Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

Santos, Rafaella Zulianello dos; Bonin, Christiani Decker Batista; Martins, Eliara Ten Caten; Pereira Junior, Moacir; Ghisi, Gabriela Lima de Melo; Macedo, Kassia Rosangela Paz de; Benetti, Magnus

doi:10.5935/abc.20170183

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Original Article, Cardiovascular Rehabilitation • Arq. Bras. Cardiol. 110 (1) • Jan 2018 • https://doi.org/10.5935/abc.20170183 copy

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients.

Objective:

To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease.

Methods:

A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis.

Results:

The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension.

Conclusion:

The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Keywords:
Hypertension / prevention & control; Rehabilitation; Health Education; Validation Studies as Topic

Variable	Category	n(%)	HIPER-Q score Median (IR)	p^† † chi-square;
Sex	Male	123(66.8)	25 (10)	0.033^* * p < 0.05.
Sex	Female	61(33.2)	27 (8.5)	0.033^* * p < 0.05.
Comorbidities	CAD	149(81)	25 (8.5)	0.033^* * p < 0.05.
	Dyslipidemias	149(81)	25 (8.5)	0.127
	Myocardial infarction	127(69)	24 (8)	0.003^* * p < 0.05.
	Diabetes Mellitus	52(28.3)	25 (10)	0.493
	POAD	24(13)	27 (10)	0.805
	Stroke	23(12.5)	26 (11)	0.928
	Smoking	03(1.6)	26 (0.0)	0.998
	COPD	02(1.1)	35 (0.)	0.539
Cardiologic procedures	Angioplasty	116(63)	24 (7.5)	0.019^* * p < 0.05.
Cardiologic procedures	Cardiac surgery	53(28.8)	23 (8)	0.275
Classes of antihypertensive drugs	ACEI	65(35.3)	28 (10.5)	0.768
	α and β adrenergic blockers	56(30.4)	28 (10.75)	0.186
	Angiotensin II receptor antagonists	52(28.3)	25 (9)	0.669
	Diuretics	21(11.4)	27 (14)	0.820
	Calcium channel blockers	05(2.7)	29 (17)	0.195
	Unknown	15(8.2)	22 (7.75)	0.755
Number of anti-hypertensive drugs	0	37(20.1)	22 (7)	0.993
	1	108(58.7)	26 (10)
	2	36(19.6)	28 (9.75)
	3	2(1.1)	23 (0.0)
Type of rehabilitation	Public	162(88)	25 (9)	0.274
Type of rehabilitation	Private	22(12)	32.5 (10.25)	0.274
Time of rehabilitation	From 01 to 06 months	105(47.3)	26 (9)	0.317
	From 06 to 12 months	10(4.5)	22 (14.25)
	From 12 to 24 months	17(7.7)	27 (10)
	Over 24 months	51(23)	27 (10)
Family income (salary)	< 01	09 (4.9)	22 (8.5)	0.023^* * p < 0.05.
	01 - 05	94(51.1)	25.5 (9)
	05 - 10	42(22.8)	26 (8)
	10 - 20	32(17.4)	31 (14.5)
	> 20	07(3.8)	35 (11)
Educational level	Never went to school	08(4.3)	20 (8.75)	0.002^* * p < 0.05.
	Some primary education	59(32.1)	25 (7)
	Completed primary	20(10.9)	27 (6.5)
	Some high school	16(8.7)	22.5 (4.75)
	Completed high school	35(19)	27 (11)
	Some college	13(7.1)	31 (14)
	Completed college	30(16.3)	31.5 (14.25)
	Graduate degree	3(1.6)	36 (0.0)

Sum of the scores	Percentage	Classification of knowledge
From 46 - 51 points	90 - 100%	Excellent
From 36 - 45 points	70 - 89%	Good
From 25 - 35 points	50 - 69%	Acceptable
From 15 - 24 points	30 - 49%	Poor
< 15 points	< 30%	Insufficient

Domain	Questions	HIPER-Q score in median (interquartile range)	ICC
Self-care	9.If a health professional finds that your blood pressure is altered, you should	3 (0)	0.72
	15. With respect to self-measurement of blood pressure, it is correct to say that	0 (1)	0.96
	17. With respect to systemic arterial hypertension patient's self-care, it is correct to say that:	1 (3)	0.79
Treatment	6. What is the ideal treatment to reduce blood pressure levels?	1 (2)	0.75
	14. Which of these drugs aim to reduce blood pressure levels?	3 (2)	0.80
Diagnosis	5. Which among the items listed below are the most accurate in the diagnosis of systemic arterial hypertension?	1 (1)	0.82
	16. About the "white coat syndrome", it is correct to say that	0 (3)	0.85
Physical exercise	4. Physical exercise for systemic arterial hypertension patients should:	1 (3)	0.81
	8. The practice of physical exercises is contraindicated when the patient:	1 (3)	0.76
	10. On the basis of your knowledge about systemic arterial hypertension, answer the following:	3 (0)	0.81
	11. What favorable changes are systemic arterial hypertension patients able to obtain with the regular practice of physical exercises?	1 (3)	0.82
Concept and pathophysiology	1. Systemic arterial hypertension is:	1 (3)	0.80
	13. What are the main consequences of untreated systemic arterial hypertension?	3 (2)	0.76
Signs and symptoms	3. With respect to systemic arterial hypertension symptoms, check the correct answer	1 (3)	0.81
Risk factors	2. Which of the risk factor groups below has the greatest influence on the development of systemic arterial hypertension?	3 (2)	0.81
	7. Which systolic arterial pressure and diastolic arterial pressure values, respectively, are recommended for systemic arterial hypertension patients?	1 (3)	0.75
	12. With respect to stress, we can say that:	1 (3)	0.78

Item	Domain	Factors
		1	2	3	4	5
17	Self-care	0.825
6	Treatment	0.792
5	Diagnosis	0.745
11	Physical exercise	0.664
1	Concept and pathophysiology	0.477
14	Treatment		0.646
13	Concept and pathophysiology		0.631
3	Signs and symptoms		0.525
16	Diagnostic			0.734
4	Physical exercise			0.63
8	Physical exercise				0.635
7	Risk factors				0.534
12	Risk factors				0.470
2	Risk factors				0.328
10	Physical exercise					0.684
9	Self-care					0.580
15	Self-care					0.426

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