Development and psychometric validation of the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II)

Cultural Adaptation and Psychometric Validation of a Cardiac Knowledge Questionnaire for Chinese Immigrants

BACKGROUND

Disease-related knowledge deficits are common in Chinese immigrants living in Western countries, putting them at risk of disease progression and mortality, particularly those with a coronary heart disease (CHD) diagnosis. However, no measurement instrument is available to assess CHD-related knowledge in this population.

OBJECTIVES

The aim of this study was to culturally adapt and examine the psychometric properties of the short version of Coronary Artery Disease Education Questionnaire (CADE-Q SV) (simplified Chinese version) in Chinese immigrants with CHD.

METHODS

Mandarin-speaking people recruited from medical centers and cardiology clinics across metropolitan Sydney completed the 20-item CADE-Q SV (5 domains; potential scores: 0-20). Internal consistency was assessed using Cronbach α . A subgroup (n = 40) repeated the survey 2 weeks later for test-retest reliability by intraclass correlation coefficient. Factor structure (confirmatory factor analysis) and discriminant (known-groups) validation using education and English proficiency (univariate general linear model) were also undertaken.

RESULTS

Participants (n = 202) had a mean (SD) age of 66.08 (10.93) years, 45.1% were male, and the mean (SD) total CADE-Q SV score was 13.07 (4.57). Reliability and consistency were good (intraclass correlation coefficient > 0.70; Cronbach α coefficients > 0.70, for total and per domain, respectively). The 5-domain structure was validated by confirmatory factor analysis. The scale demonstrated discriminant validity, with low education ( P < .001) and low English proficiency ( P = .017) associated with lower knowledge scores.

CONCLUSION

The CADE-Q SV (simplified Chinese version) can be used as a valid and reliable instrument, either paper based or digital, to evaluate the CHD-related knowledge of Chinese immigrants. This scale can be adapted to other migrant populations in the future.

Barriers to cardiac rehabilitation and patient perceptions on the usage of technologies in cardiac rehabilitation: A cross-sectional study

AIMS AND OBJECTIVES

The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation.

BACKGROUND

Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi-ethnic country.

DESIGN

A cross-sectional study design.

METHODS

A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE-Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS).

RESULTS

Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self-driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face-to-face, centre-based cardiac rehabilitation approach.

CONCLUSION

Several barriers were associated with non-participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home-based and hybrid cardiac rehabilitation may represent potential solutions to improve participation.

RELEVANCE TO CLINICAL PRACTICE

By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation.

Translation, cultural adaptation and psychometric validation of the Arabic short version of the coronary artery disease education questionnaire (CADE-Q SV) in Saudi Arabia

Objective

To translate, culturally adapt, and psychometrically validate the Arabic Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV).

Methods

The CADE-Q SV was translated to Arabic by two independent translators, followed by back-translation. Then, an expert panel of 10 healthcare providers and 10 patients reviewed the survey and provided input for content validity (CV) and clarity of items. For the psychometric analysis, 202 cardiac patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, construct, and criterion validity were assessed.

Results

Items were translated, and CV was confirmed. Items were rated based on relevance and understandability. The scale was finalized after changes in 5 items. Confirmatory factor analysis revealed 5 factors, all internally consistent: medical condition, risk factors, exercise, nutrition, and psychosocial health. Overall alpha was 0.84. Construct validity was established by significant associations between scores and occupation, educational level, family income, having a diagnosis of acute coronary syndrome or valve disorders and with a history of valve repair or replacement a coronary artery bypass graft procedure. Scores were significantly higher for those that participated in cardiac rehabilitation, confirming criterion validity.

Conclusions

Results from this study confirm the validity and reliability of the CADE-Q SV in Arabic-speaking patients.

Innovation

The CADE-Q SV can be used as a knowledge measurement to support clinical work and development of education intervention for Arabic patients.

Effect of an avatar-based discharge education application on knowledge and behaviour in people after acute coronary syndrome: protocol for a pragmatic prospective randomised controlled trial

INTRODUCTION

Many hospital presentations for acute coronary syndrome (ACS) occur in people previously hospitalised with coronary heart disease (CHD), leading to increased costs and health burden. Secondary prevention education including a prehospital discharge plan is recommended for all individuals to reduce the risk of recurrence. However, many clinicians lack the time or support to provide education, and patients' uptake of secondary prevention programmes is limited. An avatar-based education app is a novel and engaging way to provide self-delivered, evidence-based secondary prevention information during the hospital admission and remains accessible after discharge. This protocol aims to evaluate the effect of an avatar-based education app on individuals with ACS.

METHODS AND ANALYSIS

This protocol describes a prospective, randomised controlled trial with 3-month follow-up and blinded assessment of 72 participants. Intervention group participants will download the app onto their own device during the hospital admission and independently complete six interactive education modules based on the National Heart Foundation's six steps to cardiac recovery. All participants will receive a text message reminder of the study after 3 weeks. Both groups will receive usual care consisting of bedside education and a pamphlet about cardiac rehabilitation. The primary outcome is knowledge of CHD, assessed using the Coronary Artery Disease Education Questionnaire II. Secondary outcomes include quality of life, response to heart attack symptoms, cardiac-related readmissions and mortality and modifiable cardiac risk factors. Engagement with the app will be evaluated objectively. Intention-to-treat analysis will be conducted, with between-group comparisons and 95% CIs of the primary outcome analysed using analysis of covariance, adjusting for baseline values.

ETHICS AND DISSEMINATION

This study protocol has been approved by the Western Sydney Local Health District Human Research Ethics Committee. The results of this study will be disseminated via a peer-reviewed journal and research thesis.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12622001436763).

Portuguese adaptation of the Chronic Heart Failure Knowledge Questionnaire (KQCHF)

BACKGROUND

A patient's knowledge of heart failure (HF) is associated with better outcomes. The more information patients have about their illness, the less likely they are to be readmitted to the hospital. Such knowledge includes the cause, symptoms, probable duration, and expected evolution of the clinical picture. In Portugal, a tool for testing patient knowledge is an unmet need. Therefore, this study aimed to adapt and test the Chronic Heart Failure Knowledge Questionnaire (KQCHF) for the Portuguese context.

METHODS

This work includes three cross-sectional studies. In Study 1, subjects were divided between before and after receiving information about HF. In Study 2, participants answered the questionnaire before and after reading the brochure. In Study 3, KQCHF was applied to patients with HF. Studies 1 and 2 were carried out in the general population. Study 3 was carried out with HF outpatients. Convenience sampling was applied to participants in the three studies.

RESULTS

In Study 1 (n = 45), those who received information had better scores (9.2 ± 1.9) than those who did not (6.0 ± 2.3). In Study 2 (n = 21), the scores were higher after reading the brochure (10.4 ± 1.7 vs. 6.5 ± 2.9). In Study 3 (n = 169), women had better scores than men (9.1 ± 2.1 vs. 8.3 ± 2.2, overall: 8.5 ± 2.2), and knowledge was correlated with education (r = .340, p < .001) and age (r = -.170, p = .030).

CONCLUSION

The Portuguese adaptation of KQCHF captured relevant knowledge about HF and has shown promising results for clinical and research purposes. The questionnaire can be useful in assessing HF patients' knowledge of their disease and as a basis for the implementation of general and personalised educational strategies to improve HF knowledge and, therefore, promote health literacy and self-care.

Design and Validation of a Scale of Knowledge of Cardiovascular Risk Factors and Lifestyle after Coronary Event

Background: It is important for health professionals to have tools available to assess patients’ knowledge of lifestyle and cardiovascular risk factors after they have suffered a coronary event and determine whether educational interventions are effective. This study aims to design and validate a scale to evaluate this knowledge. Methods: Four-phase instrument design: (A) Conceptual review. (B) Review by experts. (C) Pilot test–retest. (D) Psychometric validation of the final version of the questionnaire with 24 items. A panel of experts performed the content validity. The reliability of the scale was measured using Cronbach’s alpha score and criterion validity was evaluated by comparing the total scores for knowledge obtained by the participants among the three education level groups. The construct and dimensional structure validity were assessed using exploratory factor analysis. Results: A total of 143 people participated, 30 in the pilot study and 113 (68% male, 60.2 ± 9 years) in the psychometric validation of version 3 of the scale. A Cronbach’s alpha score of 0.887 was reached for this version. The factor analysis showed that the items were distributed into five factors that explained 57% of the variance. Significant differences were observed in the level of knowledge among the patients of the three levels of education (low, moderate and high) (99.20 ± 11.93, 105.92 ± 7.85, 109.78 ± 8.76 points, p = 0.003), as there was a negative correlation between age and knowledge level (r = −0.213, p = 0.024). Conclusions: The scale presents psychometric properties that are evidence of its reliability and validity. The relationship demonstrated between the level of knowledge and age, sex and level of education shows the importance of emphasizing educational interventions for elderly people and those with a lower level of education.

The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

OBJECTIVE

Patient education (PE) delivered during exercise-based cardiac rehabilitation (CR) aims to promote health behaviour change, including attendance at CR exercise sessions, by imparting knowledge about coronary artery disease (CAD) and improving CR-related attitudes. This study evaluated the impact of PE on aspects of patient motivation (i.e., CAD-related knowledge, attitudes towards CR) and exercise session attendance.

METHODS

Adults with CAD referred to a 12-week CR program were recruited. CAD knowledge, perceived necessity/suitability of CR, exercise concerns, and barriers to CR were assessed pre/post-PE, and at 12-week follow-up. CR exercise attendance was obtained by chart review.

RESULTS

Among 90 patients (60 ± 10 years; 88% men), CAD knowledge and perceived necessity of CR improved pre- to post-PE; gains persisted at 12-weeks. Stronger pre-CR intentions to attend exercise sessions predicted greater attendance. Greater knowledge gains did not predict improvements in CR attitudes or exercise attendance.

CONCLUSION

Whereas PE may be useful for improving knowledge and attitudes regarding CAD self-management, more formative research is needed to determine whether PE can promote CR attendance.

PRACTICE IMPLICATIONS

Cardiac PE programs may be more successful in promoting exercise attendance if they target patients' behavioural intentions to attend and attitudes toward CR, rather than focussing exclusively on imparting knowledge.

Individualized mobile health interventions for cardiovascular event prevention in patients with coronary heart disease: study protocol for the iCARE randomized controlled trial

Background

Mobile health-based individualized interventions have shown potential effects in managing cardiovascular risk factors. This study aims to assess whether or not mHealth based individualized interventions delivered by an Individualized Cardiovascular Application system for Risk Elimination (iCARE) could reduce the incidence of major cardiovascular events in individuals with coronary heart disease.

Methods

This study is a large-scale, multi-center, parallel-group, open-label, randomized controlled clinical trial. This study will be conducted from September 2019 to December 2025. A total of 2820 patients with coronary heart disease will be recruited from two clinical sites and equally randomized into three groups: the intervention group and two control groups. All participants will be informed of six-time points (at 1, 3, 6, 12, 24, and 36 months after discharge) for follow-up visits. Over a course of 36 months, patients who are randomized to the intervention arm will receive individualized interventions delivered by a fully functional iCARE that using various visualization methods such as comics, videos, pictures, text to provide individualized interventions in addition to standard care. Patients randomized to control group 1 will receive interventions delivered by a modified iCARE that only presented in text in addition to routine care. Control group 2 will only receive routine care. The primary outcome is the incidence of major cardiovascular events within 3 years of discharge. Main secondary outcomes include changes in health behaviors, medication adherence, and cardiovascular health score.

Discussion

If the iCARE trial indeed demonstrates positive effects on patients with coronary heart disease, it will provide empirical evidence for supporting secondary preventive care in this population. Results will inform the design of future research focused on mHealth-based, theory-driven, intelligent, and individualized interventions for cardiovascular risk management.

Trial registration

Trial registered 24th December 2016 with the Chinese Clinical Trial Registry (ChiCTR-INR-16010242). URL: http://www.chictr.org.cn/showproj.aspx?proj=17398.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02153-9.

Validation of the Chinese Version of the Coronary Artery Disease Education Questionnaire - Short Version: A Tool to Evaluate Knowledge of Cardiac Rehabilitation Components

Background:

Patient education is the first step in implementing a cardiac rehabilitation (CR) program and a powerful tool for promoting behavioral changes in cardiac patients. In China, the clinical workload is so heavy that a short and reliable tool for assessing disease-related knowledge is needed for targeted patient education.

Objective:

The aim of this study was to translate, adapt and validate the Chinese version of the Coronary Artery Disease Education Questionnaire – Short Version (CADE-Q SV).

Methods:

The CADE-Q SV was translated to simplified Chinese and culturally adapted to the Chinese context. The translated version was reviewed by a committee of seven experts in cardiovascular disease, and the content validity of the questionnaire was established. The psychometric properties of the questionnaire were analyzed considering the responses of 240 CR patients. The Kuder-Richardson-20 (KR-20) coefficient and Cronbach’s alpha were used to assess internal consistency. The intraclass correlation coefficient (ICC) was used to assess test-retest reliability. The criterion-related validity was evaluated by determining whether there were differences in the total scores of patients with different educational levels. Confirmatory factor analysis (CFA) was used to assess the factor structure.

Results:

Three items from the original version were adapted to reflect Chinese culture. The content validity index was 0.94. The KR-20 score was 0.856. All ICC values were > 0.70. The knowledge scores of patients with different educational levels were significantly different, indicating that the criterion-related validity of the Chinese CADE-Q-SV was acceptable. CFA validated the five-factor structure of the Chinese CADE-Q-SV.

Conclusion:

The Chinese CADE-Q SV questionnaire has good reliability and validity. This short, efficient tool can be completed quickly, assess disease-related knowledge in cardiovascular patients and serve as a reference for individualized patient education in China. It can also be used to evaluate the effectiveness of CR-related patient education interventions.

Cultural adoption, and validation of the Persian version of the coronary artery disease education questionnaire (CADE-Q): a second-order confirmatory factor analysis

BACKGROUND

Evaluating knowledge in patients with coronary artery disease requires a specific measure. The aim of the present study was to translate and evaluate the CADE-Q in patients with coronary artery disease in Iran.

METHODS

Forward-backward procedure was applied to translate the questionnaire from English into Persian. Then a cross-sectional study was conducted to evaluate psychometric properties of the questionnaire. A sample of patients with coronary artery disease attending to cardiac departments of teaching hospitals affiliated to medical universities in Tehran, Iran completed the 19-item CADE-Q from April to December 2017. Structural validity of CADE-Q was assessed using both exploratory and confirmatory factor analyses. Reliability was examined using Cronbach's alpha coefficient. Stability was evaluated by estimation intraclass correlation coefficient.

RESULTS

In all 500 patients participated in the study. The mean age of patients was 53.63. (SD = 14.36) years, and 57% were male. The results obtained from the exploratory factor analysis showed a four factor solution (lifestyle habits and exercise, risk factors, diagnosis and treatment, signals & symptoms and medicine) that jointly explained 48.9% of the total variance observed. However, the second-order confirmatory factor analysis supported the three-factor solution while convergent and divergent validity were not confirmed. Finally, the Cronbach's alpha coefficient of 0.84 ranging from 0.50 to 0.82 was obtained for the scale and its subscales. In addition, the ICC value of 0.88 showed satisfactory stability for the questionnaire.

CONCLUSION

The Coronary Artery Disease Education Questionnaire was found to be a multidimensional instrument. The results confirmed the factor structure of the questionnaire with a second-order analysis. Since the convergent and divergent validity of the scale were not confirmed, further assessment is essential to establish fitness of the questionnaire in Iran.

Vietnamese version of the coronary artery disease education questionnaire-Short version: Translation, adaptation and validation

WHAT IS KNOWN AND OBJECTIVE

Coronary artery disease (CAD) is the leading cause of mortality worldwide. Patient education is an essential part of cardiac patients' care targeting self-management behaviour to reduce risk factors and subsequent events. There has been no Vietnamese questionnaire to assess patient's knowledge about CAD; therefore, the purpose of this study was to translate, cross-culturally adapt and validate the Coronary Artery Disease Education Questionnaire-Short Version (CADE-Q SV) for use in Vietnam.

METHODS

Translation and cross-cultural adaption of the tool were carried out in five stages: (a) two independent translations from English into Vietnamese were produced; (b) these two translations were then synthesized; (c) two translators blinded to the outcome measurements independently created separate back translations into English; (d) nine experts reached consensus on all items of the Vietnamese version of the CADE-Q SV; and (e) a pilot study was conducted on 35 patients with acute coronary syndrome (ACS). The validity and reliability of the questionnaires were then evaluated in 117 Vietnamese patients with ACS. The internal consistency and test-retest reliability were assessed by Cronbach's alpha and Cohen's kappa coefficient, respectively. Construct validity was determined by examining the relationship between knowledge scores and patient characteristics.

RESULTS

The Vietnamese version of CADE-Q SV was created, including 20 items divided into two domains: medical and psychological condition, and nutrition and exercise. There was good equivalence between the original and the Vietnamese versions in all four areas: semantic, idiomatic, experiential and conceptual equivalence. Cronbach's alpha coefficients were acceptable for the questionnaire as a whole (0.78) and for the two domains: medical and psychological condition (0.71) and nutrition and exercise (0.52). All Cohen's kappa coefficients confirmed test-retest reliability (Kappa > 0.600; P < .001). Construct validity was confirmed by a significant correlation of knowledge scores with education level (P = .004).

WHAT IS NEW AND CONCLUSION

The Vietnamese version of CADE-Q SV can be considered a valid and reliable questionnaire to evaluate patient's knowledge of CAD. Further studies could investigate the influence of knowledge scores on adherence to medications and clinical outcomes of patients with CAD.

Maintenance of Gains, Morbidity, and Mortality at 1 Year Following Cardiac Rehabilitation in a Middle-Income Country: A Wait-List Control Crossover Trial

Background

Despite the epidemic of cardiovascular diseases in middle‐income countries, few trials are testing the benefits of cardiac rehabilitation (CR). This trial assessed (1) maintenance of functional capacity, risk factor control, knowledge, and heart‐health behaviors and (2) mortality and morbidity at 6 months following CR in a middle‐income country.

Methods and Results

Eligible Brazilian coronary patients were initially randomized (1:1:1 concealed) to 1 of 3 parallel arms (comprehensive CR [exercise plus education], exercise‐only CR, or wait‐list control). The CR programs were 6 months in duration, at which point follow‐up assessments were performed. Mortality and morbidity were ascertained from chart and patient or family report (blinded). Controls were then offered CR (crossover). Outcomes were again assessed 6 months later (blinded). ANCOVA was performed for each outcome at 12 months. Overall, 115 (88.5%) patients were randomized, and 62 (53.9%) were retained at 1 year. At 6 months, 23 (58.9%) of those 39 initially randomized to the wait‐list control elected to attend CR. Functional capacity, risk factors, knowledge, and heart‐health behaviors were maintained from 6 to 12 months in participants from both CR arms (all P>0.05). At 1 year, knowledge was significantly greater with comprehensive CR at either time point (P<0.001). There were 2 deaths. Hospitalizations (P=0.03), nonfatal myocardial infarctions (P=0.04), and percutaneous coronary interventions (P=0.03) were significantly fewer with CR than control at 6 months.

Conclusions

CR participation is associated with lower morbidity, long‐term maintenance of functional capacity, risk factors, and heart‐health behaviors, as well as with greater cardiovascular knowledge compared with no CR.

Clinical Trial Registration

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02575976.

Validation of a Scale to Assess Patients' Comprehension of Frequently Used Cardiology Terminology: The Cardiac TERM Scale in Brazilian Portuguese

PURPOSE

The aim of this study was to psychometrically validate the translation of a questionnaire on patient understanding of cardiology terminology (TERM) to Brazilian Portuguese.

DESIGN

After piloting the translation and cross-cultural adaptation, the 16-item TERM questionnaire was psychometrically tested.

METHODS

Internal and test-retest reliability, as well as validity, were assessed in 322 cardiac patients.

FINDINGS

Internal (α = .88) and test-retest reliability (all weighted Kappa > 0.63) exceeded the minimum recommended standards. Criterion validity was supported by significant differences in mean scores by socioeconomic indicators (p < .01). Discriminant validity was supported in that cardiac rehabilitation participants had significantly higher TERM scores (p < .001). Participants did not correctly define any of the terms, and a floor effect was identified in all terms.

CONCLUSIONS

The Cardiac TERM Scale was demonstrated to have good reliability and validity.

CLINICAL RELEVANCE

The scale can be used by healthcare professionals, such as nurses. Results can be used to inform patient education, which could in turn impact patient adherence to medical advice and hence outcomes.

Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients

Background

The Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument aimed at assessing patients’ knowledge about coronary artery disease (CAD), was originally developed and psychometrically validated in Brazil. It was later translated, cross-culturally adapted, and validated to English. Although both versions demonstrated good reliability and validity, new studies in the area have pointed out the need of implementing the CADE-Q with other components of cardiac rehabilitation (CR) programs, such as psychologic factors, which had not been considered in previous version and were added in the subsequent, adapted version. Thus, a second version of CADE-Q was developed in English, the CADE-Q II.

Objective

to translate, culturally adapt and psychometrically validate the CADE-Q II in Brazilian Portuguese.

Methods

After translation and review by a Committee of specialists in CR, a version in Brazilian Portuguese was generated and tested in 307 patients in CR. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) in 49 patients; internal consistency was assessed using Cronbach’s alpha (α); and, criterion validity was assessed regarding patients’ educational level and family income. The level of significance adopted for all tests was 5%.

Results

After the ICC analysis, 4 items were excluded. The questionnaire was considered internally consistent (α > 0.7). Associations were found between the mean total scores and the variables schooling (p < 0.001) and income (p < 0.001). Median total score was 53 (14) points corresponding to 65.4% of the total possible score.

Conclusion

The Portuguese version of the CADE-Q II showed sufficient reliability, consistency and validity, supporting its use in future studies.

Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV)

Background

Patient education is an essential part of cardiovascular patients' care targeting self-management behavior to reduce risk factors and subsequent events. Herein, a short and reliable tool to assess patients' knowledge in Brazil is warranted.

Objectives

To translate, culturally-adapt and psychometrically validate the Portuguese version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV).

Methods

The Portuguese CADE-Q SV - translated and culturally-adapted - was reviewed by five bilingual experts in cardiovascular disease. This version was then pre-tested in 21 patients, and clarity of items was checked using a Likert-type scale ranging from 1 = not clear to 10 = very clear. It was then psychometrically tested in 200 cardiovascular patients (41%women; mean age = 58.4 ± 11.6 years old). The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbach's alpha, test-retest reliability through intraclass correlation coefficient (ICC), factor structure using confirmatory factor analysis, and construct validity regarding educational level, family income, and time of diagnosis.

Results

All questions were considered clear by patients (clarity range:7.8-9.6). KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6 factors, all internally consistent. Construct validity was supported by significant differences in total scores by educational level and family income (p < 0.001). The overall mean was 13.08 ± 2.61. The area with the highest knowledge was risk factors and the lowest was psychosocial risk.

Conclusions

The Portuguese CADE-SV was demonstrated to have good validity and reliability. This tool can be applicable in clinical and research settings, assessing cardiovascular patients' knowledge as part of an education programming.

The Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II): translation and validation

OBJECTIVES

It is necessary to assess disease-related knowledge in patients with coronary artery disease (CAD) for tailored patient education; however there is a lack of a well-validated measurement in China. The objective of this study was to translate and validate a Chinese version of the Coronary Artery Disease Education Questionnaire-II (CADEQ-II).

METHODS

The Chinese version of CADEQ-II was translated and culturally adapted. Then, it was tested for psychometric properties through a convenient sampling. Content validity was examined based on a panel of five experts. The item difficulty index and item discrimination index were calculated to assess the item difficulty and item discrimination. Internal consistency reliability was measured with the Cronbach's alpha coefficient. Criterion-related validity was established through comparing scores in patients with different education levels. Construct validity was assessed through confirmatory factor analysis (CFA).

RESULTS

The Chinese version of the CADEQ-II was finalized after deleting three items and modifying two items from the original version. Three hundred and sixteen participants completed the whole questionnaire. Content validity index of the whole questionnaire was 0.87. The Cronbach's alpha coefficient of the overall questionnaire was 0.907. The significant difference of the knowledge scores among patients with different education levels supported criterion-related validity. CFA confirmed the proposed four-factorial structure of the questionnaire.

CONCLUSION

The Chinese version of CADEQ-II had an acceptable reliability and validity among Chinese patients with CAD. It could be used to develop individualized health education for Chinese patients with CAD. Also, it could serve as a suitable outcome measurement to evaluate the effectiveness of education interventions related to CAD.

Development and Psychometric Validation of HIPER-Q to Assess Knowledge of Hypertensive Patients in Cardiac Rehabilitation

BACKGROUND

The absence of instruments capable of measuring the level of knowledge of hypertensive patients in cardiac rehabilitation programs about their disease reflects the lack of specific recommendations for these patients.

OBJECTIVE

To develop and validate a questionnaire to evaluate the knowledge of hypertensive patients in cardiac rehabilitation programs about their disease.

METHODS

A total of 184 hypertensive patients (mean age 60.5 ± 10 years, 66.8% men) were evaluated. Reproducibility was assessed by calculation of the intraclass correlation coefficient using the test-retest method. Internal consistency was assessed by the Cronbach's alpha and the construct validity by the exploratory factorial analysis.

RESULTS

The final version of the instrument had 17 questions organized in areas considered important for patient education. The instrument proposed showed a clarity index of 8.7 (0.25). The intraclass correlation coefficient was 0.804 and the Cronbach's correlation coefficient was 0.648. Factor analysis revealed five factors associated with knowledge areas. Regarding the criterion validity, patients with higher education level and higher family income showed greater knowledge about hypertension.

CONCLUSION

The instrument has a satisfactory clarity index and adequate validity, and can be used to evaluate the knowledge of hypertensive participants in cardiac rehabilitation programs.

Developing an Adapted Cardiac Rehabilitation Training for Home Care Clinicians: PATIENT PERSPECTIVES, CLINICIAN KNOWLEDGE, AND CURRICULUM OVERVIEW

PURPOSE

There is limited evidence that home care clinicians receive education on the core competencies of cardiac rehabilitation (CR). This article describes the development and implementation of a CR training program adapted for home care clinicians, which incorporated the viewpoints of homebound patients with cardiovascular disease.

METHODS

Literature and guideline reviews were performed to glean curriculum content, supplemented with themes identified among patients and clinicians. Semistructured interviews were conducted with homebound patients regarding their perspectives on living with cardiovascular disease and focus groups were held with home care clinicians regarding their perspectives on caring for these patients. Transcripts were analyzed with the constant comparative method. A 15-item questionnaire was administered to home care nurses and rehabilitation therapists pre- and posttraining, and responses were analyzed using a paired sample t test.

RESULTS

Three themes emerged among patients: (1) awareness of heart disease; (2) motivation and caregivers' importance; and (3) barriers to attendance at outpatient CR; and 2 additional themes among clinicians: (4) gaps in care transitions; and (5) educational needs. Questionnaire results demonstrated significantly increased knowledge posttraining compared with pretraining among home care clinicians (pretest mean = 12.81; posttest mean = 14.63, P < .001). There was no significant difference between scores for nurses and rehabilitation therapists.

CONCLUSIONS

Home care clinicians respond well to an adapted CR training to improve care for homebound patients with cardiovascular disease. Clinicians who participated in the training demonstrated an increase in their knowledge and skills of the core competencies for CR.

Effects of comprehensive cardiac rehabilitation on functional capacity and cardiovascular risk factors in Brazilians assisted by public health care: protocol for a randomized controlled trial

Background

Cardiovascular Disease (CVD) is the leading burden of disease worldwide. Moreover, CVD-related death rates are considered an epidemic in low- and middle-income countries (LMICs). Research shows that cardiac rehabilitation (CR) participation reduces death and improves disability and quality of life. Given the growing epidemic of CVD in LMICs and the insufficient evidence about CR programs in these countries, a Randomized Control Trial (RCT) in Latin America is warranted.

Objective

To investigate the effects of comprehensive CR on functional capacity and cardiovascular risk factors.

Method

The design is a single-blinded RCT with three parallel arms: comprehensive CR (exercise + education) versus exercise-based CR versus wait-list control (no CR). The primary outcome will be measured by the Incremental Shuttle Walk Test. Secondary outcomes are risk factors (blood pressure, dyslipidemia, dysglycemia, body mass index and waist circumference); tertiary outcomes are heart health behaviors (exercise, medication adherence, diet, and smoking), knowledge, and depressive symptoms. The CR program is six months in duration. Participants randomized to exercise-based CR will receive 24 weeks of exercise classes. The comprehensive CR group will also receive 24 educational sessions, including a workbook. Every outcome will be assessed at baseline and 6-months later, and mortality will be ascertained at six months and one year.

Conclusion

This will be the first RCT to establish the effects of CR in Latin America. If positive, results will be used to promote broader implementation of comprehensive CR and patient access in the region and to inform a larger-scale trial powered for mortality.

Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement

Cardiovascular disease (CVD) is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be efficacious and cost-effective for secondary prevention in high-income countries. Given its affordability, CR should be more broadly implemented in middle-income countries as well. Hence, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) convened a writing panel to recommend strategies to deliver all core CR components in low-resource settings, namely: (1) initial assessment, (2) lifestyle risk factor management (i.e., diet, tobacco, mental health), (3) medical risk factor management (lipids, blood pressure), (4) education for self-management; (5) return to work; and (6) outcome evaluation. Approaches to delivering these components in alternative, arguably lower-cost settings, such as the home, community and primary care, are provided. Recommendations on delivering each of these components where the most-responsible CR provider is a non-physician, such as an allied healthcare professional or community health care worker, are also provided.

Trust me, it is valid: Research validity in pharmacy education research

Research validity is a complex concept that is often used loosely or conflated with concepts in measurement validity in published quantitative pharmacy education literature. The problem begins with a lack of clarity of the distinction between four types of research validity including measurement, statistical conclusion, internal, and external validity (i.e., generalizability). In many cases published studies provide only incomplete discussions of measurement and external validity. The problem is exacerbated within the context of measurement validity where validation efforts are often reduced to statements about established levels of reliability. Ineffective discussions of research validity make it difficult to interpret study findings. After reading this article, the reader will be able to identify the different types research validity and discuss issues of research validity in quantitative pharmacy education research more completely.

Development, pilot testing and psychometric validation of a short version of the coronary artery disease education questionnaire: The CADE-Q SV

OBJECTIVE

To develop, pilot test and psychometrically validate a shorter version of the coronary artery disease education questionnaire (CADE-Q), called CADE-Q SV.

METHODS

Based on previous versions of the CADE-Q, cardiac rehabilitation (CR) experts developed 20 items divided into 5 knowledge domains to comprise the first version of the CADE-Q SV. To establish content validity, they were reviewed by an expert panel (N=12). Refined items were pilot-tested in 20 patients, in which clarity was provided. A final version was generated and psychometrically-tested in 132CR patients. Test-retest reliability was assessed via the intraclass correlation coefficient (ICC), the internal consistency using Cronbach's alpha, and criterion validity with regard to patients' education and duration in CR.

RESULTS

All ICC coefficients meet the minimum recommended standard. All domains were considered internally consistent (α>0.7). Criterion validity was supported by significant differences in mean scores by educational level (p<0.01) and duration in CR (p<0.05). Knowledge about exercise and nutrition was higher than knowledge about medical condition.

CONCLUSION

The CADE-Q SV was demonstrated to have good reliability and validity.

PRACTICE IMPLICATIONS

This is a short, quick and appropriate tool for application in clinical and research settings, assessing patients' knowledge during CR and as part of education programming.

Knowledge and exercise behavior maintenance in cardiac rehabilitation patients receiving educational interventions

OBJECTIVES

To test whether a theoretically-based education curriculum results in more sustained knowledge, higher scores on Health Action Process Approach (HAPA) constructs, and greater exercise behavior 6 months post-cardiac rehabilitation (CR) when compared to traditional CR education.

BACKGROUND

Patient education is a core component of CR. No research has examined whether this education results in sustained improvements post-program.

METHODS

In this quasi-experimental study, participants exposed to the traditional vs HAPA-based education completed surveys pre, post-CR, and 6 months post-discharge assessing knowledge, HAPA constructs, and exercise.

RESULTS

Ninety-three participants completed the final survey. Knowledge increases post-CR were sustained 6 months post-program, with no differences by curriculum. Many improvements in HAPA constructs observed post-CR were sustained, except for some decay in self-efficacy. Minutes of exercise per week were significantly greater in participants exposed to the HAPA-based curriculum 6 months post-program.

CONCLUSIONS

HAPA-based education in CR has sustained effects on exercise.