Development of an Instrument Assessing Perceived Risk of Hypertension-related Complications

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Pulawit Thongtang
Junjira Seesawang


          Purpose: To develop and evaluate psychometric properties of the perceived risks of hypertension-related complications tool for hypertensive older people.

          Design: A methodological research was used to develop a tool. Both qualitative and quantitative methods were used for data collection.

          Methods: This study consisted of 3 phases, studying the framework, developing the tool and testing the quality of the tool. The subjects were hypertensive older adults who lived in Northern Thailand. Phase 1, 20 hypertensive older adults were involved in in-depth interviews and 10 registered nurses were involved in focus group. Data were analyzed by content analysis. Phase 2, item pool and content validity were performed; then, a pilot study was conducted with 30 subjects to check the reliability using Cronbach’s alpha. Phase 3, reliability and item analysis of the tool were examined with 220 subjects.

          Main findings: The final version of the perceived risks of hypertension-related complications tool has 19 items with 4-point Likert scale. The tool consists of 5 domains: 1) anxiety, 2) optimistic bias, 3) personal risk identification, 4) perceived severity of hypertension-related complications, and 5) perceived causes of personal risk for hypertension-related complications. The Item-Objective Congruency index was .95 and the internal consistency reliability using Cronbach’s alpha coefficient was .75.

          Conclusion and recommendations: The result showed that the perceived risks of hypertension-related complications tool for hypertensive older people was reliable and had adequate validity to evaluate the perceived risk of hypertension-related complications among older people. It should be beneficial for researchers and health care providers in using this tool.


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Thongtang, P., & Seesawang, J. (2021). Development of an Instrument Assessing Perceived Risk of Hypertension-related Complications. Nursing Science Journal of Thailand, 39(2), 12-23. Retrieved from
Research Papers


1. Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol. 2012;4(5):135-47. doi: 10.4330/wjc.v4.i5.135.

2. Wongsuwan P. Development of instrument for keep taking medicine and motivation in taking medicine among elderly hypertension in community. Journal of Nursing and Education. 2017;10(1):90-104. (in Thai).

3. Sinsap N, Jankra J, Jaiman B. Hypertension in elderly: silence killer should be aware. Journal of Phrapokklao Nursing College. 2017;28(1):100-11. (in Thai).

4. Foundation of Thai Gerontology Research and Development Institute. Situation of the Thai elderly 2016. Nakhon Pathom: Printery; 2017. 138 p. (in Thai).

5. Sakboonyarat B, Rangsin R, Kantiwong A, Mungthin M. Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: a nation-wide survey in Thailand. BMC Res Notes. 2019;12:380. doi: 10.1186/s13104-019-4417-7.

6. Hallberg I, Ranerup A, Kjellgren K. Supporting the self-management of hypertension: patients’ experiences of using a mobile phone-based system. J Hum Hypertens. 2016;30(2):141-6. doi: 10.1038/jhh.2015.37.

7. Jantanon N, Singchai B, Worawong W. Self-care behavior of hypertension patients who live in Muang district, Chumphon province. KKU Research Journal. 2011;16(6):749-58. (in Thai).

8. Kummak S. Self-care behavior among hypertension patients in Tambon Nanglao Health Promoting Hospital, Amphur Satingpha, Songkhla province. The Southern College Network Journal of Nursing and Public Health. 2016;3(3):153-69. (in Thai).

9. Seesawang J, Thongtang P. Taking care of myself: role of self-care in management of hypertension among Thai older adults with hypertension. Sci Int (Lahore). 2018;30(2):143-7.

10. Thongtang P, Seesawang J. Lived experience of Thai older adults living with hypertension. Journal of the Royal Thai Army Nurses. 2014;15(3):288-95. (in Thai).

11. Chang AK, Lee EJ. Factors affecting self-care in elderly patients with hypertension in Korea. Int J Nurs Pract. 2015;21(5):584-91. doi: 10.1111/ijn.12271.

12. Lee E, Park E. Self-care behavior and related factors in older patients with uncontrolled hypertension. Contemp Nurse. 2017;53(6):607-21. doi: 10.1080/10376178.2017.1368401.

13. Rouyard T, Kent S, Baskerville R, Leal J, Gray A. Perceptions of risks for diabetes-related complications in type 2 diabetes populations: a systematic review. Diabet Med. 2017;34(4):467-77. doi: 10.1111/dme.13285.

14. Barros AA, Guedes MVC, de Jesus Moreira Moura D, de Menezes LCG, Aguiar LL, Xavier GA. Health behaviors of people with hypertension: health belief model. Rev Rene. 2014;15(3):525-32. doi: 10.15253/2175-6783.2014000300018.

15. Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychol Bull. 2014;140(2):511-43. doi: 10.1037/a0033065.

16. Freimuth VS, Jamison A, Hancock G, Musa D, Hilyard K, Quinn SC. The role of risk perception in flu vaccine behavior among African American and white adults in the US. Risk Anal. 2017;37(11):2150-63. doi: 10.1111/risa.12790.

17. Brawarsky P, Eibensteiner K, Klinger EV, Baer HJ, Getty G, Orav EJ, et al. Accuracy of self-perceived risk for common conditions. Cogent Med. 2018;5:1463894. doi: 10.1080/2331205X.2018.1463894.

18. Mohd Azahar NMZ, Krishnapillai ADS, Zaini NH, Yusoff K. Risk perception of cardiovascular diseases among individuals with hypertension in rural Malaysia. Heart Asia. 2016;9(2):1-4. doi: 10.1136/heartasia-2016-010864.

19. Power BJ, Oddone EZ, Grubber JM, Olsen MK, Bosworth HB. Perceived and actual stroke risk among men with hypertension. J Clin Hypertens. 2008;10(4):287-94. doi: 10.1111/j.1751-7176.2008.07797.x.

20. Peterson LM, Helweg-Larsen M, Volpp KG, Kimmel SE. Heart attack perception biases among hypertension patients: the role of educational level and worry. Psychol Health. 2012;27(6):737-51. doi: 10.1080/08870446.2011.626856.

21. Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 9th ed. Philadelphia: Lippincott; 2012. 773 p.

22. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis. 6th ed. New Jersey: Pearson Prentice Hall; 2006. 928 p.

23. Sexton E, King-Kallimanis BL, Morgan K, McGee H. Development of the Brief Ageing Perceptions Questionnaire (B-APQ): a confirmatory factor analysis approach to item reduction. BMC Geriatr. 2014;14:44. doi: 10.1186/1471-2318-14-44.

24. Ferrer R, Klein WM. Risk perceptions and health behavior. Curr Opin Psychol. 2015;5:85-9. doi: 10.1016/j.copsyc.2015.03.012.

25. Ferrer RA, Klein WMP, Avishai A, Jones K, Villegas M, Sheeran P. When does risk perception predict protection motivation for health treats? A person-by-situation analysis. PLoS One. 2018;13(3):e0191994. doi: 10.1371/journal.pone.0191994.

26. Newtonraj A, Arun S, Bazroy J, Tovia S. Lay perspectives on causes and complications of hypertension; and barrier to access health care by known hypertensive patients: a qualitative study from a rural area of South India. Int J Community Med Public Health. 2017;4(3):704-7. doi: 10.18203/2394-6040.ijcmph20170743.

27. Tan CS, Hassali MA, Neoh CF, Saleem F. A qualitative exploration of hypertensive patients’ perception towards quality use of medication and hypertension management at the community level. Pharmacy Pract. 2017;15(4):1074. doi: 10.18549/pharmpract.2017.04.1074.

28. Sadeq R, Lafta RK, Knowledge, attitude and practice about hypertension in hypertensive patients attending hospitals in Baghdad, Irag. South East Asia Journal of Public Health. 2017;7(1):29. doi: 10.3329/seajph.v7i1.34676.

29. Kisokanth G, Ilankoon IMPS, Arulanadem K, Goonewardena CSE, Sundaresan KT, Joseph J. Assessment of knowledge on the disease, its complications and management strategies among hypertensive patients attending medical clinics at teaching hospital, Batticaloa, Sri Lanka. Journal of the Postgraduate Institute of Medicine. 2016;3:E30:1-11. doi: 10.4038/jpgim.8097.

30. Shamsabadi A, Delbari A, Sadr AS, Mehraeen E, Mohammadzadeh N, Kalhori SRN. Questionnaire development and validation for designing a health telemonitoring system for frail elderly people. Digit Health. 2019;5:1-11. doi: 10.1177/2055207619838940.