ArticleBMC primary care2026
Translation, adaptation, and validation of a Moroccan version of the H-SCALE (Hypertension Self-Care Activity Level effects) for hypertensive patients.
Article in BMC primary care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHypertension is the leading cause of premature death worldwide and the primary risk factor for cardiovascular disease. Its management relies mainly on self-management practices by hypertensive patients. The Hypertension Self-Care Activity Level effects scale (H-SCALE) is one of the most widely used tools for assessing these practices. The objective of this study is to translate this tool into Moroccan dialect and to study the psychometric properties of its Moroccan version. It also aims to assess adherence to hypertension self-care behaviors using the adapted tool. MATERIALS AND
methodsA study was conducted in four primary health care centers in Settat city. The validation process included forward-backward translation with cross-cultural adaptation, assessment of content validity by six experts, face validity testing among 30 hypertensive patients, and psychometric evaluation in an independent sample of 120 patients. The questionnaire was administered through face-to-face interviews. Construct validity was assessed using exploratory factor analysis, while reliability was evaluated using Cronbach's alpha and the intraclass correlation coefficient (ICC). Sociodemographic and clinical data, as well as anthropometric measurements and blood pressure values, were collected.
resultsThe study included 120 hypertensive patients, predominantly female (71.7%), with a mean age of 56.64 ± 11.45 years. Construct validity was supported by exploratory factor analysis (KMO = 0.682; Bartlett's test p < 0.001), revealing a six-factor structure explaining 53% of the total variance. The Moroccan version of the scale demonstrated satisfactory internal consistency (Cronbach's alpha = 0.79) and good test-retest reliability (ICC = 0.80), with domain-specific coefficients ranging from 0.76 to 0.95. Furthermore, treatment adherence (p = 0.01) and weight management scores (p < 0.001) were significantly higher among patients with controlled blood pressure.
conclusionThe Moroccan version of the H-SCALE showed satisfactory reliability and acceptable exploratory construct validity. These findings support its potential use for assessing hypertension self-care behaviors in the Moroccan context.
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