The validity and reliability of the Malaysian Osteoporosis Knowledge Tool in postmenopausal women

Osteoporosis Knowledge Assessment Tool - Tamil (OKAT-T) in postmenopausal women: A validity and reliability study

Introduction

Osteoporosis is a silent disease that is more prevalent among postmenopausal women (PMW) due to hormonal transition. Various toolkits, including the Osteoporosis Knowledge Assessment Tool (OKAT), were available for the knowledge assessment. The Osteoporosis-related knowledge is crucial for preventing osteoporosis, but there is no validated, reliable questionnaire in Tamil to measure this knowledge.

Aim

To validate the Tamil version of the OKAT (OKAT-T) and its psychometric properties to measure the knowledge of osteoporosis for use in postmenopausal women.

Methodology

This cross-sectional study was done in two phases, as translation of OKAT in Tamil and validation of OKAT-T among 430 postmenopausal women in both rural and urban regions. Reliability was examined by the Flesch reading ease (FKRE&G) and McNemar's test, along with difficulty index, item discrimination and item-total correlations, inter-item consistency (Cronbach's alpha coefficient).

Result

The overall mean age of the 430 PMW was 59.53 ± 9.83 years. The results showed a good and satisfactory face validity and FKRE&G score (55.9). The Cronbach's alpha for the overall scale was calculated as 0.85 and considered to be good and satisfactory. As per the difficulty index, 19 items had a 0.3 to 0.7, implying that the questionnaire was easy to understand and satisfactory. Similarly, a test-retest was assessed, which was statistically significant for only six items out of 26, showing that the tool has stable reliability.

Conclusion

The management of chronic disorders such as osteoporosis has become more challenging for patients especially among PMW and healthcare professionals due to the increasing life expectancy and urbanization. The use of an Osteoporosis Knowledge Assessment tool that has been tailored to people's understanding and developed in the local language can raise awareness levels about osteoporosis, encourage the adoption of osteoprotective strategies, and provide guidance on treatment options.

Development and validation of the Adult cirrhosiS Knowledge Questionnaire

BACKGROUND

Assessing a patient's knowledge regarding liver cirrhosis is important to improve patient outcomes. This study aimed to develop and validate the Adult cirrhosiS Knowledge Questionnaire (ASK-Q) to assess patients' knowledge regarding liver cirrhosis from multiple aspects.

METHODS

A 24-item ASK-Q with four domains: self-understanding (5 items), aetiology (5 items), complications (5 items) and management (9 items) of liver cirrhosis was developed based on literature review and expert panel input. It was then piloted in five English-speaking patients with liver cirrhosis. These patients commented that the font size was too small. Hence, the font was enlarged and the final version of the ASK-Q was administered to English-speaking patients with liver cirrhosis, aged ≥18 years, with or without decompensation, at a tertiary hospital, from September 2020 to November 2021, at baseline and fortnight later. Patients with encephalopathy were excluded.

RESULTS

120/135 patients agreed to participate (response rate = 88.9%). The overall median score was 59.1 (45.6-68.2). A total of 7/22 (31.8%) items were "easy", 14/22 (63.6%) items were "moderately easy" and 1/22 (4.5%) items were "difficult". Exploratory factor analysis extracted nine factors, and two items were omitted. The ASK-Q was able to discriminate the knowledge level of patients with and without tertiary education [59.1 (50.0-72.7) vs. 54.5 (36.4-63.6); P < 0.05]. The overall Kuder-Richardson coefficient was 0.760, indicating adequate internal consistency. At retest, 77/120 patients participated (response rate = 64.2%) and 15/22 items were not statistically significant, indicating adequate reliability.

CONCLUSIONS

The ASK-Q was found to be a valid and reliable questionnaire for evaluating the knowledge of liver cirrhosis among English-speaking adult patients.

The development and validation of the awareness and knowledge of diabetes distress questionnaire among doctors in Malaysia

The main objective of this study was to develop and validate the Awareness and Knowledge of Diabetes Distress (AKODD) questionnaire, so that it can be used to assess the knowledge attitude and practice of doctors who treat patients with diabetes distress. This validation study was conducted at the University Malaya Medical Centre, Kuala Lumpur, Malaysia from June to July 2019. Doctors from the Departments of Primary Care Medicine, Medicine, Psychological Medicine, Emergency Medicine and Staff Health Unit, who could understand English were recruited, as they treat patients with diabetes or diabetes distress. The AKODD was developed based on literature review. Next, an expert panel met to review findings from literature and to develop the items for AKODD. The AKODD has 3 sections: socio-demographic information, awareness and knowledge. It was then piloted among 7 doctors from the Departments of Primary Care Medicine, Medicine, Psychological Medicine and Emergency Medicine. No problems were encountered. Hence, no changes were made, and the AKODD was administered twice: at 0 and 2 weeks as part of the validation process. Discriminative validity was assessed by comparing scores of doctors who had/had not attended a diabetes course before. A total of 103/119 doctors agreed to participate (response rate = 86.6%). Flesch Reading Ease was 51.1. Thirty-three doctors (32.0%) have heard of diabetes distress before. Doctors had a good level of knowledge regarding diabetes distress with a median score of 77.8% (IQR:66.7–88.9). The AKODD had adequate discriminative validity between participants who had (83.3%)/had not attended a diabetes course before (72.2%; p<0.049). The AKODD had good internal consistency (Kuder-Richardson = 0.931) and adequate reliability as 9/18 items were not statistically significant at test-retest. The AKODD was found to be a valid and reliable questionnaire to assess the awareness and knowledge of diabetes distress among doctors in Malaysia as it had adequate psychometric properties.

How much do patients know about osteoporosis? A survey among patients referred to the dual-energy X-ray absorptiometry exam

BACKGROUND

Inadequate osteoporosis education can make patients ill-informed concerning preventive and therapeutic interventions and creates misconceptions and unnecessary concerns about the disease.

AIM

Our study aimed to assess whether patients referred to the DXA exam by their general practitioner are informed about risk factors for osteoporosis, comparing patients who received a diagnosis of osteoporosis before the exam with those without this diagnosis.

METHODS

An observational single-center study was performed among patients who were referred to the DXA exam at the Osteoporosis Service of Marche Nord Hospital (Fano, Italy) between April and July 2019. Socio-demographic and clinical characteristics, awareness of suffering from osteoporosis, femoral and lumbar spine T-score and bone mineral density, risk of fracture and the I-FOOQ score were assessed.

RESULTS

A pilot study was carried out to validate the questionnaire in the Italian language (alpha-Cronbach 0.75). After that, a sample of 128 patients was enrolled (response rate 93.3%). Mean age was 66 ± 10.6 years, 95.6% were women. Overall, I-FOOQ mean score was 12 ± 3.5. Age, educational level, menopausal age, body mass index, femoral T-score were not associated with a better knowledge (p > 0.05). A comparison between who know to suffer from osteoporosis and others found no differences (12.2 ± 3.4 and 12 ± 3.5, respectively, p = 0.772). Effect of walking, recommended calcium intake, and familiar predisposition are the less known topics.

CONCLUSION

Patients who undergo the DXA exam are poorly informed about risk factors for osteoporosis, independently of age, education, bone mineral density and risk of fracture. Knowing to suffer from osteoporosis does not increase the likelihood to be informed. It is mandatory to improve the education that is provided to the patients, as there are effective non-pharmacological interventions to prevent and treat osteoporosis.

The Development and Validation of the Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia

OBJECTIVES

To develop and validate Osteoporosis Prevention and Awareness Tool (OPAAT) in Malaysia.

METHODS

The OPAAT was modified from the Malaysian Osteoporosis Knowledge Tool and developed from an exploratory study on patients. Face and content validity was established by an expert panel. The OPAAT consists of 30 items, categorized into three domains. A higher score indicates higher knowledge level. English speaking non-osteoporotic postmenopausal women ≥ 50 years of age and pharmacists were included in the study.

RESULTS

A total of 203 patients and 31 pharmacists were recruited. Factor analysis extracted three domains. Flesch reading ease was 59.2. The mean ± SD accuracy rate was 0.60 ± 0.22 (range: 0.26-0.94). The Cronbach's α for each domain ranged from 0.286-0.748. All items were highly correlated (Spearman's rho: 0.761-0.990, p < 0.05), with no significant change in the overall test-retest scores, indicating that OPAAT has achieved stable reliability. Pharmacists had higher knowledge score than patients (80.9 ± 8.7 vs 63.6 ± 17.4, p < 0.001), indicating that the OPAAT was able to discriminate between the knowledge levels of pharmacists and patients.

CONCLUSION

The OPAAT was found to be a valid and reliable instrument for assessing patient's knowledge about osteoporosis and its prevention in Malaysia. The OPAAT can be used to identify individuals in need of osteoporosis educational intervention.

Osteoporosis: a study of knowledge, attitude and practice among adults in Riyadh, Saudi Arabia

Osteoporosis is a growing chronic health problem that could result in mortalities and poor living quality. This study aimed at assessing the awareness of adults in Riyadh about this disease and its associated factors as well as compare KAP levels of men and women. A cross sectional study including 505 participants was conducted in several malls of Riyadh city during March 2012, selected by stratified random sampling technique. Self-administered questionnaire was used for data collection. 86% of the participants had heard of osteoporosis. Media was the main source for Participants' knowledge; the mean knowledge score was 56.6% of the maximum achievable score. There was significant differences in knowledge scores by educational level, employment, income and residence (P = 0.005), (P = 0.008) (P = 0.0122) and (P = 0.009), respectively. Participants had low frequencies of preventive practices, especially females who had a mean total score equivalent to 48.8% of the maximum score, while males' mean score was 54.7% (P = 0.000). Perceived susceptibility was higher among females (83 vs. 74%, P = 0.000), and thus had less perception of the barriers to preventive actions, than men (49.6 vs. 55.5%, P = 0.000). Self-efficacy and perceived benefits had the highest scores (95% of the maximum achievable scores). Considerable number of adult males and females are unaware about osteoporosis. Since there is deficiency in the knowledge, and poor application of the preventive actions. Therefore, Education programs are needed to improve awareness and motivating healthy behaviours.

The reliability of the Arabic version of osteoporosis knowledge assessment tool (OKAT) and the osteoporosis health belief scale (OHBS)

Background

Knowledge and awareness about osteoporosis and its related risk factors are important contributors to osteoporosis preventive behavior. There is a need to assess the reliability of international osteoporosis-related knowledge and belief measurement tools in Arabic community. This study aimed to assess the reliability of the Arabic version of Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) among Syrian women.

Methods

The study included two phases. The first phase included a forward and backward translation of the osteoporosis-related tools (OKAT and OHBS) followed by a pilot testing. The second phase was an assessment of the test-retest reliability of the tools among a convenience sample of one hundred working women at Damascus Faculty of Medicine and its teaching hospitals. For this purpose each instrument was administered twice to all women at an interval of two weeks. Data collection took place in the fall of 2011, and was facilitated by a trained interviewer whose task was to administer the tools and collect some background data from the women who consented to participate in the study.

Results

A total of one hundred women were recruited in this study for the reliability test-retest of the Arabic version of the tools. The mean age of studied women was 37.1 (SD = 8.4) years. Most of the women were married and nearly one-half of them had a university education. The internal consistency values for OHBS (Cronbach’s alpha = 0.806) as well as the OKAT (Cronbach’s alpha = 0.824) met the 0.7 Cronbach’s alpha value requirement. Item analysis did not necessitate any omissions in either tool. McNemar’s test identified only three items on the OKAT questionnaire that significantly differed from the test to the retest. The OKAT mean score (SD) for the test was 9.4 (2.6) and that for the re-test was 10.1 (2.9). Paired t test did not show significant difference (P = 0.068).

Conclusion

The Arabic version of both the Osteoporosis Knowledge Assessment Tool (OKAT) and the Osteoporosis Health Belief Scale (OHBS) was found to be reliable as well as acceptable. Further research is needed as to complete the validation of those tools and to use them at larger scale whether in knowledge assessment or in assessing interventions.