Abstract
Background: Home blood pressure monitoring (HBPM) has been proved to be beneficial to blood pressure control for both patients with hypertension and patients with chronic kidney disease (CKD). However, what are the psychodynamic predictors like perception for the establishment and persistence of HBPM have not been deeply explored, and there is a lack of instruments for assessing psychodynamic characteristics on HBPM from patients’ perspectives, which has limited the in-depth understanding of HBPM behavior. The study aimed to develop an instrument for evaluating HBPM perception in patients with CKD, and to test the reliability and validity of the instrument. Methods: The original item pool of the HBPM perception scale was developed according to the framework of the health promotion model and literature review. The psychometric characteristics of the instrument were examined with a sample of 436 CKD patients in China. Internal consistency reliability, split-half reliability, test-retest reliability and construct reliability were used to verify the reliability of the scale. And content validity, construct validity and criterion-related validity were used to test the validity of the scale.Results: The expert consultation showed satisfactory content validity of the HBPM perception scale and produced a first draft of the survey with 43 items. By exploratory factor analysis and confirmatory factor analysis (CFA), we found evidence for the construct validity of the following factors: perceived benefits of HBPM, perceived barriers of HBPM, perceived self-efficacy of HBPM, situational influences and commitment to a plan of HBPM, and immediate competing demands and preferences. The finalized five-component HBPM perception scale has 27 items. CFA suggested the model fit the data well (ꭓ2=679.649, df=310, ꭓ2/df=2.192, root mean square error of approximation =0.074, confirmatory fit index=0.902). The HBPM perception scale was positively associated with the Self-Efficacy for Managing Chronic Disease 6-item Scale ( r= 0.256, p＜0.001). The Cronbach’s α coefficient of all dimensions was above 0.750, the split-half reliability was above 0.624, and the test-retest reliability was above 0.749. The construct reliability of dimensions ranged from 0.749 to 0.951. Conclusion Given reasonable psychometric properties, the HBPM perception scale is a valid and reliable instrument that can be used to assess the perception of HBPM.
Practical Use of Home Blood Pressure Monitoring in Chronic Kidney Disease