Validation of a questionnaire measuring patient knowledge of atrial fibrillation in an Asian cohort

Abstract

Background: Poor patient understanding of atrial fibrillation (AF) may contribute to underuse of anticoagulation. There are no validated instruments to measure patient knowledge in Asian cohorts. This study aims to validate a disease-specific questionnaire measuring the level of understanding of AF and its treatment among patients with AF in Singapore.

Methods: A 10-item interviewer-administered questionnaire was created based on previously published questionnaires. Face and content validity were assessed. 165 participants were identified by convenience sampling at cardiology clinics of a tertiary hospital. The questionnaire was administered in either English (n = 53) or Mandarin (n = 112). Exploratory factor analysis was performed using principal component method. Internal consistency was evaluated using Cronbach's alpha coefficient.

Results: Face validity was tested by surveying 10 cardiologists who could all identify what the questionnaire was designed to measure. Mean content validity ratio across items was 0.9. Participants were 68.7 (SD 10.5) years old. 55.8% were male. 95.2% were on oral anticoagulation. Kaiser-Meyer-Olkin measure was 0.67 and Bartlett's test of sphericity was significant (p < 0.01). Four factors were retained based on the eigenvalue > 1. These were knowledge of the following: disease characteristics, disease-specific treatment, role of treatment in symptom management and treatment mechanisms. Internal consistency was good (Cronbach's alpha = 0.71).

Conclusions: A questionnaire on the knowledge of AF and its treatment was validated in a cohort of Asian patients in English and Mandarin. It allows quantification of patient knowledge and may be useful in Asian populations to assess the efficacy of interventions to improve patient understanding of AF.

Keywords: atrial fibrillation; patient knowledge; psychometric; questionnaire.

Figure 1

English version of questionnaire. AF, atrial fibrillation; INR, international normalised ratio; NUH, National University Hospital; TIA, transient ischaemic attack.