Short communicationDevelopment and validation of a low-literacy Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q)
Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide with an estimated prevalence of approximately 10% in adults aged 40 years or more [1], [2], [3]. Disease management programs emphasizing patient education can improve health-related quality of life and decrease hospital admissions [4]. Disease state education should be patient-specific and take into account any educational deficiency or evidence of low health literacy skills [5]. Inadequate health literacy, affecting almost 50% of American adults, is a barrier to quality healthcare [6].
Appropriately counseling patients can improve their disease state knowledge level and positively impact patient-specific disease outcomes. Specifically, White et al. found that COPD-related knowledge increased following a COPD educational intervention [7]. The purpose of this study was to develop a content valid, understandable, readable, and reliable COPD knowledge assessment instrument.
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Methods
Development of the COPD-Q followed a step-by-step approach consisting of content validation, patient comprehension, and assessment of readability and reliability [8], [9], [10], [11], [12]. The Universities of Tennessee Graduate School of Medicine-Knoxville and Health Science Center-Memphis Institutional Review Boards approved the study protocol.
Step 1: content validity of COPD-Q
Thirteen COPD-Q items were identified as appropriate for inclusion based on “essential” (CVR ≥ 0.40) ratings by content jurors (see Table 1).
Step 2: field test to assess patient comprehension of COPD-Q items
Ten patient volunteers (mean age = 58.5 ± 11.5 years; female:male ratio = 7:3; 80% without prior COPD knowledge; 10% less than a high school education; 70% at risk for poor health literacy skills) reviewed the initial COPD-Q. One item was revised to improve overall clarity. “An albuterol inhaler (medicine) can be used anytime you are short of breath” was revised
Discussion
Based on content jurors’ review and evaluation, 13 of the initial 21 items had significant CVRs (≥0.40) using the “essential” threshold. Statistical significance of CVR values is inversely proportional to the number of content jurors (i.e., the greater the number of content jurors, the lower the CVR threshold) [18]. Of note, initial questions generated regarding oral steroid use were predominately rated as “not necessary.”
The COPD-Q underwent a field test where 10 volunteers confirmed the
Conflict of interest
None of the authors has any conflict of interest to disclose.
Disclosure statement
At the time of writing, Dr. Maples was a resident at the University of Tennessee Medical Center and the University of Tennessee College of Pharmacy.
Acknowledgement
We would like to acknowledge Eric Heidel, MS, NCC for statistical assistance.
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