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Yvonne Commodore-Mensah,1,2,* Sabianca Delva,3,* Oluwabunmi Ogungbe,1,2,* Lauren A Smulcer,4 Sally Rives,1 Cheryl R Dennison Himmelfarb,1,5,6 Miyong T Kim,7 Lee Bone,1,2,5 David Levine,1,2,5 Martha N Hill1,2,5 1Johns Hopkins School of Nursing, Baltimore, MD, USA; 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; 3William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA; 4Elara Caring, Fort Polk North, LA, USA; 5Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; 6Department of Health, Behavior and Society, Johns Hopkins Bloombery School of Public Health, Baltimore, MD, USA; 7School of Nursing, University of Texas at Austin, Austin, TX, USA*These authors contributed equally to this workCorrespondence: Yvonne Commodore-Mensah, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Room N530U, Baltimore, MD, 21205, USA, Tel +1 4106141519, Email ycommod1@jhmi.eduBackground: Poor medication adherence hampers hypertension control and increases the risk of adverse health outcomes. Medication adherence can be measured with direct and indirect methods. The Hill-Bone Compliance to High Blood Pressure Therapy (HBCHBPT) Scale, one of the most popular adherence measures, indirectly assesses adherence to hypertension therapy in three behavioral domains: appointment keeping, diet and medication adherence.Aim: To synthesize evidence on the use of the HBCHBPT Scale, including psychometric properties, utility in diverse patient populations, and directions for future clinical use and research.Methods: We searched electronic databases, specifically CINAHL, PubMed, PsychInfo, Embase, and Web of Science. We included original studies that used the HBCHBPT Scale or its subscales to measure a health outcome, or methodological studies involving translations and validations of the scale. We extracted and synthesized data following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.Results: Fifty studies were included in this review, 44 on hypertension, two on diabetes, and others on other chronic conditions. The scale was successfully translated into numerous languages and used in descriptive and intervention studies. The scale demonstrated sound psychometric properties (Cronbach’s α coefficient 0.75) and sensitivity to capture intervention effects when used to evaluate the effectiveness of high blood pressure adherence interventions. The medication-taking subscale of HBCHBPT performs best and is widely used in diverse contexts to assess medication adherence for chronic conditions.Conclusion: The HBCHBPT Scale has high versatility globally and has been used in various settings by various healthcare worker cadres and researchers. The scale has several strengths, including high adherence phenotyping capabilities, contributing to the paradigm shift toward personalized health care.Keywords: medication adherence, treatment adherence, treatment compliance, hypertension, high blood pressure, Hill Bone Medication Adherence Scale, Hill-Bone Compliance to Blood Pressure Therapy Scale

Oluwabunmi Ogungbe,1 Samuel Byiringiro,1 Adeola Adedokun-Afolayan,2 Stella M Seal,3 Cheryl R Dennison Himmelfarb,1,4,5 Patricia M Davidson,1 Yvonne Commodore-Mensah1,5 1Johns Hopkins University School of Nursing, Baltimore, MD, USA; 2School of Public Health, Louisiana State University, Shreveport, LA, USA; 3William H. Welch Medical Library, Johns Hopkins University and Medicine, Baltimore, MD, USA; 4Johns Hopkins University School of Medicine, Baltimore, MD, USA; 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USACorrespondence: Oluwabunmi OgungbeJohns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USATel +1-601-541-1152Email oogungb3@jh.eduPurpose: The burden of cardiovascular diseases (CVD) is high in low- and middle-income countries (LMICs). Medications are integral to the management and control of CVD; however, suboptimal adherence impacts health outcomes. This systematic review aims to critically examine interventions targeted at improving medication adherence among persons with CVD in LMICs.Methods: In this systematic review, we searched online databases PubMed, Embase, and CINAHL for studies that evaluated a medication adherence intervention for CVD, reported adherence as an outcome measure, were conducted in LMICs and reported the strategy or tool used to measure adherence. We included articles published in English, available in full text, peer-reviewed, and published between 2010 and 2020.Results: We included 45 articles in this review. The majority of the studies implemented counseling and educational interventions led by nurses, pharmacists, or community health workers. Many of the studies delivered medication-taking reminders in the form of phone calls, text messages, short message services (SMS), and in-phone calendars. Multi-component interventions were more effective than unifocal interventions. Interventions involving technology, such as mobile phone calls, electronic pillboxes, and interactive phone SMS reminders, were more effective than generic reminders. The outcomes reported in the studies varied based on the complexity and combination of strategies. When interventions were implemented at both the patient level, such as reminders, and at the provider level, such as team-based care, the effect on medication adherence was larger.Conclusion: In LMICs, medication adherence interventions among persons with CVD included a combination of patient education, reminders, fixed-dose combination therapy and team-based care approach were generally more effective than singular interventions. Among patients who had CVD, the medication adherence interventions were found to be moderately effective. Future studies focusing on improving medication adherence in LMICs should consider non-physician-led interventions and appropriately adapt the interventions to the local context.Keywords: medication adherence, cardiovascular diseases, LMICs, systematic review