Development and validation of a new measure to assess Hypertension Self-Care Activity Level Effects (H-SCALE)

African Americans experience a higher prevalence of hypertension than Whites. They are less likely than Whites to have their hypertension well-managed, potentially leading to substantial health disparities. Most adults take medication to manage their hypertension, however research suggests that medication alone is insufficient to control blood pressure. This study examined individuals' self-care behaviors related to managing hypertension. We developed the H-SCALE (Hypertension Self Care Activity Level Effects), a series of 6 subscales addressing self-care activities, based on the national evidence-based recommendations for hypertension management and DASH diet guidelines. The H-SCALE had an expert panel review, pilot test, and then a larger field test to assess how well African Americans were conforming to these self-management practices. One-hundred and eighty African Americans who had been diagnosed with hypertension for at least 6 months completed the H-SCALE (aged 21-85).

We examined internal consistency and performed confirmatory factor analyses to determine theoretical consistency for each subscale. All six sub-scales had acceptable Cronbach's alphas (.71 - .87). Items loaded onto hypothesized factors, establishing preliminary evidence of construct validity.

Participants were largely adherent to the recommended behaviors: 73% were non-smokers, two-thirds abstained from alcohol, over half engaged in 30 minutes of physical activity every day, and 57.9% took medication as prescribed. However they reported lower levels of adherence to low-salt dietary practices (21.1%) or to weight management activities (30.9%). We propose that the H-SCALE is a valid and reliable measure for assessing recommended hypertension self-management behaviors. Future research will establish criterion validity.