Translation, Reliability, Psychometric Validation, and Confirmatory Factor Analysis of the Urdu Version of the Self‐Efficacy for Appropriate Medication Use Scale (SEAMS‐U) Among Hypertensive Patients in Lahore, Pakistan: A Validation Study

Background: The Self-efficacy for Appropriate Medication Use Scale, also known as SEAMS, is a widely used self-reported measure of confidence in taking medications correctly. However, the scale has not been validated in different languages. Aim: The present study aims to translate and investigate the psychometric properties of the translated version of the scale SEAMS-Urdu (SEAMS-U) administered to hypertensive patients in Lahore, Pakistan, a South Asian country. Methods: The present study was a cross-sectional which enrolled hypertensive patients aged ≥ 18 years. The forward-backward method was employed for translation purposes. Content and face validity were assessed, and construct validity was evaluated using principal component analysis (PCA) and confirmatory factor analysis (CFA), with convergent validity also assessed. Internal consistency measures such as Cronbach's alpha, split-half reliability, and test-retest reliability (over a 4-week interval) were also employed. Results: Of the 1012 participants, the majority of our respondents were male (67.4%) and aged 50 and above (45.5%). The SEAMS-U 13 items had good internal consistency, with Cronbach's alpha: 0.878. In item analysis, Cronbach's alpha varied between 0.849 and 0.883, while the values for the two halves of the questionnaire were 0.838 and 0.789, indicating good reliability of the questionnaire. The test-retest reliability analysis was adequate (0.686), while the intra-class correlation (ICC) remained high at 0.814. Exploratory factor analysis (EFA) makes a 2-factor model in rotated space that explained 68.162% of the total variation. Later, CFA confirmed the 2-factor model with goodness-of-fit measures indicating an acceptable model fit. Convergent validity was adequate, with the Cronbach's alpha reliability of the 9-item SEAMS-U 2-factor model of 0.886. Conclusion: The SEAMS-U is a valid and reliable measure of self-efficacy for antihypertensive medication in Pakistan. This simple tool can be used to assess the confidence of persons with hypertension outside of the tertiary hospital setting to adhere to their medication.