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Development and validation of a low-literacy Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q)

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Abstract

Objective

The objective of this study was to develop a content valid, understandable, readable, and reliable Chronic Obstructive Pulmonary Disease knowledge Questionnaire (COPD-Q).

Methods

Twenty-one questions were generated as potential items to include in the COPD-Q. Twenty-two content experts provided both qualitative and quantitative assessments of two COPD-Q drafts. Ten patient volunteers completed a field test to assess clarity of individual COPD-Q items. An additional 24 patient volunteers completed a pilot test to determine internal consistency and test–retest reliability of the COPD-Q. The Flesch Reading Ease (FRE) was used to assess reading grade level of the COPD-Q.

Results

Thirteen items were rated as “essential” (content validity ratio = p < 0.05) by content experts and composed the final COPD-Q. Internal consistency, using Cronbach's alpha, was 0.72. Test–retest reliability, using intraclass correlation coefficient, was 0.90. The FRE score of the COPD-Q was 74.7 (equivalent to a 5th grade reading level).

Conclusion

The COPD-Q is a valid, readable and reliable knowledge assessment instrument for assessing COPD knowledge in patients who may have low health literacy skills.

Practice implications

Health care providers can use the COPD-Q to tailor counseling efforts according to individual patient needs, and to assess the effectiveness of their educational interventions.

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.

Section snippets

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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