ABC | Volume 110, Nº1, January 2018

Original Article Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation Rafaella Zulianello dos Santos, 1 Christiani Decker Batista Bonin, 1 Eliara Ten Caten Martins, 1 Moacir Pereira Junior, 1 Gabriela Lima de Melo Ghisi, 3 Kassia Rosangela Paz de Macedo, 2 Magnus Benetti 1 Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), 1 Florianópolis, SC; Instituto de Cardiologia de Santa Catarina, 2 São José, SC – Brazil; Toronto Rehabilitation Institute - University Health Network, 3 Toronto – Canada Mailing Address: Rafaella Zulianello dos Santos • Av. Engenheiro Max de Souza, 890 apt. 303. Postal Code 88080-000, Coqueiros, Florianópolis, SC – Brazil E-mail: rafaella.zulianello@gmail.com Manuscript received January 31, 2017, revised manuscript July 19, 2017, accepted July 31, 2017 DOI: 10.5935/abc.20170183 Abstract Background: The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients. Objective: To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease. Methods: A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach’s alpha and the construct validity by the exploratory factorial analysis. Results: The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach’s correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension. Conclusion: The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs. (Arq Bras Cardiol. 2018; 110(1):60-67) Keywords: Hypertension / prevention & control; Rehabilitation; Health Education; Validation Studies as Topic. Introduction Cardiovascular diseases are the leading cause of mortality in the world, as a consequence of population aging and disease‑related epidemiological changes, 1 imposing high costs to health. 2 Among these conditions, systemic arterial hypertension (SAH) stands out as a multifactorial clinical condition associated to functional, structural andmetabolic changes, with consequent increase in the risk of fatal and nonfatal cardiovascular events. 3 SAH is a serious public health problem, affecting nearly one billion people. 4 In an important study, 5 SAH emerges as the main risk factor in the world, and is associated with 9.4 million global deaths a year. 5 In Brazil, the prevalence of SAH is estimated to be from 22 to 42% of adult population. 6 Cardiac rehabilitation (CR) is one of the recommended treatments for cardiovascular diseases, consisting of a multidisciplinary approach for secondary prevention, 7 that reduces the recurrence of cardiovascular events and mortality. 8 The benefits of CR are mostly due to habit changes and, in this regard, patient education has been considered one of the most important approaches. 9-12 In this context, an efficient SAH management depends on patient’s understanding about his condition and treatment. 13 Therefore, patients that participate in education programs are more able to successfully control over their own health care. Thus, hypertensive patient’s knowledge about his condition is part of the therapeutic success, who becomes co-responsible for the treatment. 9,14,15 Nevertheless, there are few validated tools able to provide accurate information about education of hypertensive patients. While some instruments does not focus CR, 16-19 others include only questions deemed as relevant by the authors, without undergoing a psychometric validation. 13-15,20-23 This gap in the knowledge opens the possibility of investigation, since assessment tools are important instruments in educational programs. These instruments enable the identification of patients’ 9 educational needs and of specific conditions involving paradigms of health and disease, which are likely to change. 10 Thus, the aim of this study was to develop and psychometrically validate an instrument to assess the knowledge about the disease of patients enrolled in CR programs (HIPER-Q). 60