[The Spanish version of the Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ). Transcultural adaptation and reliability analysis]

Transcultural adaptation of the revised caregiving appraisal scale (RCAS) in the Spanish population

AIM

To develop a transcultural adaptation of the Revised Caregiving Appraisal Scale among Spanish caregivers of dependent older people and to test the psychometric properties of the scale.

DESIGN

Cross-sectional study.

METHODS

The Revised Caregiving Appraisal Scale was transculturally adapted to the Spanish population following the methodology of direct and back translation. The Spanish version of the Revised Caregiving Appraisal Scale was administered to a total of 182 family caregivers of older dependent people. The study began in January 2016 and ended in December of the same year. The construct validity was studied by means of the scree plot and parallel analysis. The exploratory factorial analysis was carried out, and the correlation between factors was studied. To verify the reliability of the process, Cronbach's alpha and homogeneity were calculated by the corrected total item correlation. The validity of the convergent criterion was studied by means of the Pearson correlation coefficient, using the Zarit Caregiver Load Interview and the Family Satisfaction Scale as the gold standard.

RESULTS

The construct validity revealed three factors: 'Subjective Burden' (15 items), 'Satisfaction' (7 items) and 'Competence' (3 items). The Cronbach alpha was .86 for 'Subjective Burden', .74 for 'Satisfaction' and .74 for 'Competence'. The corrected total item correlation was greater than .25. The validity of the convergent criterion of the 'Subjective Burden' and 'Competence' factors with the 'Zarit Caregiver's Load Interview' presented a very high statistically significant correlation, unlike 'Satisfaction' which presented a low positive correlation with the 'Family Satisfaction Scale'.

CONCLUSION

The Spanish version of the Revised Caregiving Appraisal Scale is a valid and reliable scale according to the tests performed on a random sample of family caregivers of older dependent people in Spain.

IMPACT

This scale will enable the simultaneous assessment of negative ('Subjective Burden' and 'Competence') and positive ('Satisfaction') perceptions among family caregivers of older dependent people.

Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol

INTRODUCTION

Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.

METHODS AND ANALYSIS

Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study

Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.

Knowledge on asthma, food allergies, and anaphylaxis: Assessment of elementary school teachers, parents/caregivers of asthmatic children, and university students in Uruguaiana, in the state of Rio Grande do Sul, Brazil

INTRODUCTION

Allergic diseases have become an increasingly common reality in the last years, extending beyond the family context.

OBJECTIVE

Assessing the level of knowledge on asthma, food allergies and anaphylaxis of asthmatic children's parents/caregivers (PC), elementary school teachers (EST) and university students (US) in Uruguaiana, RS, Brazil.

METHOD

577 individuals (PC - N=111; EST - N=177; US - N=299) took part in the study, answering the Newcastle Asthma Knowledge Questionnaire (validated for Portuguese) and another questionnaire on Food Allergy (FA) and anaphylaxis.

RESULTS

Although PC have asthmatic children, their asthma knowledge level was average, slightly above that of EST and EU. The lack of knowledge on passive smoking, use of medications and their side effects should be highlighted. US have shown to be better informed about FA and anaphylaxis. However, even though a significant proportion of respondents know the most common symptoms of FA and anaphylaxis, few named subcutaneous adrenaline as the drug of choice for treating anaphylaxis. Although a significant number of respondents know about the possibility of anaphylactic reactions happening at school or in activities outside the school, we were surprised by the absence of conditions in schools to provide emergency care to such students.

CONCLUSION

Despite the high prevalence of allergic diseases in childhood, asthmatic children's parents/caregivers, elementary school teachers and university students have inadequate levels of knowledge to monitor these patients.

Levels of knowledge about asthma of parents of asthmatic children

Objective

To evaluate the levels of knowledge about asthma of parents of school children.

Methods

A cross-sectional study was carried out with parents of children with medical diagnosis of asthma (mild, moderate and severe), followed up at an outpatient referral center for childhood asthma in the Southern region of Brazil (Asthma Group). Parents of children with asthma in remission and healthy children were also selected (Control Group). The Newcastle Asthma Knowledge Questionnaire (NAKQ) questionnaire was applied in both groups.

Results

A total of 154 parents of children participated in the study; in that, 62 (40.26%) in the Asthma Group, and 92 (59.74%) in the Control Group, with a mean age of 35.60±10.03 years. Of these, 132 (85.7%) were female, and 72 (46.8%) parents studied up to high school. The average score of level of knowledge was 18.06±4.11 points. Only 30.5% parents had acceptable levels of knowledge about asthma, which were more prevalent in the Asthma Group than in the Control Group (41.9% versus 22.8%, p=0.01). The mean score in Newcastle Asthma Knowledge Questionnaire (NAKQ) was higher in the Asthma Group (19.32±3.92 versus 17.21±4.03, p=0.001), respectively. The parents with mild and moderate asthmatic children scored more than those of severe asthma (19.5 and 19.9 versus 18.2 points, p=0.02).

Conclusion

Most parents had an unsatisfactory level of knowledge about asthma, which reinforces the need for changes in public asthma management programs.

An instrument to measure nurses' knowledge in palliative care: Validation of the Spanish version of Palliative Care Quiz for Nurses

BACKGROUND

Palliative care is nowadays essential in nursing care, due to the increasing number of patients who require attention in final stages of their life. Nurses need to acquire specific knowledge and abilities to provide quality palliative care. Palliative Care Quiz for Nurses is a questionnaire that evaluates their basic knowledge about palliative care. The Palliative Care Quiz for Nurses (PCQN) is useful to evaluate basic knowledge about palliative care, but its adaptation into the Spanish language and the analysis of its effectiveness and utility for Spanish culture is lacking.

PURPOSE

To report the adaptation into the Spanish language and the psychometric analysis of the Palliative Care Quiz for Nurses.

METHOD

The Palliative Care Quiz for Nurses-Spanish Version (PCQN-SV) was obtained from a process including translation, back-translation, comparison with versions in other languages, revision by experts, and pilot study. Content validity and reliability of questionnaire were analyzed. Difficulty and discrimination indexes of each item were also calculated according to Item Response Theory (IRT).

FINDINGS

Adequate internal consistency was found (S-CVI = 0.83); Cronbach's alpha coefficient of 0.67 and KR-20 test result of 0,72 reflected the reliability of PCQN-SV. The questionnaire had a global difficulty index of 0,55, with six items which could be considered as difficult or very difficult, and five items with could be considered easy or very easy. The discrimination indexes of the 20 items, show us that eight items are good or very good while six items are bad to discriminate between good and bad respondents.

DISCUSSION

Although in shows internal consistency, reliability and difficulty indexes similar to those obtained by versions of PCQN in other languages, a reformulation of the items with lowest content validity or discrimination indexes and those showing difficulties with their comprehension is an aspect to take into account in order to improve the PCQN-SV.

CONCLUSION

The PCQN-SV is a useful Spanish language instrument for measuring Spanish nurses' knowledge in palliative care and it is adequate to establish international comparisons.

Knowledge of asthma in school teachers in nine Spanish cities

OBJECTIVE

To analyze the knowledge of asthma and its management in Spanish school teachers using the Newcastle Asthma Questionnaire (NAKQ).

DESIGN

Descriptive, observational prevalence study, using a self-report questionnaire on knowledge about childhood asthma and its management by teachers in pre-school, primary, and secondary schools in nine Spanish cities. Age, sex, academic training, teaching experience, courses in which they taught, and personal and family history of asthma, were collected from each teacher. For knowledge determination, the validated Spanish version of the NAKQ was used.

RESULTS

A total of 208 centers participated, including 7,494 teachers. The questionnaire was completed by 4,679 teachers (62.4%). The mean score of correct responses was 16.0 ± 4.8 points out of 31 (median = 17, range: 0-30). Only 6.8% of teachers were capable of pointing out the three main symptoms of the disease; 1.5% knew the triggering factors of an asthma attack; 8.6% knew two medicines useful during an asthma attack; 32.7% knew that inhaled medications had less side effects than pills, and only 3.8% knew of ways to prevent asthma attacks during exercise. In the multivariate analysis, variables significantly associated with a higher questionnaire score were a "lower age" (Beta coefficient = -0.09), "male gender" (Beta = 0.77), "being asthmatic" (Beta = 2.10), or "having close relatives with asthma" (Beta = 1.36) and "teaching in a private school" (Beta = 0.66) or in "compulsory secondary education" (Beta = 0.59).

CONCLUSIONS

Teachers have a low level of knowledge about asthma, with an important limitation in some aspects of the disease. They should be trained to recognize the main symptoms of the disease, on how to act in the event of symptoms, and the early identification of situations in which the pupils require health care assistance. Pediatr Pulmonol. 2016;51:678-687. © 2015 Wiley Periodicals, Inc.

Validation of a questionnaire in Spanish on asthma knowledge in teachers

OBJECTIVE

To evaluate the reliability and validity of the Spanish version of the NewCastle Asthma Knowledge Questionnaire (NAKQ) for determining asthma knowledge in teachers.

METHODS

DESIGN AND SAMPLE

A cross-sectional observational study in educational centers of A Coruña providing preschool, primary school and/or compulsory secondary education. Centers were selected by random sampling, stratified by ownership and educational level (24centers, 864teachers). A total of 537 (62.1%) teachers responded (precision, ±4%, confidence, 95%).

MEASUREMENTS

Age, sex, academic training, teaching experience, personal/family history of asthma, NAKQ.

ANALYSIS

Evaluation of internal consistency (Cronbach's alpha). Concurrent validity was determined by comparing scores of asthmatic teachers or with asthmatic relatives with teachers with no contact with asthma. Test-retest reliability was evaluated in two randomly selected centers by the kappa index, Bland-Altman method and intraclass correlation coefficient.

RESULTS

Mean score on the NAKQ was 15.7±5.3 (median 17), correctly answering 50.6% of items. Cronbach's alpha coefficient was 0.824 (95%CI: 0.802-0.845). NAKQ score was higher in asthmatic teachers or with close asthmatic relatives (17.7±3.3) than in teachers with distant asthmatic relatives (16.1±5.4) and teachers without close contact with asthma (15.1±5.6; P<0.001). In the test-retest analysis (kappa 0.33-1), there were no differences in NAKQ score between the first and second completion (mean difference, 0.3±2.3; intraclass correlation coefficient, 0.863).

CONCLUSIONS

Scores obtained with the Spanish version of the NAKQ in teachers of Spanish school centers are reliable and valid to measure their degree of asthma knowledge.

Facial disability index (FDI): adaptation to Spanish, reliability and validity

Objectives: To adapt to Spanish the facial disability index (FDI) described by VanSwearingen and Brach in 1995 and to assess its reliability and validity in patients with facial nerve paresis after parotidectomy. Study Design: The present study was conducted in two different stages: a) cross-cultural adaptation of the questionnaire and b) cross-sectional study of a control group of 79 Spanish-speaking patients who suffered facial paresis after superficial parotidectomy with facial nerve preservation. The cross-cultural adaptation process comprised the following stages: (I) initial translation, (II) synthesis of the translated document, (III) retro-translation, (IV) review by a board of experts, (V) pilot study of the pre-final draft and (VI) analysis of the pilot study and final draft. Results: The reliability and internal consistency of every one of the rating scales included in the FDI (Cronbach’s alpha coefficient) was 0.83 for the complete scale and 0.77 and 0.82 for the physical and the social well-being subscales. The analysis of the factorial validity of the main components of the adapted FDI yielded similar results to the original questionnaire. Bivariate correlations between FDI and House-Brackmann scale were positive. The variance percentage was calculated for all FDI components. Conclusions: The FDI questionnaire is a specific instrument for assessing facial neuromuscular dysfunction which becomes a useful tool in order to determine quality of life in patients with facial nerve paralysis. Spanish adapted FDI is equivalent to the original questionnaire and shows similar reliability and validity. The proven reproducibi-lity, reliability and validity of this questionnaire make it a useful additional tool for evaluating the impact of facial nerve paralysis in Spanish-speaking patients.

Key words:Parotidectomy, facial nerve paralysis, facial disability.

[Impact of an asthma educational intervention programme on teachers]

OBJECTIVE

Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management.

MATERIAL AND METHOD

Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied.

RESULTS

A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001).

CONCLUSIONS

An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.

[Knowledge, attitudes and asthma quality of life of adolescents in schools. The need to educate our teaching centres]

INTRODUCTION

Knowledge and attitudes toward asthma can condition the integration of adolescents with asthma in school and affect their quality of life. Our objective was to determine the state of knowledge, attitudes on asthma in secondary schools, and its relationship to quality of life of pupils with asthma, as an early step to an educational intervention.

METHODS

Descriptive and cross-sectional study of pupils aged 13 and 14 years old and their teachers in 26 schools of Seville and province. We used, as study tools, the Newcastle Asthma Knowledge Questionnaire, the Gibson attitudes towards asthma, and the Paediatric Asthma Quality of Life Questionnaire. To assess the normality of variables, the Kolmogorov-Smirnov test was used, and for non-parametric variables the U Mann-Whitney and W Wilcoxon tests were used. For the association between variables, we use the regression coefficients and rho Spearman.

RESULTS

We studied 3827 pupils (279 with asthma) and 548 teachers. All had little knowledge about asthma. The quality of life in asthma was mild to moderately affected, and lower in girls, 5.38±1.08 (95% CI=5.20 to 5.55) than in boys 5.77 (± 1.18) (95% CI=5.56 to 5.97), P=.0000. We found no relationship between knowledge, attitudes and quality of life in asthma.

CONCLUSIONS

We found a low level of knowledge about asthma in pupils and teacher. Asthma sufferers have a mild to moderate asthma quality of life, which is worse for girls. Knowledge has no relationship with attitudes to asthma in all groups, or with the quality of life of asthma sufferers.

[Knowledge and attitudes of teachers on children with asthma]

INTRODUCTION

The right management of asthma in the school background is an important issue in order for the disease to make good progress.

AIMS

To find out the situation in schools in Tenerife, to identify the information teachers have about asthma in children, the origin of the information, experience, attitudes and the existence of working protocols in school centres, and educational needs.

INDIVIDUALS AND METHODS

284 teachers of 35 public, private and state financed schools. A survey with 11 questions was performed.

RESULTS

A total of 84% of the teachers were informed about the asthmatic pupils in class, of which. 27% attended to an asthma crisis during school hours. 64% admitted they did not know the main steps to control a seizure, and a 10% of this group had to attend to at least one (p<0.001). There were 58% who could help the child to administer the aerosol, but did not know the first steps on how to control a seizure, versus a 42%, who could not help and did not know those steps (p<0.001). Almost all (95%) expressed their intention to get such information.

CONCLUSIONS

The information and knowledge teachers have is limited and not recorded. The design of a program on educational intervention, as well as individualized information to teachers is needed, and must be suitable for those needs. The symptoms, first steps to stop a seizure and aerosol therapy technique should be considered as fundamental training.