SC-HI English

Authored by

Dr. Victoria Vaughan Dickson, PhD, RN, FAAN

Director, Pless Center for Research

NYU Rory Meyers College of Nursing
433 First Avenue
New York, NY 10010
p +1 212 998 5300
e vdickson@nyu.edu

 

SELF-CARE OF HIGH BLOOD PRESSURE

V2.0 (March 2016)

All answers are confidential.

Think about how you have been feeling in the last month or since we last spoke as you complete these items.

SECTION A:

Listed below are common instructions given to persons with high blood pressure. How routinely do you do the following? Circle one number for each item.

 

 

Never or rarely

Sometimes

Frequently

Always or daily

1.      Check your blood pressure?

1

2

3

4

2.      Eat lots of fruits and vegetables?

1

2

3

4

3.      Do some physical activity?

1

2

3

4

4.      Keep doctor or nurse appointments?

1

2

3

4

5.      Eat a low salt diet?

1

2

3

4

6.      Exercise for 30 minutes?

1

2

3

4

7.      Take medicines as prescribed?

1

2

3

4

8.      Ask for low salt items when eating out or visiting others?

1

2

3

4

9.      Use a system to help you remember your medicines? For example, use a pill box or reminders.

1

2

3

4

10.  Eat a low fat diet?

1

2

3

4

11. Try to lose weight or control your body weight?

1

2

3

4

 

SECTION B:

Many patients have difficulty controlling their blood pressure.

 

In the past month, has your blood pressure been high, even briefly? Circle one.

0)      No

1)      Yes

 

 

12.  If you had trouble controlling your blood pressure in the past month…

(circle one number)

 

Have not had this

I did not recognize it

Not Quickly

Somewhat Quickly

   Quickly

Very Quickly

How quickly did you recognize that your blood pressure was up?

   N/A

0

1

2

   3

4

 

Listed below are actions that people use to control their blood pressure. If your blood pressure goes up, how likely are you to try one of these actions?

 

(circle one number for each remedy)

 

Not Likely

Somewhat Likely

Likely

Very Likely

13. Reduce the salt in your diet

1

2

3

4

14. Reduce your stress level

1

2

3

4

15. Be careful to take your prescription medicines more regularly

1

2

3

4

16. Call your doctor/ nurse for guidance

1

2

3

4

 

17. Think of an action you tried the last time your blood pressure was up,

 

(circle one number)

 

I did not try anything

Not Sure

Somewhat Sure

Sure

Very Sure

How sure were you that the action helped or did not help?

0

1

2

3

4

 

 

SECTION C:

In general, how confident are you that you can:

 

Not Confident

Somewhat Confident

Very Confident

Extremely Confident

18. Control your blood pressure?

1

2

3

4

19. Follow your treatment regimen?

1

2

3

4

20. Recognize changes in your health?

1

2

3

4

21. Evaluate changes in your blood pressure?

1

2

3

4

22. Take action that will control your blood pressure?

1

2

3

4

23. Evaluate how well an action works?

1

2

3

4