Translation, adaptation, and validation of a Chinese version of the Hypertension Self-Care Activity Level effects (H-SCALE) for patients with hypertension

Ting-Yu Chen; Chi-Wen Kao; Shu-Meng Cheng; Chieh-Yu Liu

doi:10.1186/s12912-024-01993-y

Translation, adaptation, and validation of a Chinese version of the Hypertension Self-Care Activity Level effects (H-SCALE) for patients with hypertension

BMC Nurs. 2024 May 17;23(1):334. doi: 10.1186/s12912-024-01993-y.

Authors

Ting-Yu Chen¹, Chi-Wen Kao², Shu-Meng Cheng³, Chieh-Yu Liu⁴

Affiliations

¹ Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
² School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd Neihu Dist, Taipei, 11490, Taiwan. chiwenkao@mail.ndmctsgh.edu.tw.
³ Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.

Abstract

Background: Lifestyle modification is an essential component of prevention and management of hypertension. Existing instruments in Taiwan focus on assessing lifestyle modifications by evaluating medication adherence or confidence in controlling blood pressure. However, other self-care activities, such as diet, physical activity, weight management, smoking, and alcohol consumption are also important. The Hypertension Self-Care Activity Level Effects (H-SCALE) is one such instrument, but there are no similar tools available in Taiwan.

Aim: This study aimed to translate the H-SCALE into Chinese and test its validity, and reliability in a sample of adults with hypertension.

Methods: The English version of the 31-item H-SCALE was translated into Chinese using the forward-backward method. The content validity index (CVI) of the translated scale was determined by five experts in hypertension. Item analysis was conducted with a pilot sample of 20 patients with hypertension. Cronbach's α was used to establish the internal consistency reliability for the Chinese version of the H-SCALE (H-SCALE-C). Exploratory factor analysis (EFA) explored the structure of the H-SCALE-C. Additionally, construct validity was examined with confirmatory factor analysis (CFA). Patients with hypertension were recruited by convenience sampling from a cardiovascular outpatient clinic of a medical center in northern Taiwan. A total of 318 patients met the inclusion criteria and participated in factor analysis in the study.

Results: Pilot testing of the scale items indicated most patients could not accurately estimate the number of days of alcohol consumption for the previous week. Therefore, three alcohol-related items were removed. The adaptation resulted in a 28-item H-SCALE-C. EFA revealed a 4-factor solution with 13 items that explained 63.93% of the total variance. CFA indicated a good fit for a 4-factor model and construct validity was acceptable. Internal consistency reliability was acceptable (Cronbach's alpha for the four subscales ranged from 0.65 to 0.94). Convergent validity was acceptable, and discriminant validity was significant.

Conclusions: The H-SCALE-C is a valid, reliable tool for promptly assessing life-style activities for patients with hypertension in Taiwan. The instrument is suitable for assisting healthcare providers in evaluating self-care activities, which could be used to facilitate lifestyle modifications for patients with hypertension.

Keywords: H-SCALE; Hypertension; Lifestyle; Translation; Validation.