Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA.
Transplantation. 2019 Mar;103(3):565-572. doi: 10.1097/TP.0000000000002349.
Kidney transplant is the best treatment for most end-stage renal disease (ESRD) patients, but proportionally few ESRD patients receive kidney transplant. To make an informed choice about whether to pursue kidney transplant, patients must be knowledgeable of its risks and benefits. To reliably and validly measure ESRD patients' kidney transplant knowledge, rigorously tested measures are required. This article describes the development and psychometric testing of the Knowledge Assessment of Renal Transplantation (KART).
We administered 17 transplant knowledge items to a sample of 1294 ESRD patients. Item characteristics and scale scores were estimated using an Item Response Theory graded response model. Construct validity was tested by examining differences in scale scores between patients who had spent less than 1 and 1 hour or longer receiving various types of transplant education.
Item Response Theory modeling suggested that 15 items should be retained for the KART. This scale had a marginal reliability of 0.75 and evidenced acceptable reliability (>0.70) across most of its range. Construct validity was supported by the KART's ability to distinguish patients who had spent less than 1 and 1 hour or longer receiving different types of kidney transplant education, including talking to doctors/medical staff (effect size [ES], 0.61; P < 0.001), reading brochures (ES, 0.45; P < 0.001), browsing the internet (ES, 0.56; P < 0.001), and watching videos (ES, 0.56; P < 0.001).
The final 15-item KART can be used to determine the kidney transplant knowledge levels of ESRD patients and plan appropriate interventions to ensure informed transplant decision making occurs.
肾移植是治疗大多数终末期肾病（ESRD）患者的最佳方法，但比例相对较少的 ESRD 患者接受肾移植。为了对是否进行肾移植做出明智的选择，患者必须了解其风险和益处。要可靠和有效地衡量 ESRD 患者的肾移植知识，需要经过严格测试的措施。本文描述了肾移植知识评估（KART）的开发和心理计量学测试。
我们向 1294 名 ESRD 患者样本发放了 17 项移植知识项目。使用项目反应理论等级反应模型估计项目特征和量表得分。通过检查在接受各种类型的移植教育的时间少于 1 小时和 1 小时或更长时间的患者之间的量表得分差异，检验了结构效度。
项目反应理论建模表明，应保留 KART 的 15 项。该量表的边缘可靠性为 0.75，在其大部分范围内具有可接受的可靠性（>0.70）。KART 能够区分接受少于 1 小时和 1 小时或更长时间接受不同类型的肾移植教育的患者，包括与医生/医务人员交谈（效果大小[ES]，0.61；P <0.001），阅读手册（ES，0.45；P <0.001），浏览互联网（ES，0.56；P <0.001）和观看视频（ES，0.56；P <0.001），这支持了结构效度。
最终的 15 项 KART 可用于确定 ESRD 患者的肾移植知识水平，并计划适当的干预措施，以确保进行知情的移植决策。
