title: Cardiac instrument development in a low-literacy population: the revised Chest Discomfort Diary.
abstract: OBJECTIVE
  The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy.
  
  
  METHODS
  The study design was descriptive and correlational.
  
  
  METHODS
  The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain.
  
  
  RESULTS
  Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of "typical angina." Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy.
  
  
  CONCLUSIONS
  The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients' chronic angina.
authors.affiliation: Emory University School of Nursing, Atlanta, Georgia, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Kimble
authors.forename: S B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: D B
authors.initials: DB
authors.lastname: McGuire
authors.forename: A
authors.initials: A
authors.lastname: De
authors.forename: S
authors.initials: S
authors.lastname: Fazio
authors.forename: O L
authors.initials: OL
authors.lastname: Strickland
mesh_terms: D000328:Adult; D001741:Black or African American / Q000193:education / Q000706:statistics & numerical data; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology; D002637:Chest Pain / Q000453:epidemiology* / Q000209:etiology*; D002908:Chronic Disease; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation*; D008499:Medical Records; D008875:Middle Aged; D010147:Pain Measurement / Q000295:instrumentation* / Q000379:methods; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D010358:Patient Participation; D010865:Pilot Projects; D012647:Self-Assessment; D015144:Southeastern United States / Q000453:epidemiology; D011795:Surveys and Questionnaires