1 Department of Health Education and Health Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran,

2 Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran

3 Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,


BACKGROUND: This study was aimed at developing and studying the scale of self‑efficacy in
adherence to treatment in Iranian patients with hypertension.
METHODS: A mix‑method study was conducted on the two stages: in the first phase, a qualitative
study was done using content analysis through deep and semi‑structured interviews. After data
analysis, the draft of tool was prepared. Items in the draft were selected based on the extracted
concepts. In the second phase, validity and reliability of the instrument were implemented using a
quantitative study. The prepared instrument in the first phase was studied among 612 participants. To
test the construct validity and internal consistency, exploratory factor analysis and Cronbach’s alpha
were used, respectively. To study the validity of the final scale, the average score of self‑efficacy in
patients with controlled hypertension were compared with patients with uncontrolled hypertension.
RESULTS: In overall, 16 patients were interviewed. Twenty‑six items were developed to assess
different concepts of self‑efficacy. Concept‑related items were extracted from interviews to study
the face validity of the tool from patient’s point of view. Four items were deleted because scored
0.79 in content validity. The mean of questionnaire content validity was 0.85. Items were collected
in two factors with an eigenvalue >1. Four items were deleted with load factor <0.4. Reliability was
0.84 for the entire instrument.
CONCLUSION: Self‑efficacy scale in patients with hypertension is a valid and reliable instrument that
can effectively evaluate the self‑efficacy in medication adherence in the management of hypertension.


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