Measuring self-care in patients with hypertension: a systematic review of literature.
BACKGROUND
High blood pressure (HBP) self-care is critical for the control of HBP. Adequate measurement of HBP self-care is a necessary first step toward ameliorating the global pandemic of HBP.


OBJECTIVE
The aims of this study were to identify, describe, and critique existing HBP self-care instruments. The degree of adequacy of these instruments was evaluated against well-established behavioral guidelines for HBP care.


METHODS
This review was limited to articles published in English before October 2012. In addition, the following criteria were used: (1) the study described the validity and/or the reliability of a self-care/self-management instrument and (2) the study targeted patients with hypertension. Electronic database searches identified 1701 potentially relevant articles. Two authors reviewed the titles and the abstracts of all the retrieved articles independently. On the basis of the inclusion and the exclusion criteria, as well as cross-referencing, 29 articles were included in this review.


RESULTS
From the 29 articles, 19 unique HBP self-care instruments were identified (some were modified or translated versions of an original measure). Medication taking, a key domain of HBP self-care, was the main focus of 12 of the 19 instruments. Other key domains of HBP self-care were often missing or omitted. Seven instruments measured multiple dimensions of self-care; however, these either failed to capture all the main HBP self-care domains or had poor psychometric profiles. Nineteen of the 29 articles reported both validity and reliability, with varying degrees of rigor.


CONCLUSIONS
The current assessment tools do not capture all the critical elements of HBP self-care. The few instruments that attempted to measure the multiple behavioral dimensions of HBP self-care failed to report adequate levels of psychometric properties of those domains because of their incompleteness. Challenges remain in translating the HBP self-care guidelines into effective intervention and relevant assessment tools. Developing a valid and reliable instrument that captures the multidimensional nature of HBP self-care is urgently needed.
Hae-Ra Han, PhD, RN, FAAN Associate Professor, School of Nursing, Department of Community and Public Health, the Johns Hopkins University, Baltimore, Maryland. Hee-Jung Song, PhD Assistant Professor, College of Agriculture and Natural Resources, Department of Nutrition and Food Science, University of Maryland, College Park. Tam Nguyen, PhD, RN, MPH Research Associate, School of Nursing, Department of Community and Public Health, the Johns Hopkins University, Baltimore, Maryland. Miyong T. Kim, PhD, RN, FAAN Professor, School of Nursing, Department of Community and Public Health, the Johns Hopkins University, Baltimore, Maryland.
Hae-Ra
HR
Han
Hee-Jung
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Song
Tam
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Nguyen
Miyong T
MT
Kim
D006801:Humans; D006973:Hypertension / Q000628:therapy*; D055118:Medication Adherence; D011594:Psychometrics; D012648:Self Care