Development and validation of a knowledge, attitude, belief and practice scale for safe medication in patients with chronic kidney disease

doi:10.3969/j.issn.1674-8115.2022.12.011

Abstract

Abstract:

Objective ·To develop a knowledge, attitude, belief and practice (KABP) scale for safe medication in patients with chronic kidney disease (CKD), and test its reliability and validity. Methods ·Based on the KABP theory, the initial items were discussed and designed comprehensively by research group members through a systematic literature review and semi-structured interviews. The Delphi method of expert panel consultation and the pre-investigation were conducted to improve the initial scale. Next, the patients with CKD in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were enrolled to complete the initial scale. The item analysis was conducted by critical ratio and homogeneity test. The construct validity and the content validity of scale were tested by exploratory factor analysis (EFA) and logic analysis, respectively. The reliability of the scale was evaluated by Cronbach's α coefficient, split-half reliability, and test-retest reliability. Results ·The initial scale consisted of 29 items with three dimensions. A total of 213 questionnaires were distributed and 209 valid questionnaires were collected. Items No.1, 2, 3 and 19, which did not meet the criteria of three or more indicators, were deleted after item analysis. The KMO (Kaiser-Meyer-Olkin) was 0.946, and the χ² value of Bartlett's spherical test was 4 554.451 (P=0.000). The results suggested that the overall correlation matrix had common factors, which was suitable for factor analysis. The principal component analysis and the maximum variation method of orthogonal rotation axis were adopted. Item No.13 was deleted finally. According to the variable characteristics contained in each factor, three extracted common factors were named as "Practice of safe medication", "Knowledge about safe medication", and "Belief of safe medication", respectively. The eigenvalues of three dimensions were 6.565, 6.176, and 3.863, respectively, and the cumulative variance contribution rate was 69.18%. The scale-level-content validity index (S-CVI)/universal agreement was 0.860. The S-CVI/average was 0.987. The formal scale was formed of 24 items with three dimensions. The α coefficient of the total scale was 0.964. The split-half reliability coefficient was 0.911 and the test-retest reliability was 0.892 for the scale. Conclusion ·The KABP scale of safe medication in CKD patients has good reliability and validity.

Key words: chronic kidney disease (CKD), safe medication, knowledge, attitude, belief and practice (KABP) theory, scale

CLC Number:

R692

WEI Shan, JI Ouyang, CHEN Zhihao, HUANG Zehui, LI Pu, FANG Junyan, LIU Yingli. Development and validation of a knowledge, attitude, belief and practice scale for safe medication in patients with chronic kidney disease[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1729-1738.

Figures/Tables 5

TrendMD

References 31

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Index	Number of patients/n	Percentage/%
Age/year
18‒44	26	12.44
45‒59	64	30.62
60‒74	90	43.06
≥75	29	13.88
Gender
Male	126	60.29
Female	83	39.71
Education level
Primary education	36	17.22
Secondary education	125	59.81
Higher education	48	22.97
Monthly per capita income/yuan
<3 000	49	23.44
3 000‒6 000	85	40.67
>6 000	75	35.89
Marital status
Unmarried	12	5.74
Married	181	86.60
Divorced/widowed	16	7.65
Residence status
Living with partner	150	71.77
Living with kids or parents	32	15.31
Living alone	27	12.92
Health insurance
Social medical insurance	192	91.87
Commercial medical insurance	6	2.87
Self-funded	11	5.26
CKD stage
Stage 1‒2	10	4.79
Stage 3‒4	23	11.00
Dialysis	176	84.21

Index	Number of patients/n	Percentage/%
Age/year
18‒44	26	12.44
45‒59	64	30.62
60‒74	90	43.06
≥75	29	13.88
Gender
Male	126	60.29
Female	83	39.71
Education level
Primary education	36	17.22
Secondary education	125	59.81
Higher education	48	22.97
Monthly per capita income/yuan
<3 000	49	23.44
3 000‒6 000	85	40.67
>6 000	75	35.89
Marital status
Unmarried	12	5.74
Married	181	86.60
Divorced/widowed	16	7.65
Residence status
Living with partner	150	71.77
Living with kids or parents	32	15.31
Living alone	27	12.92
Health insurance
Social medical insurance	192	91.87
Commercial medical insurance	6	2.87
Self-funded	11	5.26
CKD stage
Stage 1‒2	10	4.79
Stage 3‒4	23	11.00
Dialysis	176	84.21

Item No.	CR	Correlation between item score and total score		Homogeneity test			Substandard indicators/n	Outcome
Item No.	CR	Correlation （r）	Corrected correlation （r）	Reliability coefficient after item deletion	Commonality	Factor loading	Substandard indicators/n	Outcome
1	6.088	0.426	0.382	0.958	0.144	0.379	4	Delete
2	2.457	0.237	0.195	0.959	0.030	0.174	6	Delete
3	2.803	0.273	0.228	0.959	0.044	0.209	6	Delete
4	19.602	0.790	0.765	0.955	0.613	0.783	0	Keep
5	16.770	0.785	0.761	0.955	0.610	0.781	0	Keep
6	16.195	0.773	0.747	0.955	0.595	0.771	0	Keep
7	14.897	0.758	0.731	0.955	0.565	0.752	0	Keep
8	11.618	0.699	0.667	0.955	0.489	0.699	0	Keep
9	9.631	0.684	0.650	0.956	0.452	0.673	0	Keep
10	13.700	0.735	0.705	0.955	0.538	0.733	0	Keep
11	15.601	0.778	0.751	0.955	0.607	0.779	0	Keep
12	19.077	0.818	0.797	0.954	0.674	0.821	0	Keep
13	8.026	0.598	0.567	0.956	0.323	0.568	0	Keep
14	12.427	0.703	0.681	0.955	0.518	0.719	0	Keep
15	12.166	0.748	0.732	0.955	0.589	0.767	0	Keep
16	7.946	0.567	0.544	0.956	0.345	0.587	0	Keep
17	10.929	0.681	0.658	0.956	0.494	0.703	0	Keep
18	11.692	0.705	0.686	0.956	0.517	0.719	0	Keep
19	3.366	0.284	0.243	0.958	0.077	0.277	5	Delete
20	14.774	0.809	0.794	0.955	0.666	0.816	0	Keep
21	12.346	0.752	0.731	0.955	0.563	0.750	0	Keep
22	15.790	0.806	0.791	0.955	0.677	0.823	0	Keep
23	16.761	0.778	0.751	0.955	0.622	0.788	0	Keep
24	16.104	0.771	0.747	0.955	0.623	0.790	0	Keep
25	16.545	0.764	0.742	0.955	0.598	0.774	0	Keep
26	15.400	0.761	0.740	0.955	0.593	0.770	0	Keep
27	13.471	0.709	0.679	0.955	0.507	0.712	0	Keep
28	15.075	0.735	0.711	0.955	0.551	0.742	0	Keep
29	13.919	0.661	0.632	0.956	0.448	0.669	0	Keep

Item No.	CR	Correlation between item score and total score		Homogeneity test			Substandard indicators/n	Outcome
Item No.	CR	Correlation （r）	Corrected correlation （r）	Reliability coefficient after item deletion	Commonality	Factor loading	Substandard indicators/n	Outcome
1	6.088	0.426	0.382	0.958	0.144	0.379	4	Delete
2	2.457	0.237	0.195	0.959	0.030	0.174	6	Delete
3	2.803	0.273	0.228	0.959	0.044	0.209	6	Delete
4	19.602	0.790	0.765	0.955	0.613	0.783	0	Keep
5	16.770	0.785	0.761	0.955	0.610	0.781	0	Keep
6	16.195	0.773	0.747	0.955	0.595	0.771	0	Keep
7	14.897	0.758	0.731	0.955	0.565	0.752	0	Keep
8	11.618	0.699	0.667	0.955	0.489	0.699	0	Keep
9	9.631	0.684	0.650	0.956	0.452	0.673	0	Keep
10	13.700	0.735	0.705	0.955	0.538	0.733	0	Keep
11	15.601	0.778	0.751	0.955	0.607	0.779	0	Keep
12	19.077	0.818	0.797	0.954	0.674	0.821	0	Keep
13	8.026	0.598	0.567	0.956	0.323	0.568	0	Keep
14	12.427	0.703	0.681	0.955	0.518	0.719	0	Keep
15	12.166	0.748	0.732	0.955	0.589	0.767	0	Keep
16	7.946	0.567	0.544	0.956	0.345	0.587	0	Keep
17	10.929	0.681	0.658	0.956	0.494	0.703	0	Keep
18	11.692	0.705	0.686	0.956	0.517	0.719	0	Keep
19	3.366	0.284	0.243	0.958	0.077	0.277	5	Delete
20	14.774	0.809	0.794	0.955	0.666	0.816	0	Keep
21	12.346	0.752	0.731	0.955	0.563	0.750	0	Keep
22	15.790	0.806	0.791	0.955	0.677	0.823	0	Keep
23	16.761	0.778	0.751	0.955	0.622	0.788	0	Keep
24	16.104	0.771	0.747	0.955	0.623	0.790	0	Keep
25	16.545	0.764	0.742	0.955	0.598	0.774	0	Keep
26	15.400	0.761	0.740	0.955	0.593	0.770	0	Keep
27	13.471	0.709	0.679	0.955	0.507	0.712	0	Keep
28	15.075	0.735	0.711	0.955	0.551	0.742	0	Keep
29	13.919	0.661	0.632	0.956	0.448	0.669	0	Keep

Item No.	Commonality	Factor loading
Item No.	Commonality	Factor 1	Factor 2	Factor 3
Factor 1： Practice of safe medication
22	0.814	0.815	0.307	0.236
20	0.769	0.780	0.348	0.199
21	0.690	0.770	0.242	0.199
23	0.736	0.753	0.291	0.292
24	0.731	0.729	0.278	0.348
26	0.675	0.716	0.296	0.273
25	0.679	0.710	0.364	0.207
27	0.573	0.649	0.321	0.222
28	0.593	0.638	0.342	0.262
29	0.483	0.576	0.335	0.198
Factor 2： Knowledge about safe medication
11	0.816	0.277	0.831	0.221
12	0.806	0.374	0.782	0.234
5	0.739	0.300	0.759	0.269
8	0.664	0.230	0.749	0.223
7	0.688	0.299	0.738	0.232
6	0.682	0.349	0.702	0.261
10	0.640	0.377	0.690	0.147
4	0.655	0.394	0.647	0.287
9	0.511	0.297	0.611	0.222
Factor 3： Belief of safe medication
16	0.776	0.179	0.142	0.850
15	0.797	0.376	0.300	0.752
17	0.714	0.265	0.352	0.721
18	0.699	0.362	0.275	0.701
14	0.675	0.310	0.365	0.668
Eigenvalue	‒	6.565	6.176	3.863
Variance explained/%	‒	27.352	53.085	69.180