Validity, reliability, and application of the electronic version of a chronic kidney disease patient awareness questionnaire: a pilot study

ABSTRACT

Objectives

A questionnaire which provides desirable reliability and validity has been previously developed to assess the disease awareness of diagnosed chronic kidney disease (CKD) patients. However, conventional paper questionnaires often have disadvantages, including recall bias. To substantially improve this, we therefore aimed to explore the feasibility of developing a smartphone-based electronic version (e-version) based upon its original paper version and subsequently tested its validity, reliability, and applicability.

Methods

A pilot study was conducted at Guangdong Provincial Hospital of Chinese Medicine in Guangzhou, China, during August 2019. The e-version had identical content to the paper version and was adapted in terms of layout and assisted functions via the Wechat-incorporated Wen-Juan-Xing platform. Eligible patients with diagnosed CKD were invited to participate and were assigned the e-version. Randomly selected respondents received a test-retest of the same e-version 2 weeks after their first completion. In some instances, psychometric properties, including validity and reliability of the e-version, were examined. In others, its clinical application was also tested, which included comparisons among the clinical profiles of patients who had/had not responded to the questionnaire as well as patients with above or below average questionnaire scores.

Results

Of the 225 patients screened, 217 were enrolled to participate, with a response rate of 52.5%. Desirable reliability (Cronbachα = 0.962, ICC for total scores = 0.948), while good convergent validity (Cronbachα = 0.962) and low discriminant validity (one extracted component), of the e-version were detected. Performing inter-group comparisons highlighted statistical differences in terms of higher education level (z = −2.436, P = 0.015) and earlier CKD stages (z = −1.978, P = 0.048), with these patients often preferring to respond. No significant differences were detected in the clinical profiles between respondents who obtained an above or below average questionnaire score.

Conclusion

The e-version is reliable but was not shown to be a valid approach. Audiences with higher education levels and less advanced disease condition may prefer to respond to the e-version. Adaptation of this e-questionnaire, from its original paper version, may not be a direct transition and meticulous modifications may be required during the transition process.

Trial registration

Chinese Clinical Trial Registry (ChiCTR1900024633).

KEYWORDS:

• Disease awareness
• chronic kidney disease
• electronic questionnaire
• patient health questionnaire
• reliability
• validity

Author contributions

All authors critically revised the manuscript for key content and approved the final manuscript. LL: conception and design, eligibility screening of the participants, analysis and interpretation of data, drafting and revision of the manuscript. MZ: eligibility screening of the participants and revision of the manuscript. CH: questionnaire delivery as well as drafting and revision of the manuscript. FT: made additional phone calls to encourage the study participation, conception and design of the study. LF: made additional phone calls to encourage the study participation. DZ: analysis and interpretation of data. BX: analysis and interpretation of data. CD: analysis and interpretation of data. YX: questionnaire delivery. LW: questionnaire delivery. NL: questionnaire delivery. XL: conception and design of the study. YW: conception and design, interpretation of data, and revision of the manuscript and final approval of the version to be published. The corresponding author (YW) attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Declaration of interest

All authors declare no competing interests to the submitted work.

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by the Guangdong Provincial Hospital of Chinese Medicine Program: randomized Controlled Trial on Effects of Telephone-APP-Based Nutritional Support Integrating Chinese and Western Medicine for Patients with Chronic Kidney Disease under Grant number YN2018ZWB04.