Hypertension (HTN) is a major health problem affecting 1 in 3 African Americans. Significant racial disparities exist in the age of onset, prevalence rate, and clinical outcomes, with African Americans bearing a disproportionate burden of this disease. A contributing factor is that African Americans have a low prevalence of engaging in HTN prevention self care behaviors. Yet, there is surprisingly little known about the attitudes and beliefs of African Americans as it relates to these lifestyle strategies and the prevention of HTN. Therefore, the purpose of this study is to develop a culturally relevant instrument that examines the attitudes and beliefs about HTN prevention behaviors among this high-risk ethnic group. It is anticipated that the resultant tool would be used in interventions designed to improve the processes of care, increase the use of self-care strategies, and decrease the risk of HTN among African Americans. Developing the culturally-relevant instrument will follow a three-phase, nine step process. The Theory of Planned Behavior is the organizing framework that guides each Phase of the study. Phase I is an elicitation study involving steps 1 and 2, which includes (1) defining the concept in emic terms, and (2) obtaining cultural consensus. Focus groups will be used to gain insight into how culture informs the belief systems of African-Americans relative to HTN prevention. Participant perceptions will be explored regarding behavioral beliefs (informational component that underlies the attitude toward preventive behaviors), normative beliefs (concerns the likelihood that important others will approve or disapprove of the preventive behavior being performed), and control beliefs (concerns the presence or absence of resources and opportunities required to perform the behaviors). Salient beliefs elicited in Phase I will be used in Phase II to develop items for the Hypertension Beliefs Scale (HBS). Phase I1involves steps 3-6 including: (3) developing a pool of potential measurement items for the HBS; (4) obtaining peer validation of items; (5) pre-testing the items in a representative sample for item clarity and readability; and (6) seeking additional peer input for revising items. Phase III is done to test the psychometric properties of the instrument with a calibration sample for the purpose of item analysis, factor analysis, and obtaining reliability and initial validity estimates; (8) confirming the psychometric findings with a validation sample; and (9) confirming the construct and criterion validity of the instrument by model testing in the full sample. Multi-group structural equation modeling techniques will be used for the psychometric evaluation. The proposed study is significant because it addresses a major gap in the state of the science relative to HTN prevention. This study will use rigorous methodology in order to explicate factors that contribute to the racial disparities noted in the prevalence and outcomes of HTN. No other studies were found that identified and quantified the hypertension-prevention attitudes and beliefs of African Americans related to the totality of self-care strategies necessary to prevent HTN.
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