ABC | Volume 111, Nº6, December 2018

Original Article Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV) Gabriela Lima de Melo Ghisi, 1 Gabriela S. S. Chaves, 2 Jessica Blanco Loures, 2 Gabriela Moreira Bonfim, 2 Raquel Britto 2 Toronto Rehabilitation Institute, University Health Network, 1 Toronto – Canada Universidade Federal de Minas Gerais (UFMG), 2 Belo Horizonte, MG – Brazil Mailing Address: Gabriela Lima de Melo Ghisi • 347 Rumsey Road Toronto ON M6S 5B7 – Toronto E-mail: gabriela.meloghisi@uhn.ca Manuscript received March 19, 2018, revised manuscript May 21, 2018, accepted June 27, 2018 DOI: 10.5935/abc.20180169 Abstract Background: Patient education is an essential part of cardiovascular patients’ care targeting self-management behavior to reduce risk factors and subsequent events. Herein, a short and reliable tool to assess patients’ knowledge in Brazil is warranted. Objectives: To translate, culturally-adapt and psychometrically validate the Portuguese version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Methods: The Portuguese CADE-Q SV – translated and culturally-adapted - was reviewed by five bilingual experts in cardiovascular disease. This version was then pre-tested in 21 patients, and clarity of items was checked using a Likert‑type scale ranging from 1 = not clear to 10 = very clear. It was then psychometrically tested in 200 cardiovascular patients (41%women; mean age = 58.4 ± 11.6 years old). The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbach’s alpha, test-retest reliability through intraclass correlation coefficient (ICC), factor structure using confirmatory factor analysis, and construct validity regarding educational level, family income, and time of diagnosis. Results: All questions were considered clear by patients (clarity range:7.8-9.6). KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6 factors, all internally consistent. Construct validity was supported by significant differences in total scores by educational level and family income (p < 0.001). The overall mean was 13.08 ± 2.61. The area with the highest knowledge was risk factors and the lowest was psychosocial risk. Conclusions: The Portuguese CADE-SV was demonstrated to have good validity and reliability. This tool can be applicable in clinical and research settings, assessing cardiovascular patients’ knowledge as part of an education programming. (Arq Bras Cardiol. 2018; 111(6):841-849) Keywords: Cardiovascular Diseases; Coronary Artery Disease; Surveys and Questionnaires; Patient Education as Topic; Knowledge; Educational Status. Introduction Cardiovascular diseases (CVDs) are among the leading burdens of disease and disability worldwide, 1 particularly in low and middle-income countries (LMICs) such as Brazil. 2 Cardiac rehabilitation (CR) is an outpatient secondary prevention care model designed to mitigate this burden. 3 Indeed, participation in CR has been shown to reduce morbidity and mortality by 20%, in a cost-effective manner. 4-7 Improved risk factor control, psychosocial well-being, and health behaviors are also shown in LMICs with CR participation. 8 However, there are incredibly few studies in this setting showing the long-term success of CR, which rests in part on the patient’s ability to maintain health behaviors, including participation in regular physical activity after the end of the program. 9,10 Patient education is an essential part of the rehabilitation of CAD patients targeting self-management behavior to reduce risk factors and subsequent cardiac events. 11 The American and Canadian Cardiovascular Societies include patient education as a quality indicator of CR, 12,13 and this component is also recommended in the delivery of CR in LMICs. 14 Indeed, meta‑analyses of education for cardiovascular patients suggest it is associated with improvements in self-management behaviors, 9-11,15 health-related quality of life, 16 decreases in healthcare costs, 16 and recurrence of acute events. 15 In this context, the Coronary Artery Disease Education Questionnaire (CADE-Q) was previously developed and psychometrically validated as a valid and reliable tool to inform Brazilianhealthcare providers oft what their cardiovascular patients know about their condition. 17 It was later validated to English. 18 It has also been used in several studies, including randomized controlled trials. 19 Although both versions demonstrated good reliability and validity, CADE-Q presented lack of detailed assessment of all core components of cardiac rehabilitation, such as nutrition and psychosocial risk. Therefore, a second version (CADE-Q II) was developed and validated in English. 20 However, both tools take around 20 minutes to be completed, and there was a need for a short and quick instrument to more easily assess CR patients’ knowledge in clinical practice. This tool was validated in English and it is called CADE-Q SV. 21 The aim of this study was to translate, culturally-adapt and psychometrically validate a Brazilian-Portuguese version of CADE-Q SV. 841