Development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test.
OBJECTIVE
Several heart failure (HF) knowledge tools have been developed and tested over the past decade; however, they vary in content, format, psychometric properties, and availability. This article details the development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test (A-HFKT) as a standardized instrument for both the research and clinical settings.


METHODS
Development and psychometric testing of the A-HFKT were undertaken with 116 New York Heart Association (NYHA) class II and III community-dwelling HF patients and their family members (FMs) participating in a family intervention study. Internal consistency, reliability, and content validity were examined. Construct validity was assessed by correlating education level, literacy, dietary sodium ingestion, medication adherence, and healthcare utilization with knowledge.


RESULTS
Content validity ratings on relevance and clarity ranged from 0.55 to 1.0, with 81% of the items rated from 0.88 to 1.0. Cronbach alpha values were .84 for patients, .75 for FMs, and .73 for combined results. Construct validity testing revealed a small but significant correlation between higher patient and FM knowledge on sodium restriction questions and lower ingested sodium, r = -0.17, P = .05 and r = -0.19, P = .04, respectively, and between patient knowledge and number of days that medications were taken correctly (diuretics: r = 0.173, P < .05, and angiotensin-converting enzyme: r = 0.223, P = .01). Finally, patients seeking emergency care or requiring hospitalization in the 4 months before study entry were found to have significantly lower FM knowledge using both t test and logistic regression modeling.


CONCLUSIONS
The A-HFKT was revised using the content and construct validity data and is available for use with HF patients and FMs. The construct validity testing indicates that patient knowledge has a significant relationship to aspects of self-care. Furthermore, family knowledge may influence patient adherence with sodium restriction and healthcare utilization behavior.
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA. cmill02@emory.edu
Carolyn Miller
CM
Reilly
Melinda
M
Higgins
Andrew
A
Smith
Rebecca A
RA
Gary
Judith
J
Robinson
Patricia C
PC
Clark
Frances
F
McCarty
Sandra B
SB
Dunbar
D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009518:New York; D010349:Patient Compliance; D011594:Psychometrics; D015203:Reproducibility of Results; D012648:Self Care; D011795:Surveys and Questionnaires