Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Selayang Campus, Jalan Prima Selayang 7, 68100, Batu Caves, Selangor, Malaysia.
Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia.
BMC Cardiovasc Disord. 2021 Jan 19;21(1):39. doi: 10.1186/s12872-020-01845-y.
BACKGROUND: Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. METHODS: This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test-retest reliability was tested on 26 PCP using kappa statistics. RESULTS: During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). CONCLUSION: This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.
背景：初级保健医生（PCP）在早期发现家族性高胆固醇血症（FH）方面发挥着重要作用。然而，马来西亚 PCP 对 FH 的知识、意识和实践（KAP）并不完善，也没有经过验证的工具来评估他们的 FH KAP。因此，本研究旨在改编 FH KAP 问卷，并确定其在马来西亚 PCP 中的有效性和可靠性。
方法：这是一项横断面验证研究，涉及在初级保健环境中工作经验≥1 年的马来西亚 PCP。在第 1 阶段，对原始的 19 项 FH KAP 问卷进行了内容验证和改编，由 7 位专家进行。然后，该问卷被转换为在线调查工具，并由 10 位 PCP 进行了面对面验证。在第 2 阶段，改编后的问卷通过电子邮件分发给 1500 位 PCP。收集他们的 KAP、人口统计学、资格和工作经验数据。使用已知组验证方法测试构念效度。假设具有研究生学历的 PCP（PCP-PG-Qual）与没有研究生学历的 PCP（PCP-noPG-Qual）相比，FH KAP 更好。使用 Kuder Richardson 公式-20（KR-20）计算内部一致性可靠性，并使用 Kappa 统计对 26 位 PCP 进行测试重测信度。
结果：在内容验证和改编过程中，有 10 个项目保持不变，8 个项目进行了修改，1 个项目移至人口统计学部分，7 个项目被添加。改编后的问卷由 25 个项目组成（11 个知识、5 个意识和 9 个实践项目）。在 1500 位 PCP 中，共有 130 位（回复率：8.7%）完成了问卷。发现 PCP-PG-Qual 的平均知识得分百分比明显高于 PCP-noPG-Qual（53.5，SD±13.9 对 35.9，SD±11.79），t（128）=6.90，p<0.001。发现 PCP-PG-Qual 的平均意识得分百分比明显高于 PCP-noPG-Qual（15.4，IQR±23.08 对 7.7，IQR±15.38），p=0.030。发现 PCP-PG-Qual 的平均实践得分百分比明显高于 PCP-noPG-Qual（69.2，SD±17.62 对 54.4，SD±19.28），t（128）=3.79，p<0.001。KR-20 值为 0.79（中等可靠性），平均 Kappa 值为 0.796（高度一致）。
结论：本研究证明，25 项改编的 FH KAP 问卷具有有效性和可靠性。它可以用于衡量和建立马来西亚 PCP 的 FH KAP。
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