Division of Pulmonary and Critical Care, Johns Hopkins School of Medicine, Johns Hopkins University of Medicine, Baltimore, Maryland.
Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, Maryland.
Ann Am Thorac Soc. 2021 Aug;18(8):1298-1305. doi: 10.1513/AnnalsATS.202007-884OC.
The majority of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs). Despite the increasing burden of COPD, disease-specific knowledge among healthcare workers and patients in LMICs remains limited. COPD knowledge questionnaires (COPD-KQ) are valid and reliable tools to assess COPD knowledge and can be employed in settings with limited health literacy. To develop and assess the validity and reliability of a COPD-KQ among individuals with COPD in three LMIC settings. Twelve questions were generated by an expert team of 16 researchers, physicians, and public health professionals to create an LMIC-specific COPD-KQ. The content was based on previous instruments, clinical guidelines, focus-group discussions, and questionnaire piloting. Participants with COPD completed the questionnaire across three diverse LMIC settings before and 3 months after delivery of a standardized COPD-specific education package by a local community health worker trained to deliver the education to an appropriate standard. We used paired tests to assess improvement in knowledge after intervention. Questionnaire development initially yielded 52 items. On the basis of community feedback and expertise, items were eliminated and added, yielding a final 12-item questionnaire, with a maximum total score of 12. A total of 196 participants with COPD were included in this study in Nepal ( = 86), Peru ( = 35), and Uganda ( = 75). The mean ± standard deviation baseline score was 8.0 ± 2.5, and 3 months after education, the mean score was 10.2 ± 1.7. The community health worker-led COPD educational intervention improved COPD knowledge among community members by 2.2 points (95% confidence interval, 1.8-2.6 points; = 10.9; < 0.001). Internal consistency using Cronbach's α was 0.75. The LMIC COPD-KQ demonstrates face and content validity and acceptable internal consistency through development phases, suggesting a reliable and valid COPD education instrument that can be used to assess educational interventions across LMIC settings. Clinical trial registered with www.clinicaltrials.gov (NCT03365713).
大多数与慢性阻塞性肺疾病（COPD）相关的发病率和死亡率发生在低收入和中等收入国家（LMICs）。尽管 COPD 的负担不断增加，但在 LMIC 中的医疗保健工作者和患者的疾病特异性知识仍然有限。COPD 知识问卷（COPD-KQ）是评估 COPD 知识的有效和可靠工具，可在健康素养有限的环境中使用。 在三个 LMIC 环境中开发并评估 COPD-KQ 在 COPD 患者中的有效性和可靠性。 由 16 名研究人员、医生和公共卫生专业人员组成的专家团队提出了 12 个问题，以创建一个特定于 LMIC 的 COPD-KQ。内容基于以前的仪器、临床指南、焦点小组讨论和问卷试点。患有 COPD 的参与者在经过当地社区卫生工作者（经培训可按适当标准提供教育）提供标准化 COPD 特定教育包之前和之后的三个月内，在三个不同的 LMIC 环境中完成了问卷。我们使用配对检验来评估干预后的知识提高情况。 问卷开发最初产生了 52 个项目。基于社区反馈和专业知识，删除并添加了项目，得出了最终的 12 个项目问卷，最高总分为 12 分。共有 196 名患有 COPD 的参与者参与了这项研究，分别来自尼泊尔（ = 86）、秘鲁（ = 35）和乌干达（ = 75）。平均基线得分 ± 标准差为 8.0 ± 2.5，教育 3 个月后，平均得分为 10.2 ± 1.7。社区卫生工作者主导的 COPD 教育干预使社区成员的 COPD 知识提高了 2.2 分（95%置信区间，1.8-2.6 分； = 10.9； < 0.001）。使用 Cronbach's α 的内部一致性为 0.75。 通过开发阶段，LMIC COPD-KQ 表现出了表面和内容效度以及可接受的内部一致性，这表明这是一种可靠且有效的 COPD 教育工具，可用于评估 LMIC 环境中的教育干预措施。临床试验在 www.clinicaltrials.gov 注册（NCT03365713）。
