title: Development and validation of a cross-cultural knowledge, attitudes, and practices survey instrument for chronic kidney disease in a Swahili-speaking population.
abstract: BACKGROUND
  Non-communicable diseases are a growing global burden, and structured surveys can identify critical gaps to address this epidemic. In sub-Saharan Africa, there are very few well-tested survey instruments measuring population attributes related to non-communicable diseases. To meet this need, we have developed and validated the first instrument evaluating knowledge, attitudes and practices pertaining to chronic kidney disease in a Swahili-speaking population.
  
  
  RESULTS
  Between December 2013 and June 2014, we conducted a four-stage, mixed-methods study among adults from the general population of northern Tanzania. In stage 1, the survey instrument was constructed in English by a group of cross-cultural experts from multiple disciplines and through content analysis of focus group discussions to ensure local significance. Following translation, in stage 2, we piloted the survey through cognitive and structured interviews, and in stage 3, in order to obtain initial evidence of reliability and construct validity, we recruited and then administered the instrument to a random sample of 606 adults. In stage 4, we conducted analyses to establish test-retest reliability and known-groups validity which was informed by thematic analysis of the qualitative data in stages 1 and 2. The final version consisted of 25 items divided into three conceptual domains: knowledge, attitudes and practices. Each item demonstrated excellent test-retest reliability with established content and construct validity.
  
  
  CONCLUSIONS
  We have developed a reliable and valid cross-cultural survey instrument designed to measure knowledge, attitudes and practices of chronic kidney disease in a Swahili-speaking population of Northern Tanzania. This instrument may be valuable for addressing gaps in non-communicable diseases care by understanding preferences regarding healthcare, formulating educational initiatives, and directing development of chronic disease management programs that incorporate chronic kidney disease across sub-Saharan Africa.
authors: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors: John W
authors: JW
authors: Stanifer
authors: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors: Francis
authors: F
authors: Karia
authors: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America.
authors: Corrine I
authors: CI
authors: Voils
authors: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America; Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, United States of America.
authors: Elizabeth L
authors: EL
authors: Turner
authors: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors: Venance
authors: V
authors: Maro
authors: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors: Dionis
authors: D
authors: Shimbi
authors: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors: Humphrey
authors: H
authors: Kilawe
authors: Kilimanjaro Christian Medical College, Moshi, Tanzania.
authors: Matayo
authors: M
authors: Lazaro
authors: Department of Medicine, Duke University, Durham, North Carolina, United States of America; Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina, United States of America; Duke Clinical Research Institute, Duke University, Durham, North Carolina, United States of America.
authors: Uptal D
authors: UD
authors: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D003431:Cross-Cultural Comparison; D003710:Demography; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys / Q000379:methods*; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D015203:Reproducibility of Results; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult