Assessment
Development and psychometric validation of the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II)

https://doi.org/10.1016/j.pec.2014.11.019Get rights and content

Highlights

  • CADE-Q II is more comprehensive and updated than its first version.

  • It was designed specifically to assess patients’ knowledge in CR.

  • It can also be used to tailor educational components of CR programmes.

  • It has strong psychometric properties, providing evidence of its reliability and validity.

Abstract

Objectives

To develop and psychometrically-validate a revised version of the Coronary Artery Disease Education Questionnaire (CADE-Q) – a tool to assess patients’ knowledge about CAD in cardiac rehabilitation (CR).

Methods

After a needs assessment, a literature review and focus group with CR experts, the revised questionnaire was developed. It underwent pilot-testing in 30 patients, which lead to further refinement. The questionnaire was then psychometrically-tested in 307 CR patients. Internal consistency was assessed using Cronbach's alpha, the dimensional structure through exploratory factor analysis, and criterion validity with regard to educational level.

Results

Cronbach's alpha was 0.91. Criterion validity was supported by significant differences in mean scores by educational level (p < 0.001). Factor analysis revealed four factors, which were internally-consistent (0.65–0.77), and well-defined by items. The mean total score was 64.2 ± 18.1/93. Patients with a history of heart failure, cardiomyopathy and percutaneous coronary intervention (p < 0.05) had significantly higher knowledge scores compared with patients without such a history. Knowledge about exercise and their medical condition was significantly higher than risk factors, nutrition and psychosocial risk.

Conclusions

The CADE-QII has good reliability and validity.

Practical implications

This tool may be useful to assess CR participants’ knowledge gaps, and to evaluate the efficacy of educational delivery in CR.

Introduction

Cardiovascular diseases (CVDs) are the leading cause of death worldwide [1], and a significant contributor to morbidity and health-related costs [2]. Coronary Artery Disease (CAD) – the most common type of CVD – is increasing in prevalence due to improvements in acute care. Accordingly, chronic disease management is needed to optimize secondary prevention, including patient education [3], [4], [5]. Findings from a recent systematic review confirm the benefits of educational interventions in CAD patients, through increasing knowledge and facilitation of heart health behaviour change [6].

Cardiac rehabilitation (CR) is a comprehensive risk reduction programme recommended for CVD patients [4], [5], [7]. Patients participate in CR approximately two times a week over a few months, during which time medical and lifestyle risk factors are managed, cardioprotective therapies are optimized and psychosocial health is promoted. Patient education is considered one of the core components of CR [3], [8], [9], [10], to promote patient understanding of the multitude of recommended therapies and behaviour changes, as well as their adoption and maintenance [11], [12], [13].

In order to plan and deliver an effective CR educational intervention, it is important to have precise information of what cardiac patients know about their condition [11], [14]. Accordingly, the 19-item Coronary Artery Disease Education Questionnaire (CADE-Q) was previously developed and psychometrically-validated to assess CR patients’ knowledge about CAD [15], [16], [17]. It is one of the very few available tools to measure CAD patient knowledge in the CR context that is psychometrically-validated [18], [19], [20], [21]. Although it demonstrated good reliability and validity, the CADE-Q failed to assess all the core components of cardiac rehabilitation (CR), most notably excluding nutrition and psychosocial knowledge. Considering that the focus of CR have been changed over the past years – from exercise-only to comprehensive secondary prevention [3], [6] – this second version of the CADE-Q II was developed to not only update content, but to address all components of cardiac patients’ care. For instance, psychosocial health is considered a core component of CR, and this area is now included in the scale. Therefore, the availability of a more comprehensive and updated CADE-Q is important to assess cardiac patients’ knowledge and to tailor the educational component of CR programmes [22]. The aim of this study was to develop and psychometrically-validate a revised version of the CADE-Q (CADE-Q II).

Section snippets

Design and procedure

This study was reviewed and approved by the University Health Network Research Ethics Board. The design consisted of a series of cross-sectional, observational studies.

The first step in this research was the development of a revised survey based on a literature review. A literature search on patient education in CR, and review of CR practice guidelines [3], [8], [9], [10] was performed to identify the most important information that coronary patients need to know about their disease and its’

Participants characteristics

For the content validation, there were 10 (75%) clinicians, and 5 (25%) researchers who reviewed the items (N = 15). For the pilot test, 50 CR graduates were contacted and 30 (60%) responded, of which 8 (27%) were female. Respondents had a mean age of 68.7 ± 8.4, and had participated in a mean (25th–75th percentile) of 15.0 ± 20.8 (1.0–29.0) months of CR.

For the psychometric validation study, 307 coronary patients (representing approximately 26% of total annual CR patients) completed the CADE-Q II.

Discussion

The development of the CADE-Q II was undertaken using best practices, and this study has demonstrated it is reliability, validity and multi-faceted structure. Since patient education is a core component of CR, the CADE-Q II will be instrumental to healthcare providers to convey what information cardiac patients need to know about CAD and its’ management, as well as to evaluate educational strategies for these patients. This initial study suggests that patients overall knowledge at the beginning

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  • Cited by (34)

    • The impact of patient education on knowledge, attitudes, and cardiac rehabilitation attendance among patients with coronary artery disease

      2021, Patient Education and Counseling
      Citation Excerpt :

      While a short version of the CADE-Q-II was recently validated (i.e., the CADE-Q SV containing 13 true-false-don’t know questions) [35], the CADE-Q-II was chosen for this study to increase potential variance in the data, and optimize statistical power. Results from a psychometric validation study conducted with patients with CAD referred to CR, who either had not yet initiated CR or were in their first week of the program (N = 307), provide good evidence for the CADE-Q-II’s reliability and validity [34]. Approximately half of participants demonstrated initial CAD knowledge ≥ 75% (≥70/93 points).

    • Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement

      2016, Progress in Cardiovascular Diseases
      Citation Excerpt :

      The CADE-Q failed to assess all core components of CR, such as nutrition and psychosocial risk. Therefore, the CADE-Q II was developed and psychometrically-validated.142 It has been demonstrated to be sensitive to change from pre to post-CR and as such should be administered at both points, but has not yet been validated in LMICs.

    View all citing articles on Scopus

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