Document Type : Original Article

Authors

1 Food Security Research Center

2 Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan,

3 Public Health Department, School of Health, Qom University of Medical Sciences, Qom, Iran

Abstract

Introduction: Measurement tools designed to ensure the achievements of studies’ objectives
must be evaluated. Based on the health promotion model (HPM), the present study was
conducted to assess the validity and reliability of the designed questionnaire of hypertensive
patients’ nutritional perceptions. Methodology: In a cross‑sectional study, the mentioned
questionnaire was assessed based on opinions of 11 experienced faculty members and
671 hypertensive patients in rural areas in the year 2013. To evaluate the reliability, internal
consistency (Cronbach’s alpha) was calculated. Concerning the validity of the questionnaire,
its content and construct validity were examined. Data analysis was performed using
Statistical Package for the Social Sciences version 18 (SPSS Inc., Chicago, IL, USA).
Results: Spearman‑Brown and Cronbach’s alpha coefficients results were acceptable in all
constructs indicating a satisfactory reliability of the questionnaire. Questionnaire’s questions
were highly correlated with the total score signifying the internal consistency of the questions;
therefore, all questions had a similar effect on the total score and the removal of each did no
increase the alpha significantly (all questions had acceptable reliability). Factor analyses showed
that all questions had acceptable factor loading and suitable validity. Moreover, the entire
constructs of the questionnaire were approved by experts with high validity coefficient of 0.9.
Conclusion: The designed questionnaire for assessment of the HPM constructs regarding
hypertensive patients’ nutritional issues had appropriate psychometric characteristics. Reliability
and validity of the questionnaire were also satisfactory and its overall structure was approved.

Keywords

1. Hammami S, Mehri S, Hajem S, Koubaa N, Frih MA, Kammoun S,
et al. Awareness, treatment and control of hypertension among
the elderly living in their home in Tunisia. BMC Cardiovasc Disord
2011;11:65.
2. Braunwald E. Heart Disease, A Textbook of Cardiovascular Medicine.
5th ed. Philadelphia: Saunders; 1997.
3. Wilson PW. Established risk factors and coronary artery disease:
The Framingham Study. Am J Hypertens 1994;7:7S‑12.
4. Noohi F, Maleki M, Orei S. Hypertension. In: Azizi F, Hatami H,
Janghorbani M, editors. Epidemiology and Control of Common
Disorders in Iran. 2nd ed. Tehran: Eshtiagh Press; 2001. p. 23‑30.
5. Haghdoost AA, Sadeghirad B, Rezazadehkermani M. Epidemiology
and heterogeneity of hypertension in Iran: A systematic review.
Arch Iran Med 2008;11:444‑52.
6. Pickering TG. Why are we doing so badly with the control of
hypertension? Poor compliance is only part of the story. J Clin
Hypertens (Greenwich) 2001;3:179‑82.
7. Burkhart PV, Sabaté E. Adherence to Long‑Term Therapies:
evidence for Action. J Nurs Scholarsh 2003;35:207.
8. Kressin NR, Wang F, Long J, Bokhour BG, Orner MB, Rothendler J,
et al. Hypertensive patients’ race, health beliefs, process of care,
and medication adherence. J Gen Intern Med 2007;22:768‑74.
9. MellenPB, GaoSK, VitolinsMZ, Goff DC Jr. Deteriorating dietary habits
among adults with hypertension: DASH dietary accordance, NHANES
1988‑1994 and 1999‑2004. Arch Intern Med 2008;168:308‑14.
10. Ndumele CD, Shaykevich S, Williams D, Hicks LS. Disparities in
adherence to hypertensive care in urban ambulatory settings.
J Health Care Poor Underserved 2010;21:132‑43.
11. Siegel D. Barriers to and strategies for effective blood pressure
control. Vasc Health Risk Manag 2005;1:9‑14.
12. Saleem F, Hassali M, Shafie A, Atif M. Drug attitude and adherence:
A qualitative insight of patients with hypertension. J Young Pharm
2012;4:101‑7.
13. DiMatteo MR. Variations in patients’ adherence to medical
recommendations: A quantitative review of 50 years of research.
Med Care 2004;42:200‑9.
14. Krousel‑Wood M, Hyre A, Muntner P, Morisky D. Methods to improve
medication adherence in patients with hypertension: Current status
and future directions. Curr Opin Cardiol 2005;20:296‑300.
15. Egan BM, Basile JN. Controlling blood pressure in 50% of all
hypertensive patients: An achievable goal in the healthy people
2010 report? J Investig Med 2003;51:373‑85.
16. Nelson CR, Knapp DA. Trends in antihypertensive drug therapy of
ambulatory patients by US office‑based physicians. Hypertension
2000;36:600‑3.
17. Hsiao CY, Chang C, Chen CD. An investigation on illness perception
and adherence among hypertensive patients. Kaohsiung J Med Sci
2012;28:442‑7.
18. Cornell S, Briggs A. Newer treatment strategies for the management
of type 2 diabetes mellitus. J Pharm Pract 2004;17:49‑54.
19. Chan YM, Molassiotis A. The relationship between diabetes
knowledge and compliance among Chinese with non‑insulin
dependent diabetes mellitus in Hong Kong. J Adv Nurs
1999;30:431‑8.
20. 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;9:1018‑29.
21. Sanne S, Muntner P, Kawasaki L, Hyre A, DeSalvo KB. Hypertension
knowledge among patients from an urban clinic. Ethn Dis
2008;18:42‑7.
22. Oliveria SA, Chen RS, McCarthy BD, Davis CC, Hill MN. Hypertension
knowledge, awareness, and attitudes in a hypertensive population.
J Gen Intern Med 2005;20:219‑25.
23. Sabouhi F, Babaee S, Naji H, Zade AH. Knowledge, awareness,
attitudes and practice about hypertension in hypertensive patients
referring to public health care centers in Khoor and Biabanak 2009.
Iran J Nurs Midwifery Res 2011;16:35‑41.
24. Li X, Ning N, Hao Y, Sun H, Gao L, Jiao M, et al. Health literacy in
rural areas of China: Hypertension knowledge survey. Int J Environ
Res Public Health 2013;10:1125‑38.
25. Viera AJ, Cohen LW, Mitchell CM, Sloane PD. High blood pressure
knowledge among primary care patients with known hypertension:
A North Carolina Family Medicine Research Network (NC‑FM‑RN)
study. J Am Board Fam Med 2008;21:300‑8.
26. Victor RG, Leonard D, Hess P, Bhat DG, Jones J, Vaeth PA, et al.
Factors associated with hypertension awareness, treatment, and
control in Dallas County, Texas. Arch Intern Med 2008;168:1285‑93.
27. Salimzadeh HH, Eftekhar H, Asasi N, Salarifar M, Dorosty AR. Dietetic
risk factors and ischemic heart disease. J Public Health Inst Public
Health Res 2004;2:1‑14.
28. Pawlak R, Colby S. Benefits, barriers, self‑efficacy and knowledge
regarding healthy foods; perception of African Americans living in
eastern North Carolina. Nutr Res Pract 2009;3:56‑63.
29. Kusuma YS. Perceptions on hypertension among migrants in Delhi,India: A qualitative study. BMC Public Health 2009;9:267.
30. Sheahan SL, Fields B. Sodium dietary restriction, knowledge, beliefs,
and decision‑making behavior of older females. J Am Acad Nurse
Pract 2008;20:217‑24.
31. Marriner T, Raile AM. Nursing Theorists and their Work. 5th ed. St.
Louis: Mosby; 2005.
32. Pender NJ, Murdaugh CL, Parsons MA. Health Promotion in Nursing
Practice. 6th ed. Boston, MA: Pearson; 2011.
33. Chamberlain B. Health promotion in nursing practice. Clin Nurse
Spec 2007;21:130.
34. Hajizadeh E, Asgari M. Research methods and statistical analysis by
looking at health and life sciences. 1st ed. Tehran: The Organization
of Jihad University Press; 2010.
35. Santos AR. Cronbach’s Alpha: A tool for assessing the reliability of
scales. J Ext 1999;37:35‑9.
36. Ebrahimi A, Neshatdoost HT, Kalantari M, Molavi H, Asadollahi GA.
Factor structure, reliability and validity of religious attitude scale.
J Fundam Ment Health 2008;10:107‑16.
37. Kazemnejad A, Heydari M, Norouzadeh R. Statistical Methods for
Healthcare Research and Application of SPSS in data Analysis.
1st ed. Tehran: Jameenegar Publication; 2010.
38. Ghasemi V. Structural Equation Modeling in Social Research Using
Amos/Graphic. 1st ed. Tehran: Azarakhsh; 2010.
39. Test MA, Greenberg JS, Long JD, Brekke JS, Burke SS.
Construct validity of a measure of subjective satisfaction with
life of adults with serious mental illness. Psychiatr Serv 2005;56:
292‑300.
40. Polit DF, Beck CT. The content validity index: Are you sure you
know what’s being reported? Critique and recommendations. Res
Nurs Health 2006;29:489‑97.
41. Mohammadizeidi I, Pakpour H, Zeidi BM. Reliability and validity
of persian version of the health‑promoting lifestyle profile.
J Mazandaran Univ Med Sci 2012;21:102‑13.