Smekal Michelle D, Donald Maoliosa, Beanlands Heather, Straus Sharon, Herrington Gwen, Waldvogel Blair, Sparkes Dwight, Delgado Maria, Bello Aminu, Hemmelgarn Brenda R
Department of Medicine, University of Calgary, AB, Canada.
Department of Community Health Sciences, University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2021 Dec 12;8:20543581211063981. doi: 10.1177/20543581211063981. eCollection 2021.
Self-management focused interventions to slow chronic kidney disease (CKD) progression are increasingly common. However, valid self-report instruments to evaluate the effectiveness of self-management interventions in CKD are limited.
We sought to develop and conduct preliminary psychometric testing of a patient-informed questionnaire to assess aspects of CKD self-management for patients with CKD categories G2-G5 (not on kidney replacement therapy [KRT]).
Self-administered electronic questionnaires (multiphase).
Online.
Canadian adults with CKD categories G2-G5 (not on KRT).
The CKD-SM questionnaire was developed and tested in 4 phases. First, we used a content coverage matrix to identify potential questionnaire items based on existing self-efficacy questionnaires, self-management theories, and patient-identified priorities. Second, the draft questionnaire was reviewed by a multidisciplinary expert panel using percent acceptance to finalize the questionnaire. Third, we tested an electronic version of the questionnaire with patients with CKD, evaluating preliminary psychometric properties including internal consistency, face validity, and content validity. Finally, we tested the questionnaire within a CKD self-management intervention study and collected data on internal consistency, test-retest reliability, and pre-post responsiveness.
We identified 22 potential questionnaire items for the first round of expert panel review. Thirteen items were retained in the first round. Eleven additional items were tested in the second review round and all were retained. Of the 24 items retained following expert review of the questionnaire, 21 had greater than 85% acceptance (content validity index [CVI], 0.75-1.00) and 3 items had 75% acceptance (CVI, 0.5). Thirty patients with CKD from across Canada participated in the pilot testing, and 29 patients participated in the CKD self-management intervention study. In the pilot test, several participants requested inclusion of a question that explicitly addressed mental health; consequently, an additional item relating to mental health was included prior to the intervention study (final questionnaire total was 25 items). Internal consistency (Cronbach α) was high for both the pilot (0.921) and intervention study (0.912). Preintervention test-retest reliability, measured with intraclass correlation coefficient, was acceptable (0.732, 95% confidence interval, 0.686-0.771, < .001), and paired pre/postintervention comparison, measured with Wilcoxon sign-rank, demonstrated significant increases in self-management ( < .05) despite stable preintervention test-retest responses. Participants were satisfied with the content, wording, and design.
The sample sizes were small for each component of the analysis, and the sampling was consecutive/convenience-based.
We used self-management theories, patient-identified self-management needs, expert review, and conducted preliminary psychometric testing to finalize a CKD self-management questionnaire for patients with G2-G5 CKD (not on KRT). The finalized questionnaire assesses aspects of self-management for individuals with CKD and may be particularly helpful as a tool to evaluate self-management interventions among patients with CKD.
以自我管理为重点的减缓慢性肾脏病（CKD）进展的干预措施越来越普遍。然而，用于评估CKD自我管理干预效果的有效自我报告工具却很有限。
我们旨在开发并进行一项由患者参与设计的问卷的初步心理测量测试，以评估G2 - G5期CKD患者（未接受肾脏替代治疗[KRT]）的CKD自我管理的各个方面。
自我管理的电子问卷（多阶段）。
在线。
加拿大G2 - G5期CKD成人患者（未接受KRT）。
CKD自我管理问卷（CKD - SM）分4个阶段进行开发和测试。首先，我们使用内容覆盖矩阵，基于现有的自我效能问卷、自我管理理论以及患者确定的优先事项来确定潜在的问卷项目。其次，多学科专家小组使用接受率对问卷初稿进行审查以最终确定问卷。第三，我们对CKD患者测试了问卷的电子版，评估包括内部一致性、表面效度和内容效度在内的初步心理测量特性。最后，我们在一项CKD自我管理干预研究中测试了该问卷，并收集了关于内部一致性、重测信度和干预前后反应性的数据。
我们确定了22个潜在问卷项目用于第一轮专家小组审查。第一轮保留了13个项目。在第二轮审查中测试了另外１１个项目，所有项目均被保留。在专家对问卷进行审查后保留的24个项目中，21个项目的接受率大于85%（内容效度指数[CVI]，0.75 - 1.00），3个项目的接受率为75%（CVI，0.5）。来自加拿大各地的30名CKD患者参与了预试验，29名患者参与了CKD自我管理干预研究。在预试验中，一些参与者要求纳入一个明确涉及心理健康的问题；因此，在干预研究之前增加了一个与心理健康相关的项目（最终问卷共25个项目）。预试验（Cronbach α为0.921）和干预研究（Cronbach α为0.912）的内部一致性都很高。用组内相关系数测量的干预前重测信度是可以接受的（0.732，95%置信区间，0.686 - 0.771，P <.001），用Wilcoxon符号秩检验测量的干预前后配对比较显示，尽管干预前重测反应稳定，但自我管理有显著提高（P <.05）。参与者对内容、措辞和设计表示满意。
分析的每个部分样本量都很小，且抽样是基于连续/便利抽样。
我们运用自我管理理论、患者确定的自我管理需求、专家审查，并进行了初步心理测量测试，最终确定了一份适用于G2 - G5期CKD患者（未接受KRT）的CKD自我管理问卷。最终确定的问卷评估了CKD患者自我管理的各个方面，作为评估CKD患者自我管理干预措施的工具可能会特别有帮助。
