A Systematic Review of the Hill-Bone Compliance to Blood Pressure Therapy Scale

Figures & data

Figure 1 PRISMA flow chart.

Notes: PRISMA figure adapted from Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. Creative Commons.¹⁶

Table 1 General Characteristics of Included Studies (N=50)

Author, Year	Country	Study Design	Sample Size (N)	Disease	Population & Setting	Age (Years)	Language*	Subscale	Administration Method	Scoring system	Psychometric Properties
Abel et al, 2014^Citation19	USA	Cross-sectional study	80	HTN	Black women	18–60	English	8-item medication-taking subscale	In person, self-administration	Scores ranged from 9–36 (9-perfect medication adherence)	Cronbach α=0.84 Mean and range of scores: 13.1 ± 4.2 75% adherent: N= 60 25% adherent: N= 20
Al-daken and Eshah, 2017^Citation20	Jordan	Cross-sectional descriptive comparison design	192	HTN	Adult patients	52.8; range 20–80)	English Arabic	Full scale (14 items)	Interviews	14 items negatively worded and rated on a 4-point Likert scale Scores ranged from 14–56, (56-perfect adherence). Scores were converted to marks out of 100 to categorize patients by adherence level.	Cronbach α = 0.79 (Arabic version) The mean (SD) of total adherence to HTN was 87.27 (10.3) out of 100.
Alsolami et al, 2013^Citation21	Saudi Arabia	Cross-sectional study	110	HTN	Adult patients at a university hospital	53.6 ±12	Arabic	Medication adherence (9 items) and appointment keeping (3-item) subscales.	Self-administration	Nine questions with four response categories ranging from 1 = None of the time to 4 = All of the time.	Cronbach α = 0.76 (Arabic version) for 9-item medication adherence subscale)
Asadullah et al, 2018^Citation22	Pakistan	Cross-sectional descriptive study	401	HTN	Adult patients	45.1; range 21–95)	NR Excluded non-patients Urdu	Full scale (14 items)	Interviews and Self-administration	4-point-scale, score ranging from 9 (perfect adherence) to 36 points and dichotomized the responses in ‘perfect adherence’ (9 points) and ‘imperfect adherence’ (>9 points).	Cronbach α= NR 336 (83.4%) had imperfect adherence and 65 (16.2%) have perfect adherence. Mean score: 24.16; Median score: 25.0.
Boulware et al, 2009^Citation23	USA	Cross-sectional	195	HTN	Adults from 15 primary care practices	51% were 60+	English	Full scale (14 items)	Interview	Scores range from 14–56 points, Higher scores indicating poorer adherence	Cronbach α= NR Mean(±SD) Score: 17.8 (±2.6), Range 14–26
Chatziefstratiou et al, 2019^Citation24	Greece	Methodolo-gical study	68	HTN	Patients with and without HTN at a general hospital	Mean: 65	Greek	Full scale	Self-administration	4-point Likert-type scale (4=all the time; 1=never)	Cronbach’s α = 0.76
Cheong et al, 2015^Citation25	Malaysia	Cross-sectional; instrument validity	262	HTN	Adults from two public primary healthcare clinics	Mean (±SD) age: 56.3 (±8.7)	Malay, but responses were in Chinese/Tamil/Malay	Full scale (14 items)	Self-administration	4-point Likert scale. Scores ranged from 1 (all the time) −4 (none of the time). Higher scores indicated better adherence.	Cronbach α= 0.64. Cronbach’s α for (items 1, 14, 10, 8, 2), (items 2, 12, 11, 9), and salt intake is 0.64, 0.55 and 0.29, respectively.
Chudiak et al, 2017^Citation26	Poland	Cross- sectional	300	HTN	Patients at a University Clinical Hospital	Mean (± SD: 71.75 (±7.79)	Polish	Full scale (14 items)	NR	Scores range between 14 and 56 points; higher scores=poorer adherence	Cronbach α= NR Full scale (Range: 14–34). Mean (±SD) score: 20.75 ±4.11. Salt Intake subscale (Range: 3–12; Mean (±SD) score: 4.79 (±1.17). Appointment Keeping subscale (Range: 2–8; Mean(±SD) score: 3.47 (±1.09). Medication Taking subscale (Range: 9–36); Mean(±SD) score: 12.49 (±3.3)
Chudiack et al, 2018^Citation27	Poland	Analytical cross-sectional study	300	HTN/ Cognitive impairment	Adults with HTN on admission at a University Teaching Hospital	Mean age: 71.8±7.8	Polish	Full scale	Self-administration	4-point Likert-type items (1=none of the time, 2=some of the time, 3=most of the time and 4=all the time)	Cronbach α = 0.851 Range of scores: 14–34. Adherence level: 63% of the participants
Dennison et a, 2007^Citation28	South Africa	Cross-sectional	403	HTN	Black patients in public and private primary care sites	Mean age=52 (range: 35–65)	Xhosa	10-item, 3- point Likert-type Hill-Bone Compliance Scale	Interview	Not reported	Cronbach α= 0.77
Dharan & Moly, 2017^Citation29	India	Cross-sectional	150	HTN	Adult patients in a tertiary care hospital	Mean (± SD): 55 (±15)	English	Full scale (14 items)	Interview	Four-point Likert scale. Scores ranged from 14–56. Score of 14–28 =good compliance, 29–42 =average, and 43–56=poor compliance.	Cronbach α= NR
Etebari et al, 2019^Citation30	Iran	Cross-sectional study	254	HTN	Adults with HTN attending a family medicine clinic	Mean (± SD): 58.16 ± 10.54	Persian	Full scale	Self-administration	5-point ‘reversed’ Likert scale: 5 considered as “I never forget”, and the score of 1 determined as “I always forget”.	Cronbach α = 0.71. Scores ranged from 14–51. Mean overall patient score was 35.96 ± 9.17. Mean (SD) scores for dietary subsection: 7.84 ± 1.94; Medication: 19.6 ± 5.86; Appointment: 8.52 ± 2.68
Fleig et al, 2018^Citation31	Germany	Prospective observa-tional	1770	HTN	Adult patients in practices of 614 internists, general practitioners and cardiologists	Mean (± SD): 60.0 ± 13.4	German	Medication subscale (9 items)	NR	Four-point Likert scale. Scores ranged from 9–36 (9 = perfect medication adherence)	Cronbach α= NR
Fongwa et al, 2015^Citation32	USA	Validation study	70	HTN	African American women from a federally funded inner-city clinic	Mean (± SD): 54 (±8) years, Range: 37–75 years	English	Full scale (14 items)	Interview	14-item Hill-Bone Compliance Scale uses a 4-point Likert scale.	Cronbach α= NR Internal consistency reliability coefficients were reported to be 0.74 and 0.84.
Gerber, 2010^Citation33	USA	Cross-sectional	450	HTN	African American and White Medicare recipients aged 65+ in a city	Mean (± SD): 77±6.65	English	Medication- subscale (9 items)	Face-to-face interviews; computer-assisted survey	Four-point Likert scale. 9–36 (9 reflecting perfect medication adherence)	Cronbach α= 0.68
Glasgow, 2012^Citation34	USA	Three-arm RCT	463	Type 2 Diabetes	Range: 25–75 years, Dx with DM II, (BMI) of 25 kg/m2 or greater, and at least one other risk factor for heart disease	Mean (± SD): 58.4±9.2	English	Medication- subscale (9 items)	Not reported	Dichotomized adherence scores 1 = perfect adherence, 0 = other levels of adherence	Cronbach α= NR
Greer & Abel, 2017^Citation35	USA	Mixed methods, Cross-sectional quantitative arm	20	HTN	African- American women	Mean (± SD): 54 ± (11.6)	English	Full scale (14 items)	Self-administration	4-point Likert scale; Score ranged from 14–56. Higher scores =poorer adherence.	Cronbach α= 0.81
Greer & Ostwald, 2015^Citation36	USA	Randomized controlled trial	60	HTN	African- American women	Mean (± SD): 57.98 ± (12.37)	English	Full scale (14 items)	Self-administration	Scores ranged from 14 (perfect adherence-56. A cutoff score of 22 was used to distinguish high and low adherence.	Cronbach α=NR
Han et al, 2014^Citation37	USA	Validation study	213	HTN	Adults in an inner city	Mean (± SD): 68.6 ± (12.3)	English	Full scale (14 items)	Self-administration	Four-point Likert scale. Scores ranged from 9–36 (9 = perfect medication adherence)	Cronbach α= 0.70 Pearson’s correlation coefficients of HBP SCP-Behavior with existing HBP self-care instruments were moderately strong (r = −0.493 with the Hill-Bone scale; P <0.001 for all correlation coefficients), indicating concurrent validity
Hill-Briggs et al, 2006^Citation38	USA	Randomized controlled trial	65	Diabetes	Adult urban African Americans	Mean (± SD): 59.5±11.6	English	Full scale (14 items)	Self-administration	4-point Likert scale; Scores range from 4 to 36, higher scores = higher medication adherence.	Cronbach α=Not reported Mean (± SD): score: 33.1 (±3.9)
Hsu et al, 2010^Citation39	USA	Cross-sectional	94	HTN	Chinese American elders from three Chinese churches and one community center	Mean (± SD): 75 ± 12.5	Chinese	Medication- subscale (9 items)	Interview	4-point Likert scale; Scores ranged from 9 to 36; The higher the scores, the lower the compliance	Cronbach α= Not reported The scores ranged from 9 to 22. Mean (± SD): 10.63 (±2.53)
Ingram and Ivanov, 2013^Citation40	USA	Descriptive correlational design.	121	HTN	Community - African American community members	Mean (± SD)59.75 (± 7.94) Range 50–87	English	Full scale (14 items)	Self-administration	4-point Likert scale; 14–56 higher scores indicating less adherence.	Cronbach α = 0.73. Mean: 24, and 50% non-adherent
Karademir et al, 2009^Citation41	Turkey	Validation study	200	HTN	Primary health clinic- Adult patients	58% of partici-pants were >61 y/o	Turkish	Full scale (14 items)	Interview	4-point Likert scale; lower scores= better adherence	Full scale: Cronbach α = 0.72 Medication subscale: (Cronbach α =0.83 Salt intake subscale: (Cronbach α= 0.62
Kim et al, 2007^Citation42	USA	Cross-sectional	208	HTN	Community - Korean Americans in a metropolitan area	Mean (± SD): 52.6 ± 5.6	English and Korean	Medication subscale (4 items)	Interview	4-point Likert scale; lower scores= better adherence	Medication subscale: Cronbach α =0.74 53.8% of participants endorsed at least 1 type of nonadherent behavior.
Kosachack et al, 2010^Citation43	Germany	Comparison and validation study	353	HTN	General practice - Adults attending 23 German general practices	Mean (± SD): 64 ± 11	German	Full scale (14 items)	Telephone interview	4-point Likert scale; low score = better adherence, dichotomized the responses in “perfect adherence” (9 points) and “imperfect adherence” (>9 points)	Cronbach α = 0.73.
Krousel-Wood et al, 2005^Citation44	USA	Cross-sectional survey	239	HTN	Community - Patients attending the hypertension section of the Internal Medicine Clinic in a large multispecialty group practice	Mean: 69; Men Mean (± SD): 68.3 ±11.2, Women Mean (± SD): 69.8 ± 13.0	English	Full scale (14 items)	Self-administration	4-point Likert scale; higher scores= poor adherence	Full scale: Cronbach α = 0.43. Medication subscale: Cronbach α=0.68 Salt intake subscale: Cronbach α= 0.49
Krousel-Wood et al, 2008^Citation45	USA	Cross-sectional survey	210	HTN	Community - patients attending the HTN section of an established urban multispecialty group practice after Hurricane Katrina	Mean: 63.6	English	Medication subscale (9 items)	Self-administration	4-point Likert scale; higher scores= poor adherence	Cronbach α = NR 46% of the patients had less-than-perfect adherence to antihypertensive medications in the year following Hurricane Katrina.
Krousel-Wood et al, 2013^Citation46	USA	Cross-sectional survey, prospective cohort study	394	HTN	Adults > 65 years from a large managed care organization	Mean (± SD): 76.6 ± 5.6	English	Medication subscale(9-items)	Self-administration	4-point Likert scale, higher scores= poor adherence	Cronbach α = NR Concordance statistic = 0.66 (95% CI 0.622–0.674)
Lambert et al, 2006^Citation47	South Africa	Validation study	98	HTN	Community Patients from peri-urban community health centers or a government work site in	Mean (± SD): 52 ± 7.6	Xhosa	Full scale (14 items); 10-item adapted scale	Interview	4-point Likert scale; lower scores= higher adherence	10-item scale: Cronbach α = 0.79 Salt-intake subscale: Cronbach α = 0.41. Medication subscale(8-items): Cronbach α=0.76
Mafutha and Wright, 2013^Citation48	South Africa	Cross-sectional	101	HTN	Primary health clinic - Patients living in a city and attending one of the three primary healthcare clinics	Range 20–80	English	Full scale (14 items)	Interviewer-assisted (face-to-face interviews with fieldworkers fluent in local languages)	4-point Likert scale; higher scores= better compliance label 80% and above as good compliance, between 70% and 79.9% as moderate compliance and 69.9% and below as poor compliance	Good compliance = 70% Moderate compliance = 23% Low compliance = 7%
Manze et al, 2015^Citation49	USA	Prospective cohort	819	HTN	Hospitalized adults at an urban safety-net hospital	Mean: 59.6	English	Salt-intake subscale	Self-administration	Higher score indicates worse diet, range 1–12	Cronbach α = NR
Maslakpak and Safaie, 2016^Citation50	Iran	Randomized controlled clinical trial study with a pretest-posttest design	123	HTN	Community-dwelling adults in a city	Control group: 50.54 (mean)±8.14, Text message group: 53.68 (mean) ± 6.94, Reminder card group: 50.29 (mean) ± 10.51	Not specified	Full scale (14 items)	Interviewer administered	1 = never, 2 = occasionally, 3 = often, and 4 = always	Cronbach α = NR
Maslakpak et al, 2018^Citation50	Iran	Single-blind randomized, parallel-group controlled trial	100	HTN	Adult patients referred to a clinical-educational center	18–60 years	Persian	Full scale	4-point Likert scale: never (1), occasionally (2), often (3) and always (4)	Cronbach α = 0.87, 0.94, 0.79, 0.88, respectively for total treatment, medication, low sodium regimen and medical appointments adherence.	4-point Likert scale: never (1), occasionally (2), often (3) and always (4)
Mutneja et al, 2020^Citation51	India	Observational cross-sectional study	452	HTN	Patients prescribed antihypertensives attending cardiology and geriatrics outpatient clinics	Mean ± SD: 54.6 ± 13.7 years	Not Specified	Full scale	Self-administration	4-point Likert-type scale (1=never, 4=always)	Cronbach’s α: overall = 0.7; Subscales: Salt intake = 0.7; appointment keeping = 0.8; medication adherent = 0.7 Mean inter-item correlation: 0.341; Kaiser-Meyer-Olkin (KMO): 0.591
Nashilongo et al, 2017^Citation52	Namibia	Descriptive cross-sectional observational study/validation study	120	HTN	Primary health clinic - Adults from public primary health clinics in four sub-urban townships	Mean (± SD): 47.3 ± 11.1	Afrikaans and Oshiwamb	Modified 12-item Namibian version (items 6 and 12 from original scale removed)	Interview	4-point Likert scale; Lower scores=better compliance. Replies to questions with a mean score > 2 indicated poor compliance.	Cronbach α = 0.695
Ndumele et al, 2010^Citation53	USA	Cross-sectional survey	141	HTN	Primary health clinic - African American (AA) and Non-Hispanic White patients	AA median = 64 (59–73 range), White median = 67 (57–71 range)	English	Full scale(14-items)	Interviewer administered	4-point Likert scale; lower scores=better adherence.	Cronbach α = NR
Nguyen et al, 2009^Citation54	USA	Cross-sectional	235	Inflammatory Bowel Disease (IBD)	Primary health clinic - IBD patients from outpatient clinic	Mean (± SD): 41.2± 14.2	English	10 items along with 2 behavior domains: medication-taking and prescription refill (8 items), and appointment keeping (2 items)	Telephone interview	4-point Likert scale; Scores ranging from 10 (most adherent/least non-adherent) to 40 (least adherent/most non-adherent). Adherence was also dichotomized with a threshold score of less than 16 reflecting adherence versus non-adherence.	Cronbach α = NR
Nogueira-Silva et al, 2016^Citation55	Portugal	Validation study	One group with 9 people	HTN	Clinic - Adults in HTN clinic	Not reported	Portuguese	Full scale (14 items)	Self-administration	4-point Likert scale; 1 = Always, 4 = Never. Lower scores=better adherence	Cronbach α = NR
Rose et al, 2014^Citation56	USA	Descriptive correlational design	98	Serious Mental Illness	Community - Psychiatric Treatment program	Mean (± SD): 51.84 ± 8.79, 31–75 (range)	English	Full scale	Interview	4-point Likert scale; Lower scores=better adherence	Cronbach α = NR Mean (± SD): score = 21.21 (± 4.41)
Sarfo et al, 2018^Citation57	Ghana	Cross-sectional design	2870	HTN and/or Type 2 DM	5 Hospitals - participants with HTN with or without diabetes	Mean (± SD): 58.9 ± 16.6	English	Full scale (14 items)	Interview	4-point Likert scale; 1=none of the time, 4=all of the time; higher scores=poorer adherence	Cronbach α = NR
Shawler et al, 2019^Citation58	USA	Longitudinal predictive	51 dyads Analysis of Hill-Bone scale of 18 hypertensive mother-daughter dyads.	HTN	Older mother-adult daughter dyads recruited from 4 senior citizen centers in an urban area	Mean: mothers; 781; daughters: 52.5.	English	Full-scale	Interviews	Not reported	Cronbach’s α = 0.69 and 0.68 at baseline and follow-up, respectively Mean scores: At baseline: Mothers: 52.0 ± 2.6 Daughters: 48.5 ± 4.0 At 6-month follow-up: Mothers 52.4 ± 2.5. Daughters: 49.2 ± 2.5
Song et al, 2011^Citation59	USA	Validation study	525	HTN	Community - Korean Americans from two community-based HTN intervention trials	Mean (± SD): 52.5 ± 5.42	Korean	8-item modified medication subscale	Face-to-face interviews with bilingual interviewers	4-point Likert scale; 1=none of the time, 4=all of the time; Lower scores=better adherence	Cronbach α = 0.76
Uchmanowicz et al, 2016^Citation60	Poland	Validation study	117	HTN	Private medical center	Mean (± SD): 60.7± 12.41	Polish	Full scale (14 items)	Self-administration	4-point Likert scale; 1=none of the time, 4=all of the time; Lower scores=better adherence	Full Scale Cronbach α = 0.851. Medication subscale Cronbach α = 0.78
Uchmanowicz et al, 2018^Citation61	Poland	Prospective, cross-sectional, and analytical study	186	HTN	Hypertensive elderly patients at the hypertension clinic	Mean age: 71.05±7.47 years	Polish	Full-scale	Interview	Not reported	Overall mean score= 20.39±4.31 points. Mean score in the subscale analyses: reduced sodium intake =4.75±1.33 Appointment keeping = 3.45±1.07 Medication taking = 12.19±3.46
Uchmanowicz et al, 2018^Citation62	Poland	Cross-sectional study	150	HTN	Hypertensive adult patients at the University Clinical Hospital	Mean: 72.1 ±8.0	Polish	Full scale	Interviews	4-point scale: “none of the time=1”, “some of the time=2”, “most of the time=3”, and “all the time=4”	Cronbach α = 0.851. Scores ranged from 14 to 32 points. The median was 19 points. The first and third quartiles were 17 and 22. Mean overall score: 20.19 ±4.05. Subscale analysis: Reduced sodium intake: 4.82 ±1.09; Appointment keeping: 3.33 1±19; medication taking: 12.05 ±3.08.
Uchmanowicz et al, 2019^Citation63	Poland	Cross-sectional study	160	HTN	Adult patients hospitalized at the Hospital in a city	65–78, Mean, 72.09 ±7.98	Polish	Full scale	Self-administration	Modified scale: “none of the time”, “some of the time”, “most of the time”, “all the time”, “not applicable”, and “do not know”.	Cronbach α = NR Scores ranged from 14 to 32 points. Mean overall score: 20.24 ±4.01. Median score: 19.5.
Wang et al, 2015^Citation64	USA	Cross-sectional correlation study	45	Alzheimer’s	Adult caregivers and Alzheimer’s patients at university geriatric clinics and local communities in a large city.	Patients: Mean (± SD): 81.3 ± 7.9 Caregivers: Mean (± SD): 66.8 ± 10.5	English	6-item version of the full scale	Interview	5-point Likert-type scale (1 = never, 5 = all the time), responses to both measures were reverse coded; higher scores = higher adherence to medications and appointments	Cronbach α = 0.88.
Zabihi et al, 2012^Citation65	Iran	Descriptive study	120	HTN	Hospital clinics - Adults attending clinics affiliated with the hospitals	40–60 (range), 64.2% >51 y/o	Not reported	Full scale (14 items)	Interview	NR To classify adherence scores, scores of patients in each subscale were calculated, divided by the total score of the same subscale, and finally multiplied by 100	Cronbach α = 0.71.
Zare et al, 2019^Citation66	Iran	Matched RCT	101	HTN	Outpatients referred to two heart clinics	Mean (range): Intervention: 43.17 (26–60); Control: 44.24 (27–58)	Persian	Full scale	Self-administration during clinic visits	Not Reported	Cronbach α = 0.71
Zwar et al, 2017^Citation67	Austra-lia	Pretest posttest	47	HTN	Adults at general practices	Mean (± SD): 62.5 ± 19.2	English	Full scale (14-items)	Interview	NR	Cronbach α= NR

Notes:*Languages scales were translated into or administered in, if applicable.

Abbreviations: HTN, Hypertension; DM, Diabetes Mellitus; RCT, Randomized Controlled Trial; NR, Not Reported; HBP, High Blood Pressure.

Table 2 Randomized Controlled Trials Measuring Adherence in Hypertension (n=4) and Diabetes (n=2) Treatment

Author	Condition	Purpose	Intervention	Effect Size (Cohen’s d)	Medication Adherence/Clinical Outcome
Glasgow et al, 2012^Citation34	Diabetes	To address 3 self-management behaviors for adults with diabetes: medication adherence, exercise, and food choices, using the diabetes self-management website.	My Path/Mi Camino, a computer-assisted diabetes self-management (CASM) intervention vs a CASM plus human support (CASM+) condition.	d for Medication adherence=0.12 at 4 months, 0.13 at 12 months comparing CASM vs CASM+	Internet conditions improved health behaviors significantly vs usual care over the 12-month period (d for effect size = 0.09–0.16)
Greer & Ostwald, 2015^Citation36	Hypertension	To improve outcomes for 60 African American women with hypertension.	90-minute educational sessions offered once a week for 6 weeks to groups of 8 to 12 women. Participants randomized to a wait-list control group received only usual care from their healthcare provider. After data collection, participants in the wait-list group were offered the classes, and 11 of 30 women enrolled, were shown a DVD, and received the lecture materials, pamphlets, and handouts.	–	A significant favorable overall main effect (time) was found for systolic blood pressure (F3, 174 = 11.104, P = 0.000) and diastolic blood pressure (F3, 174 = 4.781, P = 0.003) for both groups.
Hill-Briggs et al, 2006^Citation38	Diabetes	To examine, in a sample of urban African Americans with type 2 diabetes, the association of social problem-solving with glycemic control and health behaviors.	Participants underwent standardized interviews, physical assessment, and laboratory testing. They also received additional assessments of health behaviors and psychosocial factors.	–	Difference between mean A1C for the Above Average avoidant style group, as compared to the Below Average avoidant style group, was 2.2 (p = 0.03, 95% CI = 0.20–4.31), indicating significantly worse glycemic control in the Above Average group. Linear regression showed that for every 1.62 increase in A1C in the Avoidant group, there was a –0.95 decrease in medication adherence.
Maslakpak & Safaie, 2016^Citation50	Hypertension	To compare the effectiveness of short message service (SMS) to reminder cards about medication adherence in patients with hypertension.	3-month intervention with three groups: the control group received the standard education; SMS groups were sent 6 messages a week and the reminder card group. Also, all the patients were asked to visit the clinical center 6 times.	–	Medication adherence for three groups: control (46.63±2.99), SMS (57.70±2.75) and the reminder cards (57.51±2.69) after the intervention.
Maslakpak et al, 2018^Citation50	Hypertension	To evaluate the effectiveness of family involvement in patient education on hypertension management.	The participants in the control group were given routine education. The control group received the paper-based educational materials and all participants completed the Hill-Bone Scale and their blood pressure was measured at the end of the intervention.	–	Mean medication adherence scores: control group: 21.72 ± 2.20, family-oriented group: 13.44 ± 3.26, patient-oriented group: 16.64 ± 2.59 and patient and family-oriented group: 12.36 ± 2.36; p < 0.0001. Treatment compliance was best in the patient and family-oriented groups compared to other groups after the intervention.
Zare et al, 2019^Citation66	Hypertension	To evaluate the effect and acceptance of an educational self-care application.	The control group participants received the routine care and underwent no interventions. The patients in the intervention group were asked to use the application for eight weeks. They were also asked to measure and save their BP in the application every two weeks.	–	There was a significant difference between the intervention and control groups regarding the mean score of self-care behaviors (4.13 ± 0.23 versus 3.18 ± 0.27, p < 0.001). Additionally, a significant difference was observed between the two groups concerning the mean scores of the two subscales of self-care behaviors, including “medication taking” and “proper diet”.

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