title: Development and psychometric evaluation of a cardiovascular risk and disease management knowledge assessment tool.
abstract: OBJECTIVE
  This article describes the systematic construction and psychometric analysis of a knowledge assessment instrument for phase II cardiac rehabilitation (CR) patients measuring risk modification disease management knowledge and behavioral outcomes derived from national standards relevant to secondary prevention and management of cardiovascular disease.
  
  
  METHODS
  First, using adult curriculum based on disease-specific learning outcomes and competencies, a systematic test item development process was completed by clinical staff. Second, a panel of educational and clinical experts used an iterative process to identify test content domain and arrive at consensus in selecting items meeting criteria. Third, the resulting 31-question instrument, the Cardiac Knowledge Assessment Tool (CKAT), was piloted in CR patients to ensure use of application. Validity and reliability analyses were performed on 3638 adults before test administrations with additional focused analyses on 1999 individuals completing both pretreatment and posttreatment administrations within 6 months.
  
  
  RESULTS
  Evidence of CKAT content validity was substantiated, with 85% agreement among content experts. Evidence of construct validity was demonstrated via factor analysis identifying key underlying factors. Estimates of internal consistency, for example, Cronbach's α = .852 and Spearman-Brown split-half reliability = 0.817 on pretesting, support test reliability. Item analysis, using point biserial correlation, measured relationships between performance on single items and total score (P < .01). Analyses using item difficulty and item discrimination indices further verified item stability and validity of the CKAT.
  
  
  CONCLUSIONS
  A knowledge instrument specifically designed for an adult CR population was systematically developed and tested in a large representative patient population, satisfying psychometric parameters, including validity and reliability.
authors.affiliation: James S. Rosneck, MS, RN Manager, Cardiovascular and Pulmonary Rehabilitation, and Administrative Director, Center for Cardiovascular Research, Summa Health System, Akron; Associate Professor, Department of Sports Science and Wellness Education, The University of Akron, Ohio. Joel Hughes, PhD Director, Applied Psychology Center, and Associate Professor, Psychology Department, Kent State University; Scientific Director, Center for Cardiovascular Research, Summa Health System, Akron; Adjunct Assistant Professor, Francis Payne Bolton School of Nursing, and Adjunct Assistant Professor, Department of Medicine, Case Western Reserve University, Cleveland, Ohio. John Gunstad, PhD Associate Professor, Psychology Department, Kent State University; Research Associate, Center for Cardiovascular Research, Summa Health System, Akron; Adjunct Assistant Professor, Department of Medicine, Case Western Reserve University, Cleveland, Ohio. Richard Josephson, MS, MD Professor of Medicine, Case Western Reserve University School of Medicine, Cleveland; Director, Cardiac Intensive Care Unit/Director, Cardiovascular and Pulmonary Rehabilitation, Harrington Heart & Vascular Institute, University Hospitals Health System, Cleveland, Ohio. Donald A. Noe, BSE Research Associate, Department of Research Administration, Summa Health System, Akron, Ohio. Donna Waechter, PhD Coordinator, Center for Cardiovascular Research, Summa Health System, Akron; Adjunct Professor, Psychology Department, Kent State University, Ohio.
authors.forename: James S
authors.initials: JS
authors.lastname: Rosneck
authors.forename: Joel
authors.initials: J
authors.lastname: Hughes
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.forename: Donald A
authors.initials: DA
authors.lastname: Noe
authors.forename: Donna
authors.initials: D
authors.lastname: Waechter
mesh_terms: D000328:Adult; D000072038:Cardiac Rehabilitation; D019468:Disease Management; D005163:Factor Analysis, Statistical; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006331:Heart Diseases / Q000534:rehabilitation; D006801:Humans; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment; D055502:Secondary Prevention