicina Interna, Centro Hospitalar S. João, Porto, Portugal; CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal. Electronic address: luisnogueirasilva@gmail.com.
authors: Luís
authors: L
authors: Nogueira-Silva
authors: CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal.
authors: Ana
authors: A
authors: Sá-Sousa
authors: Serviço de Medicina Interna, Centro Hospitalar S. João, Porto, Portugal.
authors: Maria João
authors: MJ
authors: Lima
authors: Faculdade de Medicina, Universidade do Porto, Portugal.
authors: Agostinho
authors: A
authors: Monteiro
authors: Johns Hopkins University School of Nursing, Baltimore, USA.
authors: Cheryl
authors: C
authors: Dennison-Himmelfarb
authors: CINTESIS - Centro de Investigação em Tecnologias e Sistemas de Informação em Saúde, Universidade do Porto, Portugal; Unidade de Alergologia, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal.
authors: João A
authors: JA
authors: Fonseca
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D000067010:Literacy; D055118:Medication Adherence; D010349:Patient Compliance; D011174:Portugal; D011795:Surveys and Questionnaires; D014177:Translations
chemical_list: D000959:Antihypertensive Agents
keywords: Adesão à terapêutica; Hipertensão arterial; Hypertension; Medication adherence; Patient-reported outcomes; Questionnaires; Questionários; Tradução e adaptação cultural; Translation and cultural adaptation