Development of a Comprehensive Heart Disease Knowledge Questionnaire

Article excerpt

BACKGROUND

For over 80 years, heart disease has been the leading cause of mortality for both men and women in the United States. (1,2) In 2005, heart disease claimed the lives of more than 860 000 Americans? Coronary heart disease (CHD), the most common type of heart disease in the U.S., (4) is responsible for about 500 000 deaths per year. (3) Results from the National Heart, Lung, and Blood Institute's Framingham Heart Study found that the lifetime risk for developing CHD at age 40 is a 1-in-2 chance (48.6%) for men and 1-in-3 chance (31.7%) for women. (4) Moreover, it is estimated that every 30 seconds an American will suffer from a coronary event and every 60 seconds the event is fatal. (3)

Not only is heart disease the number one killer of Americans, but some of the disease's modifiable risk factors comprise the leading three direct contributors to death in the U.S.: tobacco use, poor diet and physical inactivity, and alcohol consumption? Other modifiable risk factors for developing heart disease include obesity, high blood pressure, high blood cholesterol, and stress. (6) Thus, much of an individual's risk of heart disease--and likewise, of death--can be mitigated by addressing one or more of these modifiable factors through individual means such as by quitting smoking, exercising, improving diet, or obtaining medical treatment for conditions such as diabetes, high blood pressure, or unhealthy blood cholesterol.

Heart disease will continue to be a modern-day health threat unless the American public has a clear and comprehensive understanding of what, and how, risk factors contribute to the development of the disease. Further, individuals need not only be able to identify their risk factors, but also to understand them in the context of overall heart health knowledge. Ensuring that individuals possess a basic understanding of the disease itself--including its symptomatology, as well as related medical and dietary knowledge--will enable them to identify specific actions they can take to reduce their risks and to build a foundation upon which they can effectively take control of their health. Hence, having the ability to assess peoples' level of knowledge about heart disease through a standardized tool would be valuable in aiding the design of effective health interventions, as well as in measuring the efficacy of such interventions. In addition, such a tool could effectively serve as a means by which to tailor educational materials to individuals directly, to address their specific gaps in knowledge.

PURPOSE

The goal of the current study was to develop an easily-administered and psychometrically sound heart disease knowledge questionnaire that could be used in a variety of adult populations. To achieve our purpose, we identified and extracted selected items from existing scales, merging them with newly developed items based on current cardiovascular research. The current scale encompasses five relevant knowledge domains: dietary knowledge, epidemiology, medical information, risk factors, and heart attack symptoms. Sources for the existing and new items are reported in the Methods section.

The questionnaire was developed in two phases. The first phase (Phase I) was exploratory; we developed and tested a paper and pencil 84-item questionnaire with a university student sample. The primary goals were to validate the questionnaire's five-domain structure and to reduce the number of items. We also included additional items that evaluated participants' perceptions of their heart disease knowledge. In Phase II, we validated a refined version of the scale with a second university student sample.

We identified existing measures of heart disease knowledge through a search of literature published as of February 2010 using PubMed and PsyclNFO databases and Google Scholar. Articles reviewed were restricted to those written in English, with no limits on year of publication. …