Cross-Cultural Adaptation, Validity, and Reliability of the Ses6c Instrument in Indonesian Patients with Hypertension
DOI:
https://doi.org/10.37287/ijghr.v8i6.2858Keywords:
chronic disease management, hypertension, psychometric properties, self-efficacy, SES6CAbstract
Hypertension requires ongoing disease management, making self-efficacy important for patients’ ability to manage chronic disease. However, culturally and linguistically appropriate instruments for assessing self-efficacy among Indonesian patients with hypertension remain limited. This study aimed to conduct a cross-cultural adaptation and evaluate the validity and reliability of the Indonesian version of the 6-Item Self-Efficacy for Managing Chronic Disease Scale (SES6C). A non-experimental quantitative study with a cross-sectional approach was conducted. The validation process included content validity, pilot testing, Psychometric evaluation included examination of the factor structure using CFA, assessment of internal consistency, and evaluation of reliability across two measurement occasions.Content validity involved five experts, and pilot testing involved 15 patients. The content validity assessment yielded an I-CVI and S-CVI/Ave of 1.00,with 100% comprehensibility for all items, indicating excellent content validity. CFA factor loadings ranged from 0.532 to 0.775, but the one-factor model showed inadequate fit (CFI = 0.870; TLI = 0.783; RMSEA = 0.157). Cronbach’s alpha was 0.801, while test-retest reliability showed an ICC of 0.805 (95% CI = 0.421–0.914; p < 0.001). The Indonesian SES6C demonstrated excellent content validity, good internal consistency, and good stability.
References
Acar, T. O. (2025). Improving Cross-Cultural Psychometric Scales: A Focus on Readability. Measurement: Interdisciplinary Research and Perspectives, 23(1), 90–100. https://doi.org/10.1080/15366367.2023.2292936
Alavi, M., Biros, E., & Cleary, M. (2024). Notes to Factor Analysis Techniques for Construct Validity. Canadian Journal of Nursing Research, 56(2), 164–170. https://doi.org/10.1177/08445621231204296
Alkhadim, G. S. (2022). Cronbach’s Alpha and Semantic Overlap Between Items: A Proposed Correction and Tests of Significance. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.815490
Brigita, M., Hijrawati, H., & Artama, S. (2023). Characteristics and adherence of the elderly to the management of hypertension treatment. Jurnal Ilmiah Kesehatan Sandi Husada, 12(2), 435–444. https://doi.org/10.35816/jiskh.v12i2.1114
Campos-Romero, S., Lucchini Raies, C., Rodríguez, C., Muñoz, P., Márquez-Doren, F., & Bustamante-Troncoso, C. (2023). Adaptación cultural y validación del instrumento de Autoeficacia para el manejo de enfermedades crónicas en población chilena. Revista Médica de Chile, 151(12), 1596–1603. https://doi.org/10.4067/s0034-98872023001201596
Cruchinho, P., López-Franco, M. D., Capelas, M. L., Almeida, S., Bennett, P. M., Miranda da Silva, M., Teixeira, G., Nunes, E., Lucas, P., & Gaspar, F. (2024). Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers. Journal of Multidisciplinary Healthcare, Volume 17, 2701–2728. https://doi.org/10.2147/JMDH.S419714
Dolnicar, S., Grün, B., & MacInnes, S. (2022). Assessing survey response stability: A complementary quality assurance protocol for survey studies in the social sciences. Social Sciences & Humanities Open, 6(1), 100339. https://doi.org/10.1016/j.ssaho.2022.100339
Nermin Eroğlu, & Gamze Temiz. (2023). The 6-item Self-Efficacy Scale in the Management of Chronic Disease in Individuals with Multiple Sclerosis (MS-CHOYO): Validity and Reliability Study. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 8(3), 963–968. https://doi.org/10.61399/ikcusbfd.1245472
Etheridge, J. T., & De Ruiter, M. (2025). To Adapt or Not to Adapt: A Decision-Making Tool for Measurement Instrument Adaptation. Academy of Management Proceedings, 2025(1). https://doi.org/10.5465/AMPROC.2025.24057poster
Finch, W. H., French, B. F., Immekus, J. C., & Dai, S. (2025). Developing validity evidence. In Educational and Psychological Measurement (pp. 213–240). Routledge. https://doi.org/10.4324/9781003439769-10
Fismasari, Z., Waluyo, W. B., Hendrawan, B. D., & Latifah, W. U. (2025). The Effect of Self-Efficacy on Individual Performance: a Theoretical Review and Practical Implications. Formosa Journal of Applied Sciences, 4(6), 1819–1826. https://doi.org/10.55927/fjas.v4i6.190
Hakim, A. R., Wang, S.-T., Widiantoro, F. X., Hannan, M., Wang, C.-J., & Fetzer, S. J. (2020). The Indonesian Version of the Exercise Self-Efficacy Scale: Cross-cultural Adaptation and Psychometric Testing. Asian Nursing Research, 14(5), 300–305. https://doi.org/10.1016/j.anr.2020.08.008
Han, H.-R., Benjasirisan, C., Metlock, F. E., Tesfai, Y., & Commodore-Mensah, Y. (2025). Use of the Hypertension Self-Care Profile: A Scoping Review. International Journal of Environmental Research and Public Health, 22(8), 1244. https://doi.org/10.3390/ijerph22081244
Hazumi, M., Kataoka, M., Nakashita, A., Usuda, K., Miyake, M., Kamikawa, C., Nishi, D., & Kuroda, N. (2024). Psychometric property of the Japanese version of self-efficacy for managing chronic disease scale in individuals with chronic diseases. Heliyon, 10(22), e40218. https://doi.org/10.1016/j.heliyon.2024.e40218
Hladek, M. D., Reimer, T., Casey, J., Nkimbeng, M., Peeler, A., Nelson, K. E., Taylor, J., Han, H.-R., & Szanton, S. L. (2025). Measuring self-efficacy in U.S. older adults with chronic disease: a systematic review. Aging & Mental Health, 29(10), 1764–1773. https://doi.org/10.1080/13607863.2025.2511226
Ichsan, B., Herawati, E., Basuki, S. W., Pramudyatama, I. W., & Khoiriyah, U. (2025). Development and Validation of Instruments to Measure Medication Adherence in Hypertensive Patients (MAHP): The Indonesian Case. Journal of Health Research, 39(6). https://doi.org/10.56808/2586-940X.1176
Kleman, C., Magnus, J. M., Andrews, M., Meyer, K., & Lutz, B. J. (2023). The work of managing a chronic illness: A job description. Journal of Evaluation in Clinical Practice, 29(1), 166–180. https://doi.org/10.1111/jep.13754
Lambert, S. D., Bartlett, S. J., McCusker, J., Yaffe, M., Ciampi, A., Belzile, E., & de Raad, M. (2022). Development and psychometric evaluation of the CanSmart questionnaire to measure chronic disease self-management tasks. BMC Psychology, 10(1), 293. https://doi.org/10.1186/s40359-022-00995-2
Lee, E.-H. (2021). Psychometric properties of an instrument 3: convergent, discriminant, known-groups, and criterion validity. Korean Journal of Women Health Nursing, 27(3), 176–179. https://doi.org/10.4069/kjwhn.2021.08.18
Madadizadeh, F., & Zare, F. (2024a). A Gentle Introduction to Cross-Cultural Adapting of Questionnaires in Medical Research. Journal of Community Health Research. https://doi.org/10.18502/jchr.v12i36.14793
Madadizadeh, F., & Zare, F. (2024b). A Gentle Introduction to Cross-Cultural Adapting of Questionnaires in Medical Research. Journal of Community Health Research. https://doi.org/10.18502/jchr.v12i36.14793
Mengjiao, L., Xujie, Z., Ping, J., Liwen, H., Yuping, N., Yangjing, Z., & Jianjun, Y. (2025). Self-management assessment tools for people with hypertension: a scoping review. BMC Nephrology, 26(1), 219. https://doi.org/10.1186/s12882-025-04134-y
Menon, V., Grover, S., Gupta, S., Indu, P., Chacko, D., & Vidhukumar, K. (2025). A primer on reliability testing of a rating scale. Indian Journal of Psychiatry, 67(7), 725–729. https://doi.org/10.4103/indianjpsychiatry_584_25
Mirza, M., Hameda Nishath, S., & Umaira Saeed, F. (2024). The Silent Storm: Understanding Hypertension. International Journal of Innovative Science and Research Technology (IJISRT), 3405–3415. https://doi.org/10.38124/ijisrt/IJISRT24APR1387
Mohiuddin, A. K. (2023). Adherence to Medication and Treatment Guidelines: Most Important but Mostly Despised. Clinical Sciences and Clinical Research, 1(1), 01–03. https://doi.org/10.58489/2836-8959/001
Natalia, E. D., & Pribadi, R. A. (2026). The Relationship Between Self-Efficacy and The Ability to Perform Physical Activities in Patients With Hypertension. Physical Activities in Patients with Hypertension. Indonesian Journal of Global Health Research, 8(2), 1003–1010. https://doi.org/10.37287/ijghr.v8i2.695
Peeters, M. J., & Harpe, S. E. (2022). Contemporary conceptualization of measurement validity. In Contemporary Research Methods in Pharmacy and Health Services (pp. 575–582). Elsevier. https://doi.org/10.1016/B978-0-323-91888-6.00020-X
Qonita, Q., Nugraha, D., & Iskandar, B. (2025). Analisis Validitas dan Reliabilitas Instrumen Sikap dan Keyakinan Guru PAUD dalam Pembelajaran STEAM. Jurnal Obsesi : Jurnal Pendidikan Anak Usia Dini, 9(6), 3580–3591. https://doi.org/10.31004/obsesi.v9i6.7714
Rani, S., & . S. (2023). Self-efficacy as a multifaceted belief. International Journal of Advanced Biochemistry Research, 7(2S), 420–423. https://doi.org/10.33545/26174693.2023.v7.i2Sf.245
Rimayanti, U. P., Mizuno, M., Kadar, K., Madjid, A., Sahraeny, S., Effendy, C., Setiyarini, S., & Mayers, T. (2023). Ensuring reliability and cultural validity of the Indonesian version of the Quality Of Life Index for patients with cancer. Research in Nursing & Health, 46(5), 527–537. https://doi.org/10.1002/nur.22334
Sadeghi-Bazargani, H., Soori, H., Motevalian, S. A., Aboubakri, O., Jafari-Khounigh, A., Razzaghi, A., Khankeh, H. R., Heydari, S. T., Rezapur Shahkolai, F., Sehat, M., Khorasani Zavareh, D., Asghari-Jafarabadi, M., Imani, A., Alizadeh Aghdam, M. B., Poustchi, H., Rezaei, M., & Golestani, M. (2024a). The Factor Structure and Generalizability of the Iranian Socioeconomic Status (SES) Questionnaire Administered in a Nationally Divergent Population. Medical Journal of The Islamic Republic of Iran. https://doi.org/10.47176/mjiri.38.37
Sadeghi-Bazargani, H., Soori, H., Motevalian, S. A., Aboubakri, O., Jafari-Khounigh, A., Razzaghi, A., Khankeh, H. R., Heydari, S. T., Rezapur Shahkolai, F., Sehat, M., Khorasani Zavareh, D., Asghari-Jafarabadi, M., Imani, A., Alizadeh Aghdam, M. B., Poustchi, H., Rezaei, M., & Golestani, M. (2024b). The Factor Structure and Generalizability of the Iranian Socioeconomic Status (SES) Questionnaire Administered in a Nationally Divergent Population. Medical Journal of The Islamic Republic of Iran. https://doi.org/10.47176/mjiri.38.37
Salami, S., Choo, S. S., Mohd Said, F., & Wilandika, A. (2023). Psychometric Properties of The Indonesian Version of Hypertension Self Care Profile. Malaysian Journal of Medicine and Health Sciences, 19(4), 231. https://doi.org/10.47836/mjmhs.19.4.34
Sanusi, A. (2025). Consequences of Hypertension. https://doi.org/10.5772/intechopen.1008447
Satink, T., & Kos, D. (2025). Self-management and Self-efficacy in Supporting Occupational Engagement. In Routledge Companion to Occupational Therapy (pp. 362–376). Routledge. https://doi.org/10.4324/9781003526766-28
Shafrin, J., Marijam, A., Joshi, A. V., Mitrani-Gold, F. S., Everson, K., Tuly, R., Rosenquist, P., Gillam, M., & Ruiz, M. E. (2022). Impact of suboptimal or inappropriate treatment on healthcare resource use and cost among patients with uncomplicated urinary tract infection: an analysis of integrated delivery network electronic health records. Antimicrobial Resistance & Infection Control, 11(1), 133. https://doi.org/10.1186/s13756-022-01170-3
Srinatania, D., Sansuwito, T. bin, & Ahmed, I. A. (2025). Translation And Validation Of Social-Emotional Development Scale In Indonesian Language. Holistic Nursing Plus, 3(1), 133–140. https://doi.org/10.58439/hnp.v3i1.323
Transyah, C. H., Daeng Ramadhan Salim, Rika Syafitri, & Bustami Rusdi. (2025). Hubungan gaya hidup pasien dengan kejadian hipertensi. Jurnal Amanah Kesehatan, 7(1), 36–45. https://doi.org/10.55866/jak.v7i1.275
Wahidin, M., Mustikawati, I. S., Handayani, R., & Letelay, A. M. (2025). Overview of Hypertension Prevalence and Its Main Risk Factors in Indonesia – a District-Level Data Analysis. Amerta Nutrition, 9(3), 438–442. https://doi.org/10.20473/amnt.v9i3.2025.438-442
Xiao, L., Hau, K., & Wang, M. D. (2024). Revisiting the Usage of Alpha in Scale Evaluation: Effects of Scale Length and Sample Size. Educational Measurement: Issues and Practice, 43(2), 74–81. https://doi.org/10.1111/emip.12604
Xu, X., Guo, T., Liu, Z., Chen, P., Zhang, Y., Ji, Q., & Xie, H. (2022). A Systematic Review of Patient Preferences, Expectations, and Values for the Management and Treatment of Hypertension. Patient Preference and Adherence, Volume 16, 2867–2876. https://doi.org/10.2147/PPA.S388356
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
