Development and Validation of HBP Self-Care Protocol

We used multiple methods to create a comprehensive pool of potential items for the HBP SCP. First, we searched the literature for current practice guidelines on HBP self-care.¹⁰ We also collected relevant items from educational materials such as pamphlets, brochures, and websites published by the Centers for Disease Prevention and Control, the American Heart Association, the National Heart, Lung, and Blood Institute, and from existing validated HBP self-care instruments such as the Hill-Bone Adherence Scale^{20 (link)} and Morisky Medication Scale.^{21 (link)} The items for the HBP SCP encompassed self-care behaviors in the following areas which are crucial to control BP: medication taking and lifestyle factors such as physical activity, low-sodium and low-fat diet, restricting alcohol consumption, non-smoking, self-monitoring of BP, weight control, regular doctor visits, and stress reduction.^{5 (link),10 –15 (link)} Subsequently, an expert panel (N = 12) of clinicians, researchers, and community health workers with extensive experience in HBP care rated each item for its relevance using a 4-point scale, with 1 being “not relevant” and 4 being “very relevant.”^{22 (link)} A content validity index was calculated by the proportion of experts who gave an item a rating of 3 or 4. Items with at least 80% of endorsement rates were retained,^{22 (link)} yielding 20 HBP self-care behavior items.