Effects of educational intervention on mortality and patient-reported outcomes in individuals with heart failure: A randomized controlled trial

ObjectiveTo examine the effects of an educational intervention on patient-reported outcomes and all-cause mortality in heart failure (HF) patientsMethodsIn this randomized controlled trial, we enrolled 122 hospitalized patients with HF. The intervention group (n = 60) received an individual nurse-led education session on HF self-management during hospitalization and three telephone calls after discharge. The control group (n = 62) received care as usual. Patient-reported outcomes were measured at baseline and at 3 and 6 months. Mortality status was determined using the National Death Records. Intervention effects were evaluated using the Cox proportional hazards regression model and linear mixed models.ResultsDuring the follow-up (median: 568 days), 7 deaths (12%) in the intervention group and 15 deaths (24%) in the control group occurred (adjusted hazard ratio, 0.40; 95% confidence interval, 0.16–0.98; P = .046). From baseline to 3 and 6 months, the intervention group showed greater improvements in HF knowledge (difference=6.14, P = .03; difference=5.76, P = .02, respectively), self-care (difference=?6.08, P < .001; difference=?6.16, P < .001, respectively), and health-related quality of life (difference=?11.90, P = .01; difference=?14.57, P = .004, respectively) than the control group.ConclusionEducational intervention with telephone follow-up reduced all-cause mortality and improved patient-reported outcomes.Practice implicationEducational intervention should be considered as part of routine care for HF patients.     

Patient education in groups increases knowledge of osteoporosis and adherence to treatment: A two-year randomized controlled trial

Objective

Non-adherence to pharmacological treatment in osteoporosis is a well-recognized problem. We hypothesized that a group-based educational programme would increase patients’ knowledge and level of adherence with medical treatment.

Methods

A total of 300 patients (32 men aged 65 ± 9 years and 268 women aged 63 ± 8 years), recently diagnosed with osteoporosis, were randomised to either an osteoporosis school programme (four classes of 8-12 participants over four weeks) or a control group. Teaching was multidisciplinary, based on patients’ experiences and background and designed to encourage empowerment. Patients’ knowledge about osteoporosis and adherence to treatment was assessed with self-completed questionnaires at baseline and after 3, 12, and 24 months.

Results

There were no significant differences at baseline between the two groups with respect to knowledge score or level of adherence. At two years’ follow-up, the improvement in knowledge score was 2 [0-4] points (median [25-75 percentiles]) in the school group and 0 [−2 to 2] in controls (p < 0.001) and self-reported adherence to pharmacological therapy was significantly higher in the school group (92%) compared to the control group (80%), p < 0.001.

Conclusion

The programme increased knowledge about osteoporosis and increased self-reported adherence to pharmacological treatment over a period of two years.     

Effects of an educational intervention on heart failure knowledge,self-care behaviors,and health-related quality of life of patients with heart failure: Exploring the role of depression

ObjectivesTo test effects of an educational intervention on patient-reported outcomes among rural heart failure (HF) patients and to examine whether effects differed between patients with and without depression.MethodsPatients (N = 614) were randomized to usual care (UC) or 1 of 2 intervention groups. Both intervention groups received face-to-face education, followed by either 2 phone calls (LITE) or biweekly calls until they demonstrated content competency (PLUS). Follow-up lasted 24 months. Statistical analyses included linear mixed models and subgroup analyses by depression status.ResultsBoth intervention groups showed improvement in HF knowledge at 3 months (LITE–UC, p = 0.003; PLUS–UC, p < 0.001). Improvement lasted 24 months only in the PLUS group. Compared to UC, both intervention groups exhibited better self-care at 3 months (LITE–UC, p < 0.001; PLUS–UC, p < 0.001) and 12 months (LITE–UC, p = 0.001; PLUS–UC, p = 0.002). There were no differences in health-related quality of life (HRQOL) among groups. In subgroup analyses, similar effects were found among non-depressed, but not among depressed patients.ConclusionThe educational intervention improved HF knowledge and self-care, but not HRQOL. No intervention effects were observed in patients with depressive symptoms.Practice ImplicationsThe simple educational intervention is promising to improve HF knowledge and self-care. Additional strategies are needed for depressed patients.     

Mobile phone-based telemonitoring for heart failure management: a randomized controlled trial

Background

Previous trials of telemonitoring for heart failure management have reported inconsistent results, largely due to diverse intervention and study designs. Mobile phones are becoming ubiquitous and economical, but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined.

Objective

The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes.

Methods

One hundred patients were recruited from a heart function clinic and randomized into telemonitoring and control groups. The telemonitoring group (N = 50) took daily weight and blood pressure readings and weekly single-lead ECGs, and answered daily symptom questions on a mobile phone over 6 months. Readings were automatically transmitted wirelessly to the mobile phone and then to data servers. Instructions were sent to the patients’ mobile phones and alerts to a cardiologist’s mobile phone as required.

Results

Baseline questionnaires were completed and returned by 94 patients, and 84 patients returned post-study questionnaires. About 70% of telemonitoring patients completed at least 80% of their possible daily readings. The change in quality of life from baseline to post-study, as measured with the Minnesota Living with Heart Failure Questionnaire, was significantly greater for the telemonitoring group compared to the control group (P = .05). A between-group analysis also found greater post-study self-care maintenance (measured with the Self-Care of Heart Failure Index) for the telemonitoring group (P = .03). Brain natriuretic peptide (BNP) levels, self-care management, and left ventricular ejection fraction (LVEF) improved significantly for both groups from baseline to post-study, but did not show a between-group difference. However, a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post-study in BNP (decreased by 150 pg/mL, P = .02), LVEF (increased by 7.4%, P = .005) and self-care maintenance (increased by 7 points, P = .05) and management (increased by 14 points, P = .03), while the control group did not. No differences were found between the telemonitoring and control groups in terms of hospitalization, mortality, or emergency department visits, but the trial was underpowered to detect differences in these metrics.

Conclusions

Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system. The use of the mobile phone-based system had high adherence and was feasible for patients, including the elderly and those with no experience with mobile phones.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00778986","term_id":"NCT00778986"}}NCT00778986     

Effects of patient education and therapeutic suggestions on cataract surgery patients: A randomized controlled clinical trial

Objective

This paper describes a randomized controlled single blind study testing the effects of a patient education intervention combined with positive therapeutic suggestions on anxiety for cataract surgery patients.

Methods

84 patients participated in the study. Physiological and behavioral indicators of anxiety were compared between a regularly treated control and an intervention group receiving an audio CD containing information, relaxation, and positive imagery.

Results

We found that the intervention group was calmer throughout the four measurement points of the study (p = .004; d = 0.71) and they were more cooperative (p = .01; d = 0.60) during the operation. The groups did not differ in sleep quality before the day of the operation, heart rate during the procedure, and subjective Well-being.

Conclusion

Findings indicate that preoperative information combined with positive suggestions and anxiety management techniques might reduce patient anxiety in the perioperative period of cataract surgery, but further research is needed to investigate the benefits of such interventions and to uncover the underlying mechanisms.

Practice implications

Patient education interventions providing additional anxiety management techniques are recommended for use prior to cataract surgery.     

Ethnic and gender differences in patient education about heart disease risk and prevention

Objective

To investigate whether there are gender and ethnic disparities in the patient education provided by primary healthcare providers about heart disease (HD) risk and prevention.

Methods

A telephone survey, conducted in four languages, was completed by 976 people, 40+ years of age, in Metro Vancouver, Canada. Questions assessing communication with healthcare providers’ provision of HD risk and management education were the focus.

Results

Statistically significant gender and ethnic differences were found. Women were less likely to report discussing HD risk and management with their healthcare providers. Chinese-Canadian participants had less likelihood of receiving HD education compared with participants of other ethnic origins. These differences persisted after multivariate adjustment with income, highest level of education attained, age, and other factors.

Conclusion

Primary healthcare providers should make improved efforts towards education about HD and its risk factors for women in general, and for postmenopausal women especially.

Practice implications

Healthcare providers should be aware that some ethnic populations may not be receiving patient education similar to that received by people of other communities, as found for Chinese-Canadian members of this study community. Further understanding of the barriers faced by ethnic groups must be gained to develop solutions.     

Effects of video-based, online education on behavioral and knowledge outcomes in sunscreen use: A randomized controlled trial

Objectives

To compare online video and pamphlet education at improving patient comprehension and adherence to sunscreen use, and to assess patient satisfaction with the two educational approaches.

Methods

In a randomized controlled trial, 94 participants received either online, video-based education or pamphlet-based education that described the importance and proper use of sunscreen. Sun protective knowledge and sunscreen application behaviors were assessed at baseline and 12 weeks after group-specific intervention.

Results

Participants in both groups had similar levels of baseline sunscreen knowledge. Post-study analysis revealed significantly greater improvement in the knowledge scores from video group members compared to the pamphlet group (p = 0.003). More importantly, video group participants reported greater sunscreen adherence (p < 0.001). Finally, the video group rated their education vehicle more useful and appealing than the pamphlet group (p < 0.001), and video group participants referred to the video more frequently (p = 0.018).

Conclusion

Video-based learning is a more effective educational tool for teaching sun protective knowledge and encouraging sunscreen use than written materials.

Practice implications

More effective patient educational methods to encourage sun protection activities, such as regular sunscreen use, have the potential to increase awareness and foster positive, preventative health behaviors against skin cancers.     

Patients are expecting to learn more: A longitudinal study of patients with heart failure undergoing device implantation

ObjectiveTo explore the educational expectations and experiences of patients with heart failure in relation to device implantation.MethodsIn this longitudinal study, patients at six Swedish and Icelandic hospitals answered instruments about their knowledge expectations, before the device implantation, and about the knowledge they had received at two weeks, six months and 12 months after the procedure. Predictors for fulfillment of knowledge expectations were assessed with linear mixed model analysis.ResultsPatients (N = 133, mean age 69.8 (±9.7) years, 80 % men) had high knowledge expectations, which for 83 % of them were unfulfilled. Predictors for fulfillment of knowledge expectations were access to knowledge from healthcare professionals (β 0.74, 95 % CI: 0.42–1.10), educational level (β −0.30, 95 % CI: −0.52 to −0.07) and knowledge expectations (β -1.03, 95 % CI: −1.30 to −0.80). Healthcare professionals were the main information source (89 %), 74 % of patients received written information, and 19 % had used the Internet.ConclusionsPatients receive less knowledge than they expect, and individual factors and communication with healthcare professionals are related to their experience. Face-to-face is the most common method of delivering education.Practice implicationsHealthcare professionals should assess patients’ expectations for information and consider implementing more diversity in their educational practices.     

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

ObjectivePatient 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.MethodsAdults 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.ResultsAmong 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.ConclusionWhereas 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 implicationsCardiac 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.     

Impact of adding a video to patient education on quality of life among adults with atrial fibrillation: a randomized controlled trial

ObjectiveTo assess whether adding a video on atrial fibrillation (AF) to a face-to-face educational session improves quality of life (QoL), knowledge, and health resource utilization (HRU) among AF patients.MethodsIn this parallel clinical trial, adults with AF received a face-to-face educational session on AF and were randomly allocated to watch an educational video or not. Self-reported questionnaires measured QoL (primary outcome; score 0–100), AF knowledge (score 0–25), and HRU. Data were collected before and after interventions. Within- and between-group changes were estimated by mixed models.ResultsSixty participants (age: 56 ± 13 years; men: n = 41) were allocated to watch the video after education (n = 30) or to receive education only (n = 30). Within groups over time, QoL and knowledge significantly improved. Knowledge increased by 2.3 units (95% confidence interval: 0.5–4.1) more in participants who watched the video than in others (P = 0.014). Changes in QoL and HRU were not different between groups.ConclusionComplementing education with a video on AF did not result in additional positive impacts on QoL and HRU among AF adults but led to greater improvements in AF knowledge.Practice ImplicationsThe video on AF could be used as part of educational sessions to increase AF knowledge in AF patients.     

The effects of two health information texts on patient recognition memory: A randomized controlled trial

Objective

To compare the effects of two health information texts on patient recognition memory, a key aspect of comprehension.

Methods

Randomized controlled trial (N = 60), comparing the effects of experimental and control colorectal cancer (CRC) screening texts on recognition memory, measured using a statement recognition test, accounting for response bias (score range −0.91 to 5.34). The experimental text had a lower Flesch–Kincaid reading grade level (7.4 versus 9.6), was more focused on addressing screening barriers, and employed more comparative tables than the control text.

Results

Recognition memory was higher in the experimental group (2.54 versus 1.09, t = −3.63, P = 0.001), including after adjustment for age, education, and health literacy (β = 0.42, 95% CI: 0.17, 0.68, P = 0.001), and in analyses limited to persons with college degrees (β = 0.52, 95% CI: 0.18, 0.86, P = 0.004) or no self-reported health literacy problems (β = 0.39, 95% CI: 0.07, 0.71, P = 0.02).

Conclusion

An experimental CRC screening text improved recognition memory, including among patients with high education and self-assessed health literacy.

Practice implications

CRC screening texts comparable to our experimental text may be warranted for all screening-eligible patients, if such texts improve screening uptake.     

The impact of an interactive,multifaceted education approach for congenital cataract on parental anxiety,knowledge and satisfaction: A randomized,controlled trial

ObjectiveThe aim of our research was to examine the impact of a patient education program for parents of children with congenital cataract on parental stress, comprehension of disease information and parental satisfaction.MethodsThis prospective study included 177 parents of children with congenital cataract. The children were randomized into the following groups: the health education program with a multifaceted, interactive approach and conventional follow-up. Self-administered questionnaires were used for parental evaluation before and after the education program. The anxiety level, parental satisfaction and comprehension of the information were evaluated at each time point.ResultsA multifaceted, interactive approach to education significantly reduced parental levels of anxiety compared with the conventional group (effect sizes: Parenting Stress Index, ƞ2 = 0.285; Ocular Treatment Index, ƞ2 = 0.346). This approach also improved comprehension–memorization scores (effect sizes: ƞ2 = 0.303) and parental satisfaction (p < 0.001). The impact of this new intervention was maintained for 6 and 12 months after the course.ConclusionThe interactive, multifaceted education approach could efficiently improve the comprehension of disease-related information and parental satisfaction, resulting in significantly decreased parental anxiety.Practice implicationsThis new patient education approach had a significant impact on congenital cataracts and may be generalized to other pediatric diseases.     

Nurse and patient communication profiles in a home-based telehealth intervention for heart failure management

OBJECTIVE: This study compared differences in nurse and patient communication profiles between two telehealth modes: telephone and videophone, and evaluated longitudinal changes in communication, nurse perceptions, and patient satisfaction. METHODS: Subjects were enrolled in a randomized controlled clinical trial evaluating a 90-day home-based intervention for heart failure. Telephone (n=14) and videophone (n=14) interactions were audio taped and analyzed using the Roter Interaction Analysis System. RESULTS: Nurses were more likely to use open-ended questions, back-channel responses, friendly jokes, and checks for understanding on the telephone compared to videophone. Compliments given and partnership were more common on the videophone. Patients were more likely to give lifestyle information and approval comments on the telephone, and used more closed-ended questions on the videophone. Nurses perceptions of the interactions were not different between the telephone and videophone, nor did their perceptions change significantly over the course of the intervention. There were no significant differences in patient satisfaction between the telephone and videophone. CONCLUSIONS: The results of this study did not support use of a videophone over the telephone. PRACTICE IMPLICATIONS: It is critical to match technologies to patient needs and use the least complex technology possible. When considering use a videophone, health care providers should critically examine the trade-offs between additional complexities with the added value of the visual interaction.     

The effect of nurse-led education on hospitalisation,readmission, quality of life and cost in adults with heart failure. A systematic review

Objective

The purpose of this systematic review was to highlight the effect of nurse-led 1:1 patient education sessions on Quality of Life (QoL), readmission rates and healthcare costs for adults with heart failure (HF) living independently in the community.

Tuning cardiac performance in ischemic heart disease and failure by modulating myofilament function

The cardiac myofilaments are composed of highly ordered arrays of proteins that coordinate cardiac contraction and relaxation in response to the rhythmic waves of [Ca(2+)] during the cardiac cycle. Several cardiac disease states are associated with altered myofilament protein interactions that contribute to cardiac dysfunction. During acute myocardial ischemia, the sensitivity of the myofilaments to activating Ca(2+) is drastically reduced, largely due to the effects of intracellular acidosis on the contractile machinery. Myofilament Ca(2+) sensitivity remains compromised in post-ischemic or "stunned" myocardium even after complete restoration of blood flow and intracellular pH, likely because of covalent modifications of or proteolytic injury to contractile proteins. In contrast, myofilament Ca(2+) sensitivity can be increased in chronic heart failure, owing in part to decreased phosphorylation of troponin I, the inhibitory subunit of the troponin regulatory complex. We highlight, in this paper, the central role of the myofilaments in the pathophysiology of each of these distinct disease entities, with a particular focus on the molecular switch protein troponin I. We also discuss the beneficial effects of a genetically engineered cardiac troponin I, with a histidine button substitution at C-terminal residue 164, for a variety of pathophysiologic conditions, including hypoxia, ischemia, ischemia-reperfusion and chronic heart failure.     

Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure

The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.     

Development and initial validation of a heart disease knowledge questionnaire for people with rheumatoid arthritis

Objective

To develop and validate two parallel versions of the Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a modified and RA-specific version of the HDFQ.

Methods

The questionnaire was composed of generic questions from the original HDFQ with additional RA-specific questions added. Cognitive interviewing was performed and the questionnaire piloted to generate two parallel questionnaires. For psychometric validation, 130 patients with RA completed the questionnaires at baseline and 2 weeks later.

Results

Parallel form reliability of both questionnaires was established; the median score for both questionnaires was 9/13 with no statistical difference in scores. Kuder–Richardson-20 formula was 0.65 and 0.67 for both questionnaires. Test–retest stability showed constant median scores of 9/13 and no statistical difference in scores between baseline and follow-up. Known groups comparison revealed that patients who had self-educated themselves about heart disease, or who were taking CVD medications, had significantly higher scores on the questionnaires.

Conclusion

The two parallel forms of the HDFQ-RA have been shown to be equivalent measures of CVD knowledge and evidence supporting their reliability and validity is presented.

Practice implications

The HDFQ-RA is an appropriate tool for application in clinical and research settings, e.g., assessing novel educational interventions or tracking participants’ progress on an education course.     

心衰大鼠心肌核因子-κB活化及其与心肌细胞凋亡的关系

目的:探讨核因子-κB(NF-κB)活化与充血性心力衰竭(CHF)大鼠心肌细胞凋亡发生、发展的关系及其对Fas和Fas配体(FasL)表达的调控作用。方法:以假手术组为对照,观察雄性Wistar大鼠心肌梗死(MI)后2周、4周及8周的血流动力学指标、心肌细胞凋亡指数、Fas、FasL、Bcl-2和κB抑制蛋白的表达及NF-κB核结合活性的改变。结果:MI后心肌细胞凋亡指数、Fas及FasL表达水平进行性升高,Bcl-2的mRNA表达下调;κB抑制蛋白水平逐渐降低,而NF-κB活性逐渐增高。结论:心肌细胞凋亡在MI后CHF发生、发展过程中起着重要作用,NF-κB活化启动Fas和FasL基因转录,Fas和FasL表达上调、Bcl-2表达下降介导大鼠MI后心肌细胞凋亡的发生。     

Predictors of refusal during a multi-step recruitment process for a randomized controlled trial of arthritis education

Objective

Randomized controlled trials in patient education often have difficulty enrolling vulnerable populations—specifically, older, poorer, and less educated individuals. We undertook a randomized controlled trial (RCT) of an educational intervention for arthritis management, which included strategies to remove literacy-related barriers to participation. This paper reports on the multi-stage recruitment process and assesses whether refusal to participate was related to education, age, gender, working status, or insurance status.

Methods

The recruitment protocol was designed to eliminate literacy-related barriers to participation. Patients were never asked to read or fill out forms. Interactions were oral, using everyday terms and short, clear sentences. Patients who declined during a screening call were considered Stage 1 Refusers. Patients who initially expressed interest but neither completed a baseline questionnaire nor provided consent were considered Stage 2 Refusers. Patients who consented were considered Enrollees. Age, gender, and insurance status were compared between Stage 1 Refusers and Enrollees. A second analysis compared these variables, plus educational attainment and working status, between Stage 2 Refusers, and Enrollees.

Results

Of 408 eligible patients, there were 193 (47.3%) Stage 1 Refusers, 81 (19.9%) Stage 2 Refusers and 134 (32.8%) Enrollees. A higher proportion of Stage 1 Refusers than Enrollees were ≥65 years old (58% vs. 37%, p = .0003). Multivariate analysis, adjusting for gender and insurance status, confirmed the effect of older age on refusal (OR = 2.3 (1.4, 3.6)). There were no significant differences between Stage 2 Refusers and Enrollees.

Conclusion

We found no evidence of refusal to participate due to educational attainment, working status, insurance status, or gender. Older patients were more likely to refuse participation at the first stage of recruitment.

Practice implications

Researchers should continue efforts to increase participation among older patients, particularly when studies are designed to be generalized to an elderly population as is the case with arthritis research. Strategies used in this recruitment protocol designed to remove literacy-related barriers to recruitment may be responsible for the observation that subjects with lower education did not have a higher rate of refusal. Such strategies deserve further study.     

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

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.