This sample included adult professionals, such as hospital personnel and schoolteachers. The study population was composed of all adults over 18 years of age living in Alpu. All adults over the age of 18 living in three of the four lottery-selected towns Fatih, Kemal Pasa and Yunus Emre of Alpu were visited individually.
All enrolled subjects were visited in their homes by Erkoc SB, one of the study authors, and by intern doctors who were trained on the questionnaire, which was completed during face-to-face interviews. Individuals with cognitive dysfunction preventing them from understanding the questions or giving clear answers, individual visitors to the study area, and individuals who did not agree to participate in the study were excluded.
Information was obtained during a 15 to 30 min face-to-face conversation. SPSS version The demographic characteristics of the study group were reported by using descriptive statistics frequencies, proportions, and means. In order to determine the qualifications measured by the scale and examine the meaning of the total scores, construct validity was assessed by factor analysis, specifically principal component analysis. Among the factor rotation methods, Equamax Rotation Method was selected.
According to factor loading assessed by factor analysis, items pertained to a sub-dimension according to their maximum factor weight. Eight sub-dimensions were identified by factor analysis. The Cronbach alpha coefficient was calculated for the reliability analysis of each sub-dimension. Ultimately, 5 items in 2 sub-dimensions were also excluded from the scale. Correlation analysis was used to assess internal consistency reliability.
The correlation coefficient must not be negative or below 0. The stability of the instrument over time was tested by the test-retest reliability method. Two weeks after the initial application, the scale was applied to of individuals Discriminative validity of the scale compares the group scores [ 24 ]. The expression was incorrect for 9 items. Each correct answer was worth 1 point. Incorrect statements were encoded inversely to the other items. The minimum score was zero for the entire scale and for all sub-dimensions.
The mean age of the individuals was Of these, A personal history of hypertension was observed in The distribution of the study group according to various demographic and medical characteristics is shown in Table 1. Distribution of the study group according to various demographic and medical characteristics. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0. Six sub-dimensions encompassed The Cronbach alpha values were as follows: 0.
The coefficients for the second application were 0. The average of the scale after excluding the item ranged between The corrected items-total score correlation coefficient was a minimum of 0. The total scale score was significantly higher in individuals with histories of hypertension compared to those without In the internal criterion validity assessment, the scores taken from 22 items are listed from lowest to highest. The distribution of sub-dimensions and total HK-LS scale according to various demographic characteristics of the study group are shown in Table 3.
The distribution of sub-dimensions and total HK-LS scale according to various demographic characteristics of the study group. Lifestyle, diet, complication sub-dimensions, and total scale mean scores were lower in individuals who had no formal education. Hypertension progressively and permanently damages target organs, leading to life-threatening complications and death [ 4 ].
Chronic diseases, such as hypertension, necessitate lifelong drug intake and changes in lifestyle. Educational interventions are necessary to control hypertension [ 20 ]. The present study was conducted to develop a scale that accurately reflects culturally consistent social norms, standards and viewpoints in an attempt to determine individual knowledge levels.
Validity is the extent to which an instrument measures the target issue without mistaking it with another issue. Reliability is a prerequisite for regarding a measurement as valid. Reliability is the extent to which an instrument gives consistent results in repeated measurements under similar conditions. Although reliability is a prerequisite for validity, it is not sufficient on its own for validity.
Scales that are reliable may not necessarily be valid [ 26 ]. The factor analysis method is used to group interdependent variables into a specific cluster [ 23 ]. Twenty-two items in six sub-dimensions were determined following the factor and reliability analysis of HK-LS.
The Cronbach alpha coefficient, which represents internal consistency reliability, should be higher than 0. Cronbach alpha coefficients for HK-LS were 0. Although Cronbach alpha is an appropriate reliability coefficient for one-dimensional scales, it is advisable to use either test-retest or parallel-forms reliability methods in addition to alpha coefficients for multi-dimensional scales based on every single item [ 23 ].
Corrected item-total score correlation coefficients were calculated to estimate the contribution of items to the conceptual construct and whether those items can better measure a feature or not.
The minimum corrected item-total score correlation coefficient of the items was 0. Scale stability over time, i. Test-retest is the application of an instrument twice to the same subjects under the same conditions, with a time interval that is long enough to prevent relevant recalls and that is short enough to disallow considerable changes in the construct being measured [ 26 ]. HK-LS test-retest reliability of the test results shows a strong positive correlation, indicating good stability.
Concurrent validity refers to the degree to which a newly developed scale correlates with another equivalent instrument that measures the same conceptual construct [ 23 ]. A major limitation of the present study was the lack of a valid and reliable equivalent scale for Turkish populations for the assessment of concurrent validity. The validity analysis determined that HK-LS is appropriate for measuring hypertension knowledge levels.
In addition, the reliability analysis determined that HK-LS can be used without measurement error, collects data accurately and is a repeatable scale [ 23 ]. The discriminative validity of a scale can also be assessed by comparing the scores of given groups [ 24 ]. In our study, significant relationships were observed between knowledge score and age, gender, educational level and history of hypertension, while no correlation was observed between knowledge score and having an income-generating job.
Sabouhi et al. Martins et al. HK-LS is the first scale that will be used in future studies for preventing hypertension, as well as for control programs and educational interventions to determine the hypertension knowledge level of Turkish adults. For instance, patients do not recognize the importance of elevated SBP levels or the current status of their BP control. An opportunity exists to focus patient education programs and interventions on the cardiovascular risk associated with uncontrolled HTN, particularly elevated SBP levels.
It is important to have access to patients' clinical BP data so that the relationship between their perception of factors, such as BP control and actual clinical BP, can be measured and evaluated in the context of their clinical values. Improved recognition of the importance of systolic blood pressure SBP has been identified as one of the major public health and medical challenges in the prevention and treatment of HTN. The significance of achieving better control of BP has only been increased by the release in May of new clinical practice guidelines for the prevention, detection, and treatment of high BP.
The purpose of this study was to assess HTN knowledge, awareness, and attitudes in a hypertensive population, especially related to SBP in a hypertensive population. We conducted a descriptive study to evaluate HTN knowledge, awareness, and attitudes in a hypertensive population. Medical record review was performed to collect actual BP values. The Henry Ford Medical Group, a system-affiliated, multispecialty, salaried physician group, provides most of the care for the Henry Ford Health System.
To ensure a high level of participation, we identified one geographic region within the system where physicians and their patients were willing to participate based on prior research studies. The Henry Ford Health System contains automated medical databases for all inpatient and outpatient encounters.
Information on outpatient encounters includes date of visit, diagnoses, physician delivering care, procedures delivered, clinic in which the care was delivered, and charges compiled. The electronic medical record includes information on inpatient interim and final diagnoses, discharge summaries, inpatient pharmacy, lab data, appointments, outpatient visit diagnoses, physiologic measures including BP values , and clinic office notes.
The system is updated continuously. To identify patients who were active members utilizing the HMO, we included only patients that had been assigned a primary care provider at the Henry Ford Health System. Patient telephone interviews were conducted to obtain information on patient demographics, medical history, risk factor status, HTN knowledge, awareness, attitudes, perceptions, and BP levels.
Additional questions focused on SBP knowledge and awareness. The questionnaire was pilot tested and standardized using trained interviewers at the Henry Ford Health System. Patients identified as having HTN were mailed an introductory letter inviting them to participate in the study and stating that they would be contacted by phone to give consent and participate in a telephone interview. Information was obtained from the computerized databases for each patient on HTN diagnosis, duration of HTN, number of total physician visits, and HTN-related visits during the past year.
Electronic medical record review was conducted by trained chart abstractors to collect detailed information on BP during the 12 months prior to the date of the patient interview, current HTN medications, family history of cardiovascular disease, and newly diagnosed HTN.
We calculated descriptive statistics to characterize the distribution of the study results. We identified 2, patients with an ICD-9 diagnosis code of HTN during the past 6 months who had at least one visit during the previous year. None of the patients identified by our algorithm had an ICD-9 code Patient telephone interviews were attempted on 1, randomly selected patients; 55 patients were excluded during the interview process because they did not speak English, were too sick to complete the interview, or were deceased.
In addition, 44 patients could not be contacted because the phone had been disconnected or had blocked their incoming calls. Characteristics of the patients who completed the interview are presented in Table 1. The median age of patients was 66 years, with a range of 20—97 years.
Ninety-one percent of the patients interviewed were currently taking HTN medication. The median duration of high BP reported by the patients was 14 years. Patient knowledge of HTN is presented in Table 2. Most of this sample of hypertensive patients were knowledgeable about the meaning of HTN and the seriousness of the condition to their health. When asked more specific questions about BP, patients were less knowledgeable.
Patients were asked about risk factors for developing high BP and the health consequences of uncontrolled BP. We included factors that were not established risk factors for high BP or health consequences of uncontrolled HTN to minimize reporting bias. Elevated BP was also reported to be associated with conditions such as kidney disease.
We asked patients about awareness of their HTN based on their communication with their doctor or health care provider Table 3. Sixty-five percent recalled being told their optimal personal BP reading. We also asked whether the patient had been told that the top number systolic level or bottom number diastolic level is important to keep under control. Only about half of the patients reported that the doctor or health care provider had specifically told them that either the top or bottom number is important to keep under control.
The results of questions relating to patient attitudes and perceptions are included in Table 4. We were interested in patients' perception of BP levels as compared to actual BP as recorded in the medical record.
We explored the relationship between patient self-report of BP levels and actual values recorded in the medical record at the most recent visit Table 5. Forty-one percent patients did not know their BP value. Patients were also asked whether they believed their BP level was high, borderline high, normal, or low. We performed further analyses in which these outcomes were stratified by demographic characteristics age, ethnicity, gender, education, and income.
In general, there were no material differences in knowledge, perceptions, or attitudes among the subgroups. Patients with at least a completed high school education tended to report better understanding of HTN than patients without a high school education.
Specifically, patients with a high school education were significantly more likely to correctly understand the components of and normal values for blood pressure e. In addition, high school—educated patients were significantly more likely to report that they had received information from a doctor regarding ideal BP values e. However, we found the small sample size made the interpretation of the subgroup analyses problematic. A key to understanding patients' attitudes toward high BP is identifying the sources for HTN information.
Seventy-four percent reported that a physician or other health care provider was a source for information about high BP. Fifty-nine percent of patients reported that mass media television, newspapers, magazines, and radio was a source for information. We conducted this descriptive survey to understand the current status of HTN knowledge, awareness, and attitudes in a group of hypertensive patients.
Our results suggest that patients are knowledgeable about HTN in general, but are less knowledgeable about specific factors related to their condition, and specifically their own level of BP control. The median duration of HTN was 14 years, suggesting that even though these patients have had this condition for a long duration their knowledge is inadequate. Patients were knowledgeable about the meaning of HTN, and the seriousness of the condition to their health.
Improved recognition of the importance of SBP has been identified in recent years as one of the major public health and medical challenges in the prevention and treatment of HTN because of the potential impact on the morbidity and mortality associated with cardiovascular disease and stroke.
This is the first study that provides information on the current state of patient knowledge and awareness with respect to SBP.
Sixty-five percent of patients were told their optimal BP reading while only about half reported that they were specifically told that the top and bottom numbers are important to keep under control. These findings suggest the need for education of patients, physicians, and other health care providers related to the importance of elevated SBP and cardiovascular risk. To understand patients' perception with respect to BP levels, we compared self-reported BP to actual BP as recorded in the medical record.
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