| In China, there are 200 million hypertensive patients, with the trend of increasing 10 million patients per year. Hypertension is the main risk factor in cardio-cerebrovascular disease, which has been the leading death cause in China. As more than half of the occurrence and death of patients with cardio-cerebrovascular disease are related with hypertension, controlling hypertension is the key point to prevent and treat the cardio-cerebrovascular disease. Hypertension has characteristics of high incidence rate and low control rate, which has become a worldwide problem. The poor therapeutic adherence to antihypertensive treatment is the main factor leading to the low blood pressure (BP) control rate which is affected by the attitude and beliefs in controlling hypertension. To efficiently evaluate patients'antihypertensive treatment related attitude and beliefs helps to perform the specific individual intervention and increase their therapeutic adherence.Antihypertensive treatment is consisted of medication treatment and non-medication treatment. In the previous study, the universal scales were used to evaluate the therapeutic adherence for hypertensive patients, which were not specific and almost not involving of the evaluation of lifestyle modification. At present, there is no generally-accepted therapeutic adherence scale for hypertensive patients at home and abroad, and no suitable scale for evaluation of attitude and briefs related to antihypertensive treatment. Because of being lack of good measurement tool, the reliability coefficient of research result and comparability of conclusion is limited, which affects the application of the research result and the treatment and management of hypertension.In our research, aiming at the drawback in the measurement tools in measuring therapeutic adherence and antihypertensive cognition, we initially established a therapeutic adherence scale and an antihypertensive therapy related attitudes and beliefs scale for hypertensive patients. We also analyzed the related factors affecting the adherence and attitude and beliefs, so as to determine the specific tailored intervention. In addition, we established the norm of the scales and primarily discussed its rational cutoff score, which provided effective measurement tools and reference criteria for evaluating hypertensive patients so as to further specify the management of hypertension and improve the BP control rate.Part 1 A series study on the therapeutic adherence scale for hypertensive patients1 Development of a new therapeutic adherence scale for hypertensive patients (TASHP) and evaluation of its reliability and validityObjectiveTo construct a new therapeutic adherence scale for hypertensive patients and evaluate its reliability and validity.MethodsFirst stage: the original item pool was formulated through literature review and in-depth interview. Following the two-turn selection and evaluation by 9 cardio-cerebrovascular professors and 2 psychological experts, then being modified after investigating 30 patients, we developed therapeutic adherence pre-scale for hypertensive patients (TASHP) (including 28 items). Second stage: we used TASHP pre-scale to perform cross-sectional study in 404 hypertensive patients, 105 of whom were finished the Morisky Medication Adherence Scale (MMAS). Meanwhile, item analysis, correlation analysis, exploratory factor analysis, criterion-related validity, internal consistency Cronbachαcoefficient and test-retest reliability were used to evaluate the reliability and validity of the scale, resulting in deleting 3 items and preserving 25 items. Third stage: based on the scale structure formed during the second stage, confirmatory factor analysis were performed in 594 hypertensive patients, so as to further revise and consummate the scale, and form the standard therapeutic adherence scale.ResultsTASHP included 25 items, which was consisted of the following dimensions: behavior of medication adherence (5 items), behavior of medication non-adherence (8 items), behavior of daily life management (10 items), behavior of smoking and drinking management (2 items). The loading value of each item in the common factor was 0.486~0.890. The coefficient correlation between each factor and total score was 0.421~0.736 ( P < 0.01 ) ; the coefficient correlation between each dimension was 0.123~0.356(P<0.01); the total Cronbachαcoefficient of the scale was 0.862 and the Cronbachαcoefficient of each dimension was 0.827~0.894. The test-retest reliability coefficient of the total scale was 0.958 and the test-retest reliability coefficient of each dimension was 0.791~0.939.Likert 5–grade scoring was applied, 1~5 scores were given from the"no time or few time"to"full time", inverse question was scored reversely, and the total score was 25~125. Patients'adherence to antihypertensive therapy during the recent month was evaluated, with higher score indicating better adherence.ConclusionThe TASHP scale showed good reliability and validity, which can be used as an efficient adherence measurement tool for hypertensive patients.2 Behaviors characteristics of therapeutic adherence in hypertensive patients and its influencing factorsObjectiveTo investigate the therapeutic adherence level in hypertensive patients and its influencing factors, so as to provide reference for determining focal objects of intervention and instituting specific individual intervention measures in Chongqing. Methods Totally 1120 hypertensive patients were performed cross-sectional study with the way of stratified random sampling, and investigated with TASHP scale and basic status questionnaire. Sociodemographic factors such as gender, age, etc. and disease related factors including hypertension course, hypertension-related complications were analyzed for investigating its effect on the therapeutic adherence in hypertensive patients.ResultsBy single factor analysis, significant difference in the therapeutic adherence of hypertensive patients was observed in the following aspects, including 14 factors: gender(female >male), age(elder>younger), education level(higher educated people> lower educated people), work status(retired people> unemployed people>urban worker>farmers), family income (higher-income people > lower-income people), course of administration antihypertensive medications(longer course > shorter course) , payment of medical cost(public expenses > urban medical insurance > private expense > new-style rural cooperative medical insurance), hypertension-related complications(people with hypertension-related complications> people without hypertension-related complications ), concomitant symptom of hypertension( people without complications > people with complications), home blood pressure monitoring (higher-frequent HBPM people > lower-frequent HBPM people), BP controlling status (normal BP people > abnormal BP people), self-evaluated effect of antihypertensive treatment (better effect > poor effect), self-evaluated health status (healthy > unhealthy)and residential status (urban people > countryside people ).The standard regression equation was as follows: therapeutic adherence to hypertension=0.140×(HBPM) -0.160×(BP controlling status) -0.184×(gender)+0.062×(residential status) +0.068×(self-evaluated the effect antihypertensive treatment) +0.090×(course of administration antihypertensive medications) +0.092×(self-evaluated health status) +0.070×(hypertension-related complications) +0.071×(family income).ConclusionThe therapeutic adherence in hypertensive patients was mainly affected by HBPM, BP controlling status, gender, residential status, self-evaluated effect of antihypertensive treatment , course of administration antihypertensive medications, self-evaluated health status , hypertension complications, concomitant symptom of hypertension, and family income, etc. With this result, emphasized intervention objects can be selected for the management of hypertension3 Establishment of the norm of the TASHP scale in ChongqingObjectiveTo establish the norm of the TASHP scale in Chongqing and make a grade range so as to provide useful information for evaluation the level of adherence in hypertensive patients. MethodsThe statistical analysis results showed that there was significant difference in the total score of therapeutic adherence scale and score of each dimension in the aspects of gender, age, education level, work status, course of administration antihypertensive medications, residential status. Therefore, in our research, integrated norm, gender norm, age norm, education norm, work status norm, course of administration antihypertensive medications norm, residential status norm were established. The norm was showed in conversion table with raw score, standard Z score, and T score.Based on the relationship with BP control, we primarily discussed the cutpoint score of the TASHP scale by ROC (receiver operator characteristic curve) analysis method. The maximal Youden's index was used to choose cutoff score, which had better sensitivity and specificity.ResultsThe raw score norm, standard Z score norm, and T score norm were respectively established in the total score of the TASHP scale and score of each dimension. The norms were involving of integrated norm, gender norm, age norm, education norm, work status norm, course of administration antihypertensive medications norm, residential status norm.The T 51 score point in norm was chosen as cutoff score, and the antihypertension therapeutic adherence was divided into high score group and low score group, with the sensitivity and specificity of 61.9% and 58.7%, respectively.ConclusionThe norm of TASHP scale has been established in Chongqing, and the level of adherence grading standard was made, so that the TASHP scale can provide useful information for evaluation patients'adherence in clinical settings.Part 2 A series study on the antihypertensive therapy related attitudes and beliefs scale1 Development of antihypertensive therapy related attitudes and beliefs scale and evaluation of its reliability and validityObjectiveTo develop an antihypertensive therapy related attitudes and beliefs scale (ATRABS) and evaluate its reliability and validity, so as to identify the incorrect cognition about antihypertensive therapy and provide reference for tailored behavioral/educational intervention for BP control.MethodsThe same as the Part 1.1ResultsATRABS was consisted of 21 items and 4 dimensions: attitude and beliefs of antihypertensive pharmacotherapy (7 items), attitude and beliefs of modification lifestyle (7 items), anxiety of persistent antihypertensive treatment (3 items), attitude and beliefs of persistent antihypertensive treatment (4 items). The loading value of each item in each factor was 0.468~0.846. The coefficient correlation of each dimension was 0.160~0.302 (P< 0.01), the coefficient correlation between each dimension and total score was 0.513~0.802 (P<0.01). The total Cronbachαcoefficient of the scale was 0.804, the total Cronbachαcoefficient of 4 dimensions was 0.639~0. 841. The test-retest reliability coefficient of the total scale was 0.922 and each dimension was 0.859~0.936.Likert 5-grade score method was applied in ATRABS, with 5 grades of"completely agree","agree","unsure","not agree"and"completely disagree", respectively, which was given 1~5 scores respectively. The reversed question was scored reversely (5~1 scores), with total score of being 21~105. And higher score indicated more positive attitude and beliefs in antihypertensive treatment.ConclusionThe new-formed ATRABS scale was tested with reliability and validity and analyzed with confirmatory factor, indicating adequate reliability and validity, which could be used as measurement tool of evaluation and intervention of hypertensive patients.2 Characteristics of antihypertensive therapy related attitudes and beliefs and its influencing factorsObjectiveTo investigate the attitude and beliefs about antihypertensive treatment in hypertensive patients and analyze the influencing factors, so as to provide reference for carrying out health education and make specific intervention.MethodsThe same as the Part 1.2ResultsBy single factor analysis, significant difference in the therapeutic adherence of hypertensive patients was observed in the following aspects, including 14 factors: age(elder>younger), marriage status (married > unmarried >widowed), education level(higher educated people> lower educated people), work status(urban worker >retired people > unemployed people>farmers), family income (higher-income people > lower-income people), payment of medical cost(public expenses > urban medical insurance > private expense > new-style rural cooperative medical insurance ), BP controlling status ( normal BP people > abnormal BP people ), concomitant symptom of hypertension( people without complications > people with complications), home blood pressure monitoring (higher-frequent HBPM people > lower-frequent HBPM people), course of administration antihypertensive medications(longer course > shorter course) , hypertension-related complications(people with hypertension-related complications > people without hypertension-related complications ), self-evaluated effect of antihypertensive treatment (better effect > poor effect), self-evaluated health status (healthy > unhealthy )and residential status( urban people > countryside people ).Multiple stepwise regression analysis showed the factors influencing antihypertensive therapy related attitudes and beliefs from high to low , which was HBPM, residential status, self-evaluated health status, self-evaluated effect of antihypertensive treatment, family income, BP control status, course of administration antihypertensive medications. The standard regression equation was as follows: antihypertensive therapy related attitude and beliefs=0.180×(HBPM) +0.097×(residential status) +0.115×(self-evaluated health status)+0.080×(self-evaluated effect of antihypertensive treatment) +0.101×(family income) -0.085×(BP control status), +0.080×(course of administration antihypertensive medications).ConclusionThe antihypertensive therapy related attitudes and beliefs were mainly affected by factors of HBPM, residential status, self-evaluated health status, self-evaluated effect of antihypertensive treatment, family income, BP control status, course of administration antihypertensive medications. While formulating individual intervention measures for hypertensive patients involving countryside residents, poor income family, short course of administration antihypertensive medications, poor self-evaluated health status, poor self-evaluated effect of antihypertensive treatment, seldom-used HBPM should paid more attention for intervention.3 Establishment of the norm of ATRABS scale for hypertensive patients in ChongqingObjectiveTo establish the norm of ATRABS scale for hypertensive patients in Chongqing and make a grade range, so as to provide reference standard for estimating patients'attitude and beliefs in antihypertensive treatment.MethodsThe statistical analysis results showed that there was remarkable difference in the total score of ATRABS scale and score of each dimension in the aspects of age, education level, work status, course of administration antihypertensive medications, residential status. Therefore, in this research, integrated norm, age norm, education norm, work status norm, course of administration antihypertensive medications norm, residential status norm were established. The norm was showed in conversion table with raw score, standard Z score, and T score.The cutoff score was selected with the same method in the part.1.3ResultsThe original score norm, standard Z score, and T score norm were respectively established in the total score of ATRABS scale and score of each dimension. The norms were involving of integrated norm, age norm, education norm, work status norm, course of administration antihypertensive medications norm, residential status norm.The T 49 score point in norm was chosen as the cutoff score, and the antihypertensive therapy related attitudes and beliefs was divided into high score group and low score group, with the sensitivity and specificity of 66.1% and 49.2 %, respectively.ConclusionThe norm of ATRABS scale has been established in Chongqing and grading criteria has been made, providing reference for evaluating hypertensive patients'attitude and beliefs in clinical settings.
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