What is the test-retest reliability of the Malay version of the Hypertension Self-Care Profile self efficacy assessment tool? A validation study in primary care

The Malay version of the attitudes and beliefs about cardiovascular disease (ABCD-M) risk questionnaire: a translation, reliability and validation study

BACKGROUND

Cardiovascular disease (CVD) and stroke are global public health problems and cause high mortality, especially in low- and middle-income countries. Knowledge and awareness are critical points in managing the risk in the general population. The Attitudes and Beliefs about Cardiovascular Disease (ABCD) risk questionnaire was developed to evaluate the awareness of stroke and CVD risk. Thus, the government can set up a practical risk assessment and management programme. The initiative will encourage people to seek healthcare timely and reduce the possibilities of developing complications.

OBJECTIVE

This study aimed to translate and validate the ABCD risk questionnaire into the Malay language and evaluate the psychometric properties of the Malay version in the general population in Malaysia.

METHODS

The questionnaire was translated using a standard forward-backwards translation method. The validation was perfomed by both expert panels and a potential user group. Next, the exploratory factor analysis was conducted to examine factorial validity. The respondents were selected from the government health clinics and according to the study criteria irrespective of the CVD risk. We used Cronbach's alpha and Raykov's rho to explore the internal consistency and composite reliability of the 18 items from three domains. Finally, the confirmatory factor analysis (CFA) was conducted using a robust maximum likelihood estimator.

RESULTS

The content and face validity indices were determined to be 0.94 and 0.99 respectively. Data were obtained from 179 respondents (mean age, 36.8 years; female, 68.2%; secondary level education, 51.1%). The internal consistency and composite reliability of the domains showed good results ranging from 0.643 to 0.885. The factor loadings of each item were acceptable (> 0.3), and the fit indices from the CFA resulted in a good model fit [χ² (p-value = 0.16), SRMR = 0.054, RMSEA = 0.029, CFI = 0.99, TLI = 0.99)].

CONCLUSIONS

The Malay version of the ABCD risk questionnaire is a valid and reliable tool to assess the awareness of stroke and CVD risk in the general population in Malaysia.

Comparing and determining factors associated with hypertension self-care profiles of patients in two multi-ethnic Asian countries: cross-sectional studies between two study populations

OBJECTIVES

To compare the sociodemography, disease characteristics and hypertension self-care profiles and to determine the factors influencing Hypertension Self-Care Profiles (HTN-SCP) in two populations in primary care settings from Singapore and Malaysia.

DESIGN

Cross-sectional, cross national.

SETTING

Multi-centre, primary care clinics Malaysia and Singapore.

PARTICIPANTS

1123 adults with hypertension enrolled and analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Comparison between sociodemography, disease characteristics and the mean scores of HTN-SCP domains (behaviour, motivation and self-efficacy) and the factors influencing hypertension self-care.

RESULTS

1123 adults with hypertension attending primary care clinics in Malaysia and Singapore were involved. The participants' mean age was 63.6 years (SD 9.7) in Singapore and 60.4 (SD 9.1) in Malaysia. Most of the participants in Singapore had tertiary education (22.3%) compared with Malaysia (13.0%), p<0.001. A higher proportion of participants from Singapore had controlled blood pressure (74.6%) compared with Malaysia (33.8%), p<0.001. The mean total score of HTN-SCP was significantly higher among Singapore participants compared with Malaysia participants 190 (SD 28) versus 184 (SD 23) (p<0.001). Similarly, the mean score for motivation domain 67 (SD 10) versus 65 (SD 9), followed by self-efficacy score 65 (SD 11) versus 62 (SD 9) and behaviour score (58 SD 9 vs 56 SD 9) were higher among Singapore participants. In both countries, the factors which influenced higher HTN-SCP mean scores across all domains were being Indian and had tertiary education.

CONCLUSIONS

The study population in Singapore had a higher HTN-SCP mean score compared with Malaysia. The common factors influencing higher HTN-SCP mean scores at both study sites were ethnicity and level of education. Future intervention to improve self-care among people with hypertension may need to be tailored to their behaviour, motivation and self-efficacy levels.

Psychometric Properties and Factorial Structure of Vietnamese Version of the Hypertension Self-care Profile Behavior Scale

BACKGROUND

The Hypertension Self-care Profile Behavior (HTN-SCPB) scale is a self-report instrument with which a patient's self-care behavior can be assessed. However, its psychometric properties for adult patients with hypertension in Vietnam require clarification.

OBJECTIVE

The aim of this study was to translate the HTN-SCPB scale into Vietnamese and to assess its psychometric properties.

METHODS

The study included 220 adult patients with hypertension. To evaluate test-retest reliability, 133 participants were tested twice with a 3-week interval between tests. For construct validity, exploratory factor analysis was used to assess factor structure, and confirmatory factor analysis was used to evaluate the structural model fit of the scale.

RESULTS

Reliability was confirmed by internal consistency (Cronbach α = 0.79) and test-retest reliability (intraclass correlation coefficient, 0.88). The Kaiser-Meyer-Olkin value was 0.75, and Bartlett's test of sphericity was significant (P < .001) and adequate for exploratory factor analysis. A 5-factor structure was obtained, and the factors were named as follows: "advanced self-management skills," "adverse health behaviors," "medication adherence," "diet-related knowledge regarding hypertension," and "information skills." Confirmatory factor analysis revealed that the model fit indices were acceptable (root-mean-square error of approximation, 0.07) or slightly less than the good fit values (comparative fit index, 0.85; incremental fit index, 0.85; goodness-of-fit index, 0.88; adjusted goodness-of-fit index, 0.84; and Tucker-Lewis index, 0.82).

CONCLUSIONS

The Vietnamese HTN-SCPB scale had satisfactory validity and reliability for assessing self-care behaviors in patients with hypertension in Vietnam.

Instruments to assess self-efficacy among people with cardiovascular disease: A COSMIN systematic review

BACKGROUND

Self-efficacy plays an important role in recovery. There is a need for valid tools that can assess self-efficacy in cardiovascular diseases to provide evidence-based practices.

OBJECTIVE

To perform a psychometric review of self-efficacy instruments in cardiovascular disease according to the COSMIN checklist in order to facilitate the selection of the most suitable measuring instruments.

DESIGN

Psychometric systematic review.

DATA SOURCES

A systematic literature search was conducted on the Web of Science, EBSCOHOST CINAHL COMPLETE, PUBMED, ScienceDirect, Scopus, Cochrane Library, OVID and PROQUEST databases from their time of inception to January 2019.

METHODS

We used COSMIN systematic review guideline to evaluate the quality of the Patient-Reported Outcome Measures (PROMs) and to facilitate the selection of the most suitable measuring instruments.

RESULTS

After the search process, a total of nine studies conducted between 1998 and 2018 were included in the systematic review, representing five instruments. The Cardiac Self-Efficacy Scale demonstrated high quality for content validity and low quality for internal consistency. The Cardiovascular Management Self-Efficacy Scale demonstrated high quality for structural validity and low quality for reliability and content validity. The General Perceived Self-Efficacy Scale demonstrated high quality for both structural validity and internal consistency. Content validity was not assessed for this scale. The Hypertension Self-Care Profile Self-Efficacy Scale demonstrated a moderate quality for structural validity, internal consistency and reliability and also high quality for content validity. The Self-Efficacy Expectations After Implantable Cardioverter Defibrillator Implantation Scale demonstrated high quality for structural validity, internal consistency and responsiveness. None of the studies determined measurement error, cross-cultural validity or criterion validity.

CONCLUSIONS

The Self-Efficacy Expectations After Implantable Cardioverter Defibrillator Implantation Scale is categorised as A and is recommended as the most suitable instrument. All other the four instruments categorised as B with potential to be recommended should be evaluated with further psychometric studies.

Psychometric evaluation of a Patient Satisfaction Survey Questionnaire to assess advanced practice nurse ambulatory services in primary care

AIM

To determine the construct validity and test-retest reliability of the Patient Satisfaction Survey Questionnaire (PSSQ).

BACKGROUND

Advanced practice nurses (APNs) co-manage patients with non-communicable diseases (NCDs) with public primary care physicians in Singapore. The original Nurse Practitioner Satisfaction Survey (NPSS) instrument was adapted (renamed as PSSQ) to assess satisfaction with APN service.

METHOD

A total of 209 patients self-administered the PSSQ at first visit and repeated it in a retest through phone within the next 2 weeks in 2018. Cronbach's alpha and intra-class correlation (ICC) coefficients were performed to evaluate the internal consistency and test-retest reliability. Construct validity was determined by confirmatory factor analysis (CFA).

RESULTS

The overall Cronbach's alpha (>0.7) and ICC scores (0.697-0.729) indicated excellent test-retest reliability and good internal consistency, respectively. The CFA results of three-factor model showed poor fit. Additional exploratory factor analysis (EFA) and principal component analysis (PCA) with varimax rotation revealed that adding another factor (communication with physician) resulted in a better model (eigenvalue > 1). The ICC for the four-factor model ranged from 0.664 to 0.825, indicating fair to excellent reliability.

CONCLUSION

The PSSQ shows good internal consistency and test-retest reliability. The four-factor model is a better instrument to assess APN service in local populations.

IMPLICATIONS FOR NURSING MANAGEMENT

The validated PSSQ can be used as instrument to assess the quality of services provided by various categories of nurses, including registered nurses, nurse clinicians and APNs.

Assessment of Hypertension Self-Care Behaviors and Self-Efficacy Among Men in Saudi Arabia

BACKGROUND AND PURPOSE

Hypertension is rapidly increasing in the Kingdom of Saudi Arabia (KSA), particularly among men. Assessment of hypertension self-care behaviors is a critical step to promoting blood pressure control. This study aimed to evaluate the Hypertension Self-Care Profile (HBP-SCP) among Saudi men in KSA.

METHODS

The HBP-SCP self-efficacy and behavior scales were translated into Arabic and tested on a convenience sample of 160 Saudi men with hypertension. Cronbach's alpha and factor analysis were conducted using SPSS.

RESULTS

Internal consistency of the Arabic HBP self-care and self-efficacy scales was 0.84 and 0.90, respectively. Factor loading ranged from 0.25 to 0.70 for HBP self-care behaviors and from 0.28 to 0.77 for HBP self-efficacy.

CONCLUSIONS

The Arabic HBP-SCP is acceptable in its reliability and validity for measuring HBP self-care behaviors and self-efficacy among Saudi men with hypertension.

The self-care profiles and its determinants among adults with hypertension in primary health care clinics in Selangor, Malaysia

INTRODUCTION

Self-care has been shown to improve clinical outcome of hypertension. Gauging the level of self-care among patients with hypertension enables the design of their personalized care plans. This study aimed to determine the self-care profiles and its determinants among patients with hypertension in the Malaysian primary care setting.

METHODS

This was a cross sectional study conducted between 1 October 2016-30 April 2017 in three primary care clinics in the state of Selangor, Malaysia. All adults aged 18 years and above with hypertension for at least 6 months were recruited with a systematic random sampling of 1:2 ratio. The participants were assisted in the administration of the structured questionnaire, which included socio-demographic information, medical information and the Hypertension Self-Care Profile (HTN SCP) tool. Statistical analysis was done using SPSS version 20.0. Multiple linear regression was performed to determine the determinants for self-care.

RESULTS

The mean age of the participants was 59.5 (SD10.2) years old. There were more women (52.5%) and most were Malays (44.0%) follow by Chinese (34%) and Indians (21%). Majority (84.2%) had secondary or primary school level of education. A third (30.7%) had a family history of hypertension. The mean total HTN-SCP score was 124.2 (SD 22.8) out of 180. The significant determinants that influenced the HTN-SCP scores included being men (B-4.5, P-value0.008), Chinese ethnicity (B-14.7, P-value<0.001), primary level education/no formal school education level (B-15.7, P-value<0.001), secondary level education (B-9.2, P-value<0.001) and family history of hypertension (B 4.4, P-value 0.014).

CONCLUSIONS

The overall hypertension self-care profile among patients in this multi-ethnic country was moderate. Being men, Chinese, lower education level and without family history of hypertension were associated with lower hypertension self-care profile score. Healthcare intervention programmes to address self-care should target this group of patients.

Hypertension self-care practice and associated factors among patients in public health facilities of Dessie town, Ethiopia

Background

Hypertension self-care practice is essential for blood pressure control and reduction of hypertension complications. Nevertheless, we know little concerning hypertension self-care practice in Ethiopia. The purpose of this study was to assess hypertension self-care practice and associated factors among patients in public health facilities in Dessie town, Ethiopia.

Methods

In this cross-sectional study, 309 hypertensive patients (mean age 58.8 years, 53.4% women) completed the interviewer-administered questionnaire in Amharic language. Descriptive and logistic regression analyses were conducted using SPSS version 22.

Result

The mean score for hypertension self-care was 37.7 ± 8.2 and 51% scored below the mean. Divorced participants (AOR = 0.115, 95% CI = 0.026, 0.508, p-value < 0.01) and those who lack source of information (AOR = 0.084, 95% CI = 0.022, 0.322, p-value < 0.01) were less likely to have good self-care practice. But, participants who had convenient place for exercise (AOR = 2.968, 95% CI = 1.826, 4.825, p-value < 0.01), who had good social support (AOR = 2.204, 95% CI = 1.272, 3.821, p-value < 0.01), who had traditional clergy-based teaching (AOR = 2.209, 95% CI = 1.064, 4.584, p-value < 0.05), and who had good self-care agency (AOR = 1.222, 2.956, p-value < 0.05) were more likely to have good self-care practice.

Conclusion

Most of the study participants reported poor self-care practices. Factors associated with hypertension self-care practice are marital status, education, source of self-care information, place for exercise, social support, and self-care agency. Targeted interventions are needed to improve hypertension self-care practice.