Propriedades de medida da escala Hypertension Knowledge Level Scale em adultos e idosos brasileiros com e sem hipertensão arterial sistêmica

Abstract

Systemic arterial hypertension (HAS) is one of the major public health challenges, exacerbated by its high prevalence, its largely asymptomatic nature, and typically late detection. A critical aspect of this condition is the low adherence to treatment and, in many cases, treatment abandonment. A thorough assessment of patients’ knowledge about the disease, its associated risks, and the benefits of treatment is closely linked to treatment adherence and constitutes an essential and inseparable component of comprehensive patient care. One of the available measures for assessing knowledge about HAS is the Hypertension Knowledge Level Scale (HK-LS); which, although available in Brazilian Portuguese, has not yet been tested regarding its construct validity or temporal stability (reliability). Therefore, the present study aimed to evaluate the measurement properties of the HK-LS among Brazilian adults and older adults, both with or without HAS. This is a quantitative, methodological study conducted with Brazilian participants aged 18 years and older, with or without a diagnosis of HAS. Following approval by the Human Research Ethics Committee of the Federal University of Juiz de Fora (approval number: 7.196.416), participants completed—either in person or online via Google Forms®—a sociodemographic questionnaire, an assessment of socioeconomic status, and the Brazilian version of the HK-LS. Exploratory factor analysis (AFE), confirmatory factor analysis (AFC), discriminant validity analysis, and reliability (test-retest and internal consistency) assessment were performed. A total of 501 Brazilian individuals participated in the study, with a mean age of 42 years; the majority were female (66.67%), and racial/ethnic composition was relatively balanced between White (46.70%) and Pardo (mixed-race) participants (41.32%). The final sample was randomly divided into two subsamples: one for AFE (n = 247) and the other for AFC (n = 254). The results from both AFE and AFC supported good construct validity, with an 18-item structure distributed across five factors, explaining a total variance of 53.50%. Discriminant validity analysis revealed that participants with higher educational levels (undergraduate/graduate) and from higher socioeconomic classes (A, B1, and B2) scored higher across the HK-LS subscales. Regarding internal consistency, test–retest correlations were positive and strong for all HK-LS factors, with the total score showing the highest magnitude (rho = 0.80; p < 0.001). The intraclass correlation coefficient (CCI3,1) ranged from moderate to good. Additionally, internal consistency analysis of the HK-LS subscales using the AFC sample yielded satisfactory values, with the total score demonstrating good internal consistency (ω = 0.86, 95% CI = 0.83–0.88). In conclusion, the Brazilian version of the HK-LS shows robust validity and reliability evidence among Brazilian adults and older adults, both with or without HAS. The scale may serve as a valuable tool in supporting hypertension prevention efforts by informing clinical and educational interventions, guiding public health policies, and identifying knowledge gaps to promote individualized and holistic care strategies.