Development and Psychometric Validation of the Hypertension Beliefs Assessment Tool Among Adult Population in Northwest Ethiopia

Abstract

Background

In Ethiopia, the majority of hypertension cases remain undiagnosed, untreated, and uncontrolled. Beliefs about hypertension and its complications play an important role in hypertension management behaviors. Accurate assessment of individuals’ beliefs towards the disease is of paramount importance in the design of hypertension education. This study aimed to develop and validate a hypertension belief assessment tool based on the Health Belief Model for the general population among rural adults in northwest Ethiopia.

Methods

The study included item construction, face and content validation, factor analysis, and establishment of reliability and validity of the tool. A total of 308 rural adults participated in the study. Inter-item and item-to-total correlations were used to examine the items assessed with the same content on a scale. Principal component analysis with promax rotation was used to extract the factors. Internal consistency reliability was assessed using Cronbach’s alpha coefficient. Convergent and discriminant validity were assessed using average variance extraction and maximum shared variance.

Results

The median age of the participants was 41 (IQR: 31–55) years. Of the participants, 175 (56.8%) were female and 287 (93.2%) were farmers. Kaiser-Meyer-Olkin test value of 0.84 and significant Bartlett’s test of sphericity (p=0.000) revealed that the data were suitable for exploratory factor analysis. The principal component analysis identified 6 factors, which explained 70.06% of the variation of the hypertension belief. Cronbach’s alpha was 0.85 for the entire scale, ranging from 0.74 to 0.92 for the sub-domains. The average variance extracted was above 0.5 for all factors, indicating convergent validity. The maximum shared variance between the two constructs was lower than the average variance extracted from each factor, indicating that discriminating validity had been established.

Conclusion

The hypertension belief assessment tool was found to be valid and reliable, which can be used to measure the health beliefs on hypertension for the rural adult population.

Keywords:

• hypertension
• belief
• validation
• exploratory factor analysis

Abbreviations

AVE, Average Variance Extracted; CHBMS, Champion’s Health Belief Model Scale; HBAT, Hypertension Belief Assessment Tool; HBM, Health Belief Model; HBS Health Belief Scale; KMO, Kaiser– Meyer – Olkin Test; TVE, Total Variance Extracted.

Acknowledgments

We would like to acknowledge the University of Gondar for the approval and facilitation of the dissertation proposal. We would like to thank Amhara Public Health Institute, Zonal, and District health administrations for their willingness to conduct the study. We would also like to thank Professor Solomon Mekonnen Abebe, Mr. Abebaw Addis Gelagay, Mr. Temesgen Yihunie Akalu, Mr. Haileab Fekadu Wolde, Mr. Getayeneh Antehunegn Tesema, and Mr. Habtamu Sewunet Mekonnen for their contribution in making face validity of the tool.

Author Contributions

All authors contributed significantly to the work reported, that is in the conception, study design, data collection, data analysis, and drafting or revising the article. The authors have agreed on the journal to which the article was submitted, gave final approval for the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

The authors declared that they have no conflicts of interest in this work.

Additional information

Funding

This validation study is part of Ph.D. training for DFT. This work was supported financially by the University of Gondar. However, the university had no role in study design, data collections, and analysis, decision to publish, or preparation of the manuscript.