Systematic review and content analysis of asthma knowledge questionnaires: A focus on the knowledge surrounding acute exacerbation management

The Flare-OA-16 questionnaire measuring flare in knee and hip osteoarthritis in the patient perspective: scale reduction and validation using a Rasch model

OBJECTIVES

The recent Flare-OA questionnaire measuring flare in knee and hip osteoarthritis (OA) (19 items in 5 domains, numerical rating scale) showed good psychometric properties along with classical test theory. This study aimed to determine its scaling properties by Rasch analysis and to present evidence for a refined scalable version.

STUDY DESIGN AND SETTING

The participants were 398 subjects (mean age 64 years [standard deviation = 8.1], 70.4% women) recruited from Australia, France, and the United States, with clinically and radiologically symptomatic knee or hip OA, who completed an online survey. The sample was split into derivation and validation subsamples, stratified by country and joint. Rasch analysis examined differential item functioning (DIF) for sex, age, country, and joint. A confirmatory factor analysis and an analysis of convergent validity were performed to document the psychometric properties of the short version.

RESULTS

To fit the Rasch model, we reordered thresholds of answering modalities when necessary. Two items were removed. A local dependency between 2 items was solved by combining items modalities into a super-item. A uniform DIF (expected and nonremoved) was identified for one item that was split by joint, and a nonuniform DIF for one item for age and country (removed). The person-item threshold distribution showed a well-focused scale; the confirmatory factor analysis and the analysis of convergent validity showed good fit indicators for the short version.

CONCLUSION

The Rasch analysis was helpful in guiding the decision to refine the measurement instrument. After analysis, the 16-item Flare-OA self-report questionnaire is available for use in clinical research.

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study

OBJECTIVE

We explored Jordanian caregivers' knowledge, attitudes, and practices (KAP) toward asthma in their children.

METHODS

This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants' characteristics were examined using the student-t test and ANOVA.

RESULTS

A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma's clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039).

CONCLUSION

While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Mothers’ knowledge about childhood asthma influences management practices and disease control, but validating knowledge/practice questionnaires is difficult due to the lack of a gold standard. We hypothesized that Latent Class Analysis (LCA) could help identify underlying mother profiles with similar knowledge/practices. A total of 438 mothers of asthmatic children answered a knowledge/practice questionnaire. Using answers to the knowledge/practice questionnaire as manifest variables, LCA identified two classes: Class 1, “poor knowledge” (33%); Class 2, “good knowledge” (67%). Classification accuracy was 0.96. Mothers in Class 2 were more likely to be aware of asthma-worsening factors and indicators of attacks. Mothers in Class 1 were more likely to prevent exposure to tobacco smoke (91.1% vs. 78.8%, p = 0.005). For attacks, mothers in Class 2 were more likely to go to the emergency department and follow the asthma action plan. Mothers in Class 2 more frequently had a high education level (79.5% vs. 65.2%, p = 0.004). Children in Class 2 more frequently had fully controlled asthma (36.7% vs. 25.9%, p = 0.015) and hospitalizations for attacks in the previous 12 months (24.2% vs. 10.7%, p = 0.003). LCA can help discover underlying mother profiles and plan targeted educational interventions.

Development and validation of a Fever Management Questionnaire aimed at parents and care givers

AIM

The symptoms of childhood fever are often inappropriately managed by care givers resulting in overuse of health resources and medication errors. Understanding care giver's knowledge, attitudes and beliefs about fever management using a validated questionnaire is warranted. The aim of this study was to develop and validate a comprehensive Fever Management Questionnaire.

METHODS

The questionnaire items were developed through a content analysis of the literature and current fever management guidelines. For the knowledge component, a multidisciplinary panel of 12 experts assessed content validity of items (n = 35) through a one-round Delphi process. The construct validity of the attitudes and belief items (19 items) were assessed using principal components analysis utilising response data collected from 149 Australian parents and care givers.

RESULTS

Based on the responses from the panel of experts, six items were removed, six items required substantive modification, 13 items required minor modification with the remaining eight items retained in original form. For the Attitudes and Beliefs items, a parsimonious solution with three principal components resulted after removal of six cross-loading items. The factor loadings of each item displayed a strong correlation to one of three components with scores ranging from 0.791 down to 0.541. The resulting Cronbach's α for the tool was 0.729.

CONCLUSION

Psychometric testing of this two-part Fever Management Questionnaire has resulted in a tool with acceptable validity and reliability. This tool should now be used to gather the knowledge and attitudes of care givers surrounding fever management to further understand factors that lead to inappropriate fever management.

Impact of scenario based training on asthma first aid knowledge and skills in school staff: an open label, three-arm, parallel-group repeated measures study

Objective: To test the hypothesis that scenario-based skills training is more effective than knowledge training alone in improving the asthma first aid skills of school personnel. Education developed specifically for non-primary caregivers such as school staff is vital to minimize the risk of mortality associated with asthma. Methods: Schools were allocated to one of three arms to compare AFA knowledge and AFA skills. Arm 1 underwent conventional asthma training, arm 2 underwent scenario-based training and arm 3 had a combination of the two. Conventional asthma training involved a didactic oral presentation. The scenario-based skills training required the participant to describe and demonstrate how they would manage a child having a severe exacerbation of asthma using equipment provided. Follow-up occurred at 3 weeks post baseline and again between 3-7 months after the first training/education visit. Results: Nineteen primary schools (204 participants) were recruited. One-way ANOVA and Bonferroni Post-Hoc Tests showed there was a significant difference in AFA skills scores between the study arms who underwent scenario-based training; arms 2 and 3 (91.5% and 91.1%) and arm 1 who underwent conventional asthma training (77.3%) (p < 0.001). AFA knowledge improved significantly in all study arms with no differences between study arms. Improvements seen in both AFA knowledge and AFA skills were maintained over time. Conclusions: Scenario-based training was superior to conventional didactic asthma training for AFA skills acquisition and overall competency in the administration of AFA and should be included in future asthma training programs.