1.Validity and reliability of the Malay version of the Hill-Bone compliance to high blood pressure therapy scale for use in primary healthcare settings in Malaysia: A cross-sectional study
Cheong AT ; Tong SF ; Sazlina S
Malaysian Family Physician 2015;10(2):36-44
Introduction: Hill-Bone compliance to high blood pressure therapy scale (HBTS) is one of
the useful scales in primary care settings. It has been tested in America, Africa and Turkey with
variable validity and reliability. The aim of this paper was to determine the validity and reliability
of the Malay version of HBTS (HBTS-M) for the Malaysian population.
Materials and methods: HBTS comprises three subscales assessing compliance to medication,
appointment and salt intake. The content validity of HBTS to the local population was agreed
through consensus of expert panel. The 14 items used in the HBTS were adapted to reflect
the local situations. It was translated into Malay and then back-translated into English. The
translated version was piloted in 30 participants. This was followed by structural and predictive
validity, and internal consistency testing in 262 patients with hypertension, who were on antihypertensive
agent(s) for at least 1 year in two primary healthcare clinics in Kuala Lumpur,
Malaysia. Exploratory factor analyses and the correlation between HBTS-M total score and
blood pressure were performed. The Cronbach’s alpha was calculated accordingly.
Results: Factor analysis revealed a three-component structure represented by two components
on medication adherence and one on salt intake adherence. The Kaiser–Meyer–Olkin statistic
was 0.764. The variance explained by each factors were 23.6%, 10.4% and 9.8%, respectively.
However, the internal consistency for each component was suboptimal with Cronbach’s alpha of
0.64, 0.55 and 0.29, respectively. Although there were two components representing medication
adherence, the theoretical concepts underlying each concept cannot be differentiated. In
addition, there was no correlation between the HBTS-M total score and blood pressure.
Conclusion: HBTS-M did not conform to the structural and predictive validity of the original
scale. Its reliability on assessing medication and salt intake adherence would most probably to be
suboptimal in the Malaysian primary care setting.
2.Poor blood pressure control and its associated factors among older people with hypertension : A cross-sectional study in six public primary care clinics in Malaysia
Cheong AT ; Sazlina SG ; Tong SF ; Azah AS ; Salmiah S
Malaysian Family Physician 2015;10(1):19-25
Introduction: Hypertension is highly prevalent in the older people. Chronic disease care is a
major burden in the public primary care clinics in Malaysia. Good blood pressure (BP) control
is needed to reduce the morbidity and mortality of cardiovascular disease (CVD). This study
aimed to determine the status of BP control and its associated factors among older people with
hypertension in public primary care clinics.
Materials and methods: A cross-sectional study on hypertensive patients aged 18 years and
above was conducted in six public primary care clinics in Federal Territory, Malaysia. A total of
1107 patients were selected via systematic random sampling. Data from 441 (39.8%) patients
aged 60 years and more were used in this analysis. BP control was determined from the average
of two BP readings measured twice at an interval of 5 min. For patients without diabetes, poor
BP control was defined as BP of ≥140/90 mm Hg and ≥150/90 for the patients aged 80 years
and more. For patients with diabetes, poor control was defined as BP of ≥140/80 mm Hg.
Results: A total of 51.7% (𝑛 = 228) of older patients had poor BP control. The factors associated
with BP control were education level (p = 0.003), presence of comorbidities (p = 0.015), number
of antihypertensive agents (p = 0.001) and number of total medications used (p = 0.002).
Patients with lower education (less than secondary education) (OR = 1.7, p = 0.008) and the use
of three or more antihypertensive agents (OR = 2.0, p = 0.020) were associated with poor BP
control.
Conclusion: Among older people with hypertension, those having lower education level, or
using three or more antihypertensive agents would require more attention on their BP control.