Document Type : Original Article(s)


1 Assistant Professor, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran

2 Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 PhD Candidate, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

5 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran


BACKGROUND: There are a number of tools to assess self-care in hypertension (HTN), but they do not cover all the dimensions of self-care and do not have a good reliability and validity. This study was conducted to develop and evaluate the psychometric properties of a tool for self-care assessment in HTN.METHODS: This cross-sectional, methodological study was conducted in Isfahan, Iran. An expert panel was held to assess the qualitative face validity of the tool. The content validity ratio (CVR) and content validity index (CVI) were measured. The questionnaire was distributed among 20 patients to measure its internal reliability. After 14 days, it was re-distributed among the same patients, as a measure of external reliability. The questionnaire was completed by 203 patients with HTN and an exploratory factor analysis was performed in order to assess the construct validity of the tool.RESULTS: The items of the self-care tool were confirmed with a CVR ≥ 0.5, Kappa ≥ 0.71, I-CVI = 0.69, and intraclass correlation coefficient (ICC) = 0.952. The factor analysis showed that the 16-item questionnaire has 5 dimensions, including follow-up [3 items; factor loadings (FL) = 0.619 to 0.869, and Cronbach's alpha (α) = 0.737], healthy lifestyle (5 items; FL = 0.709 to 0.846, α = 0.703), promoting qualifications (4 items; FL = 0.610 to 0.791, α = 0.594), medication therapy (2 items; FL = 0.699 and 0.740, α = 0.717), and following recommendations (2 items, FL = 0.577 and 0.744, α = 0.701). These 5 dimensions explained 62.686% of the variance. The Cronbach's alpha coefficient of the final self-care assessment questionnaire was 0.833.CONCLUSION: The developed questionnaire proved to have appropriate psychometric properties for measuring self-care in patients with HTN.


  1. Laslett LJ, Alagona P Jr, Clark BA 3rd, Drozda JP Jr, Saldivar F, Wilson SR, et al. The worldwide environment of cardiovascular disease: Prevalence, diagnosis, therapy, and policy issues: A report from the American College of Cardiology. J Am Coll Cardiol 2012; 60(25 Suppl): S1-49.
  2. World Health Organization. A global brief on hypertension: Silent killer, global public health crisis: World Health Day 2013. Geneva, Switzerland: WHO; 2013.
  3. Santulli G. Epidemiology of Cardiovascular Disease in the 21st Century: Updated Numbers and Updated Facts. J Cardiovasc Dis 2013; 1(1): 1-2.
  4. Cifkova R, Fodor G, Wohlfahrt P. Changes in hypertension prevalence, awareness, treatment, and control in high-, middle-, and low-income countries: An update. Curr Hypertens Rep 2016; 18(8): 62.
  5. Halpern MT, Khan ZM, Schmier JK, Burnier M, Caro JJ, Cramer J, et al. Recommendations for evaluating compliance and persistence with hypertension therapy using retrospective data. Hypertension 2006; 47(6): 1039-48.
  6. Barreto Mda S, Reiners AA, Marcon SS. Knowledge about hypertension and factors associated with the non-adherence to drug therapy. Rev Lat Am Enfermagem 2014; 22(3): 491-8.
  7. Haghdoost AA, Sadeghirad B, Rezazadehkermani M. Epidemiology and heterogeneity of hypertension in Iran: A systematic review. Arch Iran Med 2008; 11(4): 444-52.
  8. Khosravi A, Mehr GK, Kelishadi R, Shirani S, Gharipour M, Tavassoli A, et al. The impact of a 6-year comprehensive community trial on the awareness, treatment and control rates of hypertension in Iran: Experiences from the Isfahan healthy heart program. BMC Cardiovasc Disord 2010; 10: 61.
  9. Lee JE, Han HR, Song H, Kim J, Kim KB, Ryu JP, et al. Correlates of self-care behaviors for managing hypertension among Korean Americans: A questionnaire survey. Int J Nurs Stud 2010; 47(4): 411-7.
  10. Baumann LC, Dang TT. Helping patients with chronic conditions overcome barriers to self-care. Nurse Pract 2012; 37(3): 32-8.
  11. Han HR, Song HJ, Nguyen T, Kim MT. Measuring self-care in patients with hypertension: A systematic review of literature. J Cardiovasc Nurs 2014; 29(1): 55-67.
  12. Rakumakoe MD. To determine the knowledge, attitudes and perceptions of hypertensive patients towards lifestyle modification in controlling hypertension [Online]. [cited 2012]; Available from: URL:
  13. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA 2010; 303(20): 2043-50.
  14. Jerant AF, von Friederichs-Fitzwater MM, Moore M. Patients' perceived barriers to active self-management of chronic conditions. Patient Educ Couns 2005; 57(3): 300-7.
  15. Hu H, Li G, Arao T. Prevalence rates of self-care behaviors and related factors in a rural hypertension population: A questionnaire survey. Int J Hypertens 2013; 2013: 526949.
  16. Han HR, Lee H, Commodore-Mensah Y, Kim M. Development and validation of the Hypertension Self-care Profile: A practical tool to measure hypertension self-care. J Cardiovasc Nurs 2014; 29(3): E11-E20.
  17. Ayre C, Scally AJ. Critical values for lawshe's content validity ratio: Revisiting the original methods of calculation. Meas Eval Couns Dev 2013; 47(1): 79-86.
  18. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health 2007; 30(4): 459-67.
  19. Zamanzadeh V, Rassouli M, Abbaszadeh A, Alavi Majd H, Nikanfar A, Ghahramanian A. Details of content validity and objectifying it in instrument development. Nurs Prac Today 2014; 1(3): 163-71.
  20. Gliem JA, Gliem RR. Calculating, interpreting, and reporting cronbach's alpha reliability coefficient for Likert-Type scales [Online]. [cited 2003]; Available from: URL:
  21. Koh YL, Lua YH, Hong L, Bong HS, Yeo LS, Tsang LP, et al. Using a web-based approach to assess test-retest reliability of the "hypertension self-care profile" tool in an Asian population: A validation study. Medicine (Baltimore) 2016; 95(9): e2955.
  22. Costello AB, Osborne JW. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment 2005; 10(7): 1-9.
  23. Hill BD. Sequential Kaiser-meyer-olkin procedure as an alternative for determining the number of factors in common-factor analysis: A monte carlo simulation [Thesis]. Stillwater, Oklahoma: Oklahoma State University; 2011.
  24. Sidani S, Doran DI. Development and validation of a self-care ability measure. Canadian Journal of Nursing Research Archive 2014; 46(1): 11-25.
  25. Lahdenpera TS, Wright CC, Kyngas HA. Development of a scale to assess the compliance of hypertensive patients. Int J Nurs Stud 2003; 40(7): 677-84.
  26. Erkoc SB, Isikli B, Metintas S, Kalyoncu C. Hypertension knowledge-level scale (HK-LS): A study on development, validity and reliability. Int J Environ Res Public Health 2012; 9(3): 1018-29.
  27. Warren-Findlow J, Basalik DW, Dulin M, Tapp H, Kuhn L. Preliminary validation of the Hypertension Self-Care Activity Level Effects (H-SCALE) and clinical blood pressure among patients with hypertension. J Clin Hypertens (Greenwich) 2013; 15(9): 637-43.