Left-hand-dominant subxiphoid thoracoscopic thymectomy: a case series.

High blood pressure is one of the leading causes of death worldwide, responsible for nearly 10.4 million deaths each year []. The majority of these deaths are attributed to ischemic or hemorrhagic strokes, with hypertension being the main causal factor []. Has become a major public health issue on an international scale, Hypertension is recognized as the leading cardiovascular risk factor and remains the cause of often serious, even fatal, cardiac, vascular, and renal complications []. According to the World Health Organization (WHO), 1.28 billion adults aged 30 to 79 have hypertension, two-thirds of whom live in low- and middle-income countries []. Morocco is part of this trend, ranking among the countries in the eastern Mediterranean region with high mortality rates linked to non-communicable diseases, estimated at 80%, of which 38% are attributed to cardiovascular diseases []. The national survey on risk factors for non-communicable diseases revealed a prevalence of hypertension of 29.3% in Morocco, accounting for 11.70% of expenditure related to long-term conditions covered by compulsory health insurance []. Back in 2000, the results of the previous national survey identified advanced age, obesity, smoking, and certain comorbidities as factors associated with hypertension, while highlighting that 87.3% of hypertensive patients remained uncontrolled despite treatment []. Since then, several regional studies have confirmed the high prevalence of uncontrolled blood pressure (UBP) and highlighted the importance of lifestyle and dietary measures in the management of this chronic disease [–]. These measures are based primarily on the self-care responsibilities of hypertensive patients, including adopting a varied diet rich in fruits and vegetables and low in salt, engaging in regular physical activity (PA), quitting smoking and alcohol, and adhering to the prescribed antihypertensive treatment []. However, poor adherence to these self-care activities compromises stability and optimal blood pressure control (BPC) []. In this context, the existence of a validated tool for assessing adherence to self-care activities is of major interest. Such a tool would enable healthcare professionals to assess the level of compliance with recommendations, adapt treatment protocols, and improve healthcare services. It would also help patients achieve better BPC by identifying their self-management difficulties and guiding them toward healthier behaviors. The transcultural adaptation of such an instrument is also essential in order to take into account the sociocultural specificities of the Moroccan context. The aim of our work is therefore to translate, adapt, and validate a tool for assessing adherence to hypertension self-care activities in primary healthcare facilities (PHCF) in Settat city, Morocco. It also aims to assess adherence to key hypertension self-care behaviors, including medication adherence, DASH diet practices, physical activity, weight management, smoking cessation, and alcohol consumption, using the adapted tool, given that, to our knowledge, no previous study has addressed this topic in Morocco. The study was conducted in four medical PHCF in the province of Settat, which provide care and follow-up for patients with hypertension. It was carried out in four successive phases: (a) Translation, back-translation, and transcultural adaptation of the original scale into a Moroccan dialect version, in accordance with international methodological recommendations [], (b) assessment of content validity by a panel of six experts [], from the fields of public health, cardiology, and nursing research, (c) assessment of face validity in a sample of 30 hypertensive patients not included in the final sample [], (d) assessment of construct validity and reliability in a separate sample of 120 hypertensive patients [] and finally, (e) evaluation of adherence to hypertension self-care activities. The data collected during the first administration of the questionnaire (test) were used to describe the characteristics of the participants and analyze construct validity. The data from the second administration (retest) were used exclusively to assess test–retest reliability by calculating the intra-class correlation (ICC).