ABC | Volume 112, Nº1, January 2019

Original Article Validation of the Brazilian Version of CADE-Q II to Assess Knowledge of Coronary Artery Disease Patients Rafaella Zulianello dos Santos, 1 Gabriela Lima Melo Ghisi, 2 Christiani Decker Batista Bonin, 3 Gabriela Chaves, 4 Clarissa Machado Haase, 3 Raquel Rodrigues Britto, 4 Magnus Benetti 3 Universidade do Sul de Santa Catarina (UNISUL), 1 Florianópolis, SC – Brazil Toronto Rehabilitation Institute - University Health Network, 2 Toronto – Canada Centro da Ciência da Saúde e do Esporte - Universidade do Estado de Santa Catarina (UDESC), 3 Florianópolis, SC – Brazil Universidade Federal de Minas Gerais (UFMG), 4 Belo Horizonte, MG – Brazil Mailing Address: Rafaella Zulianello dos Santos • Av. Engenheiro Max de Souza, 890 apt. 303. Postal Code 88080-000, Coqueiros, Florianópolis, SC – Brazil E-mail: rszhb10@yahoo.com.br , rafaella.zulianello@gmail.com Manuscript received April 05, 2018, revised manuscript July 05, 2018, accepted July 23, 2018 DOI: 10.5935/abc.20180244 Abstract Background: The Coronary Artery Disease Education Questionnaire (CADE-Q), an instrument aimed at assessing patients’ knowledge about coronary artery disease (CAD), was originally developed and psychometrically validated in Brazil. It was later translated, cross-culturally adapted, and validated to English. Although both versions demonstrated good reliability and validity, new studies in the area have pointed out the need of implementing the CADE-Q with other components of cardiac rehabilitation (CR) programs, such as psychologic factors, which had not been considered in previous version and were added in the subsequent, adapted version. Thus, a second version of CADE-Q was developed in English, the CADE-Q II. Objective: to translate, culturally adapt and psychometrically validate the CADE-Q II in Brazilian Portuguese. Methods: After translation and review by a Committee of specialists in CR, a version in Brazilian Portuguese was generated and tested in 307 patients in CR. Test-retest reliability was assessed by intraclass correlation coefficient (ICC) in 49 patients; internal consistency was assessed using Cronbach’s alpha ( α ); and, criterion validity was assessed regarding patients’ educational level and family income. The level of significance adopted for all tests was 5%. Results: After the ICC analysis, 4 items were excluded. The questionnaire was considered internally consistent ( α > 0.7). Associations were found between the mean total scores and the variables schooling (p < 0.001) and income (p < 0.001). M edian total score was 53 (14) points corresponding to 65.4% of the total possible score. Conclusion: The Portuguese version of the CADE-Q II showed sufficient reliability, consistency and validity, supporting its use in future studies. (Arq Bras Cardiol. 2019; 112(1):78-84) Keywords: Cardiovascular Diseases/physiopathology; Coronary Artery Disease; Patient Education as Topic; Surveys and Questionnaires; Validation Studies; Cardiac Rehabilitation Introduction Cardiovascular diseases are the main cause of mortality in Brazil, as a result of both population aging and epidemiologic changes in disease, 1-3 that contribute to high costs in health. 4,5 Cardiac rehabilitation (CR) stands out among the recommended therapies to coronary artery disease (CAD). CR is a multidisciplinary approach for secondary prevention, that can effectively reduce rehospitalization rates by up to 18% and cardiovascular mortality by up to 26%. 6 Most CR benefits are related to behavioral changes, and in this context, patient education is considered and important component of these programs. Education in health allows patient to understand the nature of the disease and its treatment. Consequently, inadequate understanding of the condition may lead to unwarranted emotional distress, inappropriate behavior in coping with the disease, non‑adherence to treatment, and disease progression. 7,8 Therefore, the management of chronic diseases such as CAD is crucial for secondary prevention. 9,10 Recent studies have corroborated the benefits of educational intervention in CAD patients. That includes knowledge increase that promotes changes in self-management and health behavior resulting in improvement of quality of life, 10-12 and potentially reduce health-related costs. 8 Precise information on the level of cardiovascular disease knowledge in patients with this disease are essential in planning and proposing effective CR interventional programs. 7,8 Education in health should be provided and analyzed by a simple manner, aiming at targeting many populations, including low-income patients. 13 In this context, the coronary artery disease education questionnaire (CADE-Q) is one of the few psycometrically validated instruments available in CR, developed and validated in Brazil and also validated in other countries. 14,15 However, the focus of CR has 78