Development & Validation of a Bilingual Psychometric Instrument for Assessment of Knowledge, Attitude, Self-care Practice and Health-related Quality of Life (KAPQ-HF) among Heart Failure Patients

Objective: This study was conducted to develop and determine the validity and reliability of a bilingual psychometric instrument for assessment of knowledge, attitude, self-care practice and health-related quality of life (HRQoL) (KAPQ-HF) among Malaysian heart failure (HF) patients. Methods: This was a cross-sectional, quantitative survey conducted in a Malaysian tertiary hospital involving a total of 325 HF patients. The self-administered questionnaire was first developed in Malay language through extensive literature reviews and was assessed for content and face validities, construct validity through item analysis and exploratory factor analysis (EFA), as well as reliability. The tool then underwent forward and back-translation into English and the harmonised English version was checked for reliability. Results: Development of KAPQ-HF generated a total of 41 items and was reduced to 39 items after content and face validity testing, item analysis, factor analysis and reliability testing. Content validation showed that all the items in the questionnaires were essential, relevant and clear with content validity ratio (CVR) and content validity index (I-CVI) of 1.0 for all items. Face validation revealed that the questionnaire was fairly easy, relevant, suitable and acceptable. Factor analysis revealed the presence of simple structure with two factors in each domain with all items loading substantially only on 1 factor. KR-20 and Cronbach’s alpha values which representing reliability of the questionnaire was excellent for HRQoL domain (0.901) and acceptable for knowledge, attitude and self-care practice (0.606, 0.654 and 0.671 respectively). The English version yielded KR-20 and Cronbach’s alpha values of 0.607, 0.635, 0.708, and 0.893 for knowledge, attitude, self-care practice and quality of life respectively. The test-retest also showed that both versions of KAPQ-HF were reproducible (ICC > 0.7; P < 0.001). Conclusion: The newly developed bilingual KAPQ-HF is valid and reliable and may be useful in assessing HF patients in ambulatory settings.