Development of a Questionnaire on Predictive Factors of Stroke Preventive Behaviors among Patients with Hypertension Based on the Health Belief Model: A Case Study of Mueang District, Samut Songkhram Province, Thailand

Abstract

Background: The incidence of stroke among hypertensive patients remains a persistent concern. In Thailand, stroke is the third leading cause of mortality and long-term disability. A major contributing factor is patient health behavior, including high sodium intake, sedentary lifestyle, medication non-adherence, and a lack of awareness regarding stroke warning signs. Crucially, these are modifiable behaviors that can be effectively prevented or improved.

Objective: To assess the content validity of the questionnaire by evaluating the congruence between each questionnaire item and the operational definitions of the research variables, and to determine the reliability of the questionnaire measuring predictors of stroke prevention behaviors among patients with hypertension based on the Health Belief Model (HBM).

Methods: Descriptive research method was used in this study. The methods of study were to synthesize concepts, theories, and related research. Content validity was measured by using Index of Item-Objective Congruence (IOC), evaluated by three experts in public health and health behavior. All items yielded an IOC score of 0.94 or higher, indicating high content validity. The instrument's reliability was pre-tested with 30 individuals sharing similar characteristics to the target population. Internal consistency, measured by Cronbach’s alpha coefficient, was 0.92 for the entire questionnaire. Each HBM subscale also demonstrated acceptable reliability, confirming the instrument’s suitability for data collection.

Results: The synthesis of research results revealed that there were 5 dimensions of Health Belief Model including; (1) Perceived Susceptibility, (2) Perceived Severity, (3) Perceived Benefits, (4) Perceived Barriers, (5) Cues to Action. The questionnaire employs a 5-point Likert scale¹. As a questionnaire was developed based on those components, it was brought to test content validity. The results showed that the value of IOC for each item was .94 as well as the value of CVI = 0.81. Reliability of the questionnaire was tested by using Cronbach alpha coefficient and it was found that α = 0.92. 

Conclusion: From the research findings, it be suggested that the questionnaire should be applied to hypertensive populations in other provinces to enhance the generalizability and breadth of the data analysis.