Miller, and Achterberg (2000) constructed a multiple choice questionnaire to asses the nutrition and food label knowledge among women with type 2 diabetes mellitus who aged from 40 to 60 years. The questions were placed from the easier to the hard so as to foster confidence among the participants. The questions that measure the factual knowledge were placed in the beginning followed by the more difficult questions (procedural knowledge). The test was designed to be completed within 30 to 40 minutes by most respondents. The reliability of the test was found to be 0.80 based on Kuder-Richardson formula 20(K-R 20). After this the item analysis of the original knowledge test was done. Three questions were deleted from the test because of high index of difficulty (two questions) and item discrimination of only 0.20.The item analysis for the revised version of the test was done and the reliability of the test was found to be 0.81 using the Kuder-Richardson formula 20 (K-R 20) formula. The revised test was administered to 43 women
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Al Shafaee et al (2008) developed a questionnaire to understand the Knowledge and perceptions of diabetes in a semi-urban Omani population. 563 adult residents of Omani village were interviewed using the questionnaire. The final survey instrument contained 24 items which were subdivided into 5 sections. The first two sections covered the demographics and medical history of the participants. The third section was for the diabetic participants. It covered their diabetic history and glycemic control status. The fourth section included knowledge regarding the diabetes definition, signs and symptoms, risk factors and complications. The final section focused on the community awareness, the participant’s perception regarding diabetes prevalence, perceived risk of developing diabetes and prevention. Likert-type response scale was used in the questionnaire. To collect data that were otherwise unobtainable with a typical Likert scale, open-ended questions were included which followed a closed ended question. The questionnaire was pre-tested and piloted within a convenience sample of students and staff at the College. Substantial inter-coding agreement for the scale items was observed (r = 0.86, p < 0.001).
Heikes, Eddy, Arondekar, & Schlessinger, (2008) developed a Diabetes risk calculator for the U.S. population to calculate the probability that an individual has either undiagnosed diabetes or pre-diabetes. The diabetes risk calculator included questions on age, waist circumference, gestational diabetes, height, race/ethnicity, hypertension, family history and exercise. The tool was validated using the v-fold cross-validation and by performing an independent validation against National Health and Nutrition Examination Survey (NHANES) 1999–2004 data. The data was taken from the National Health and Nutrition Examination Survey. Two tools were built using different methods. The two methods were logistic regression and classification tree analysis. The tool that served the objective of the study was then compared and selected. Classification tree model was chosen on the basis of its equivalent accuracy but greater ease Parmenter, K., & Wardle, J. (2000)of use.
Dickson-Spillmann, Siegrist, & Keller, (2011) developed and validated a nutrition knowledge questionnaire which was administered on participants above the age of 18. The questionnaire initially consisted of sixty-four nutrition knowledge items. Two approaches were used for item generation. The first source of items was through the interviews with the consumers where they were asked about food and health. The second source of items of items was recommendations by Swiss nutrition experts. Content validity was tested by two food scientists who reviewed the questions after which some items regarded as inappropriate by the experts was removed and a few others were re-formulated for enhanced precision and clarity. Twenty items were retained to build the final nutrition knowledge scale that included declarative nutrition knowledge questions on calorie and nutrient contents. Internal reliability was assessed using Cronbach’s alpha.
Teede, Harrison, Teh, Paul, & Allan, (2011) developed a risk prediction tool to identify gestational diabetes among high-risk women in early pregnancy. The participants for the study were 4276 pregnant women who delivered at Monash Medical Centre, Australia. Previously identified maternal Gestational Diabetes Mellitus risk factors from large epidemiological studies were considered, including increasing age, increasing Body Mass Index, ethnicity, first-degree family history of diabetes, past history of Gestational Diabetes Mellitus GDM and history of poor obstetric outcome. Logistical regression was used to analyse the data. It was observed that the women’s clinical characteristics were significantly associated (p <0.05) with the prevalence of Gestational Diabetes Mellitus.
Koontz et al., in the year 2010 developed and validated a Questionnaire to Assess Carbohydrate and Insulin-Dosing Knowledge in Youth with Type 1 Diabetes. They developed a PedCarbQuiz (PCQ) questionnaire by content analysis using a panel of 14 experts. The panel identified seven domains which was necessary for successful implementation of flexible basal-bolus regimens. Each item of the domain was reviewed and revised by the expert panel. Cronbach alpha and split-half testing was used to check the reliability. Further the scores were correlated with expert assessments, A1C, parent educational level and complexity of insulin regimen to assess the validity of the questionnaire. The final PCQ questionnaire was a 20-30 minute, multiple choice, paper based, self-administered questionnaire that had 78 items.
Lai, Chua, Tan, & Chan (2012) developed the Diabetes, Hypertension and Hyperlipidemia (DHL) knowledge instrument. Twelve experienced pharmacists and researchers formulated the DHL knowledge instrument by using the face and content validity. The researchers when through three drafts before they approved the final draft having 28 questions with 5 domains which was in the true or false form. After this the final draft was piloted on 20 practising community and hospital pharmacists. It also included five diabetic patients in a tertiary hospital. This was done to obtain their feedback concerning the clarity and relevance of the instrument.
A nutrition knowledge questionnaire for obese adults was developed by Feren, Torheim, & Lillegaard (2010). The process of developing the questionnaire had four main steps. The first step was to evolve a structure that involved collecting literature review about the knowledge of nutrition. This was done to describe the scope of the questionnaire. After the information was collected from the literature review, four main sections to assess the knowledge level were formulated. The second step was to generate the items based on the literature review. 273 items were generated based on six existing nutrition knowledge questionnaires and checked for content validity and face validity by an expert panel. Finally this resulted in 98 items. The third step was to pilot study the questionnaire for internal consistency and item difficulty. This procedure reduced the items to 94 after consultation from the expert panel. The fourth step was to test and re-test it for construct validity and reproducibility. The final questionnaire had 91 items after the entire process.
A descriptive research design was used by Okolie, Ijeoma, Peace, & Ngozi (2009) to understand the Knowledge of diabetes management and control by diabetic patients at Federal Medical Center Umuahia Abia State, Nigeria. The sample included 96 diabetic patients who went to Federal Medical Centre Umuahia during the time of study. The instrument used for data collection was a questionnaire that was constructed after going through the recent literature on diabetes knowledge and self-management. The face validity was assessed by five Nigerian registered nurses after which a pilot test was conducted at another hospital. The questionnaire was also tested for the reliability by re-testing it before the study.
Paddock, Veloski, Chatterton, Gevirtz, & Nash (2000) developed and validated a questionnaire to evaluate patient satisfaction with diabetes disease management. To develop the diabetes Management Evaluation Tool (DMET) the items measuring diabetes disease management were identified by an expert panel of health care professionals who recognised the 14 major domains. Content validity was confirmed by diabetes care professionals. To establish face validity a patient focus group was conducted. The final questionnaire consisted three sections having 87 items. The questionnaire measured the satisfaction on 711 diabetes patient using the Likert scale. Further the reliability and validity of the questionnaire was assessed by calculating product-moment correlations and Cronbach’s alpha.
Kaur, Saini, & Walia (2009) developed a tool to assess mother’s preparedness for delivery, postnatal and new born care. The literature was reviewed to prepare an interview schedule. Content validity (content revision, item order revision and item wording) was done with the help of twelve experts in the field of nursing and public health department. The modified interview schedule was pre tested for feasibility in a village on 10 antenatal mothers of trimester. Cronbach’s alpha was used to check the internal consistency and factor analysis was used to assess the construct validity. After factor analysis 20 out of the 30 items tool was retained with five factors.
A cross-sectional observational study was done by Hamoudi, Al Ayoubi, Vanama, Yahaya, & Usman (2012) aimed to assess the knowledge and awareness among diabetic and non-diabetic Nigerian population in Kaduna state towards diabetes mellitus (DM). Non randomized sampling strategy was used to select three hundred forty (340) people (33.7% diabetic and 66.2% non-diabetic participants). A self-administered questionnaire was evolved using the previous review of literature and it was validated by two specialists (a community medicine expert and a clinical pharmacist). Appropriate statistics were then used to derive the results.
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Diabetes Nutrition Knowledge Survey was developed and validated by Rovner, Nansel, Mehta, Higgins, Haynie, & Laffel (2012). The Nutrition Knowledge Survey (NKS) was developd by a multidisciplinary team. It consisted of 39 multiple choice questions four response options. This was then administered on 282 youth with type 1 diabetes and their parents. To check for validity associations were made between the NKS scores with A1C and dietary quality. Reliability was assessed using the Kuder-Richardson Formula 20 (KR-20) and correlations of domain scores to total score.
Roopa, & Devi (2014) developed and validated a study pertaining to studying the effect of an educational module as an intervention programme in the management of Diabetes Mellitus among the elderly with regard to the improvement in their knowledge, attitude and practices. The sample was determined through purposive random sampling. The sample constituted 80 people between the ages of 65-76. The sex ratio of the sample population was 1:1. The method of study preferred by the investigators was the Structured Interview Schedule (SIS) on knowledge, attitude and practices (KAP) with regard to diabetes was used for assessment.The study involved co-operative action research with an initial exploration of knowledge, attitude and practices in the management of diabetes mellitus among the elderly people as well as a post intervention study. The data obtained during pre and post assessment was analysed.
Huizinga et al., (2008) conducted a study in regards to the development and validation of the Diabetes Numeracy Test (DNT).The first phase of development included item generationby a group of experts in diabetes, literacy and numeracy. 70 items were developed and administered to 40 individuals without diabetesto assess understandability. The next phase involved the recruitment of a convenience sample of 398 participantsat clinic visits. The sample was determined based onthediagnosis of type 1 or 2 diabetes, age of the individual (between 18-80) and language spoken by the individual (English speaking) .To eliminate redundancy,the expert panel reduced the measure to 45 itemsthat represented the five self-management areas. The presence of the 45 items was accepted as an adequate indicator to address the range of numeracy skills required in the management of diabetes. Reliability was evaluated through internal consistency testing with the Kuder-Richardson 20 formula.
Hearnshaw, Wright, Dale, Sturt, Vermeire, & Van Royen, (2007) developed and validated the Diabetes Obstacles Questionnaire (DOQ) to assess obstacles in living with Type 2 diabetes. The questionnaire was developed with the help of previous research and literature review. The sample for the study included 180 people with Type 2 diabetes who were recruited from 22 general practices in the UK. The questionnaire initially comprised of 113 items having five themes which was reduced to 77 items after analysis. The Face and content validity were established by 21 members of the Warwick Diabetes Care Research User Group. These people gave extensive feedback to the research team on the questionnaire design and content. The Diabetes Obstacles Questionnaire was combined with two other questionnaires for the study to establish criterion validity of the questionnaire.
Smith, Lang, Sullivan, & Warren (2004) made use of two new tools for assessing patients’ knowledge and beliefs about Obstructive Sleep Apnea (OSA) and continuous positive airway pressure therapy. The sample for the study consisted of81 consecutive adult patients, diagnosed via polysomnography with OSA in the clinical group and 35 members in thenon-clinical group recruitedfrom a local community group in response to an advertisement calling for healthy volunteers without a sleep disorderdiagnosis. The investigators in the initial version of the Apnea Knowledge Test (AKT) based it on a similar measure as developed by Murphy et al., (2000). They initially formulated a set of20 AKT items; however an expert review process resulted in the exclusion offive items and modification of two items. Post this review, it is seen that the version of the AKT that the investigators finally chose to administer included 15 items multiple choice questionnaire, six items from the original Murphy et al., (2000). The test was then subjected to patient review. The test was administered to the first 10 study participants withinstructions to comment on any difficulties experienced with the items. Further, Cronbach’s alpha was calculated to evaluate the internalconsistency of the AKT.The second tool used by the investigators was the Apnea Beliefs Scale (ABS). These items were evolved based onan exhaustiveliterature review and consultation with the staff members. Content thought to be fundamental to compliance was targeted inconstructing this questionnaire. The final version included 24 statements to assesspatients’ attitudes and beliefs about sleep Apnea andContinuous Positive Airway Pressure.
Wright, Wallston, Elasy, Ikizler, & Cavanaugh, (2011) investigated the development and results of a kidney disease. The investigation was carried out through the administration of a knowledge survey given to patients with Chronic Kidney Disease (CKD).The survey questions had been developed by experts. The sample consisted of 401 adult patients with CKD (stages 1-5) attending a nephrology clinic from April-October 2009.Approximately 100 questions were generated first to maximize content relevant to kidney knowledge. This was done through an exhaustive study of pre-existing literature. Using an iterative process, items were reviewed for face and content validity and redundancy and ultimately decreased to 34 kidney knowledge questions. These questions were initially tested on a small group of clinical and nonclinical personnel for clarity. The first20 study participants were asked to comment on clarity and content and it was seen that there were no additional suggestions. In order to calculate survey reliability, the Kuder-Richardson-20 coefficient was used. They established construct validity by testing a priori hypotheses of associations between survey results and patient characteristics. The descriptive statistics that was assimilated was analysed.
Warden, Hurley, & Volicer (2003) developed and evaluated the Pain Assessment in Advanced Dementia (PAINAD). The PAINAD scale was developed after extensive study of existing literature and available pain assessment tools. The projects were carried out in a Dementia Special Care Unit where 96 in-patients received care for dementia. The sample was determined based on the following criteria, (1) diagnosis of dementia written on the medical record, (2) no planned discharge, (3) inability to report pain or discomfort to caregivers, and (4) a proxy decision maker identified in the medical record. The construct validity was determined using the contrasted groups and hypothesis testing methods. Further, Cronbach’s alpha was selected as the measure for verifying internal consistency.
Zeolla, Brodeur, Dominelli, Haines, & Allie (2006) development and validated an instrument to determine patient knowledge about oral anticoagulation. The oral anticoagulation knowledge test consisted of20 multiple choice questions. To develop this, Four nationally recognized anticoagulation experts contributed in the making to ensure content validity. The test was administered to subjects on warfarin and a group of age-matched subjects not on warfarin. This was done to assess construct validity and to check test–retest reliability a subgroup of warfarin subjects were retested after 2-3 months of the initial testing. Kuder–Richardson 20 value was calculated to assess internal consistency reliability. Also, to assess performance of each individual the item analysis was done.
Peyrot, Peeples, Tomky, Charron-Prochownik, & Weaver (2007) developed the Diabetes Self-management Assessment Report Tool (D-SMART). Thefirst resource that the investigators used was a set of existing DSMEmeasurement tools .The second resource they availed of was a set of publications regardingthe evaluation of diabetes education programs,including a description of a comprehensive DSME evaluation system,reviews of studies of DSME,and anumber of studies of specific programs that illustratedkey components of an evaluation system. After multiple drafts of the D-SMART, it was administeredto several individuals with diabetes and diabeteseducators to obtain feedback regarding readability andfeasibility. Post this plot test, several changes were made. D-SMART has completed three rounds of pilot testing and is currently undergoing a fourth round. Eachround is resulting in revisions to the original instrument.
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