Psychometric Properties of the Heart Disease Knowledge Scale: Evidence from Item and Confirmatory Factor Analyses

Main Article Content

Bee Chiu Lim
Yee Cheng Kueh
Wan Nor Arifin
Kok Huan Ng

Abstract

Background: Heart disease knowledge is an important concept for health education, yet there is lack of evidence on proper validated instruments used to measure levels of heart disease knowledge in the Malaysian context. Methods: A cross-sectional, survey design was conducted to examine the psychometric properties of the adapted English version of the Heart Disease Knowledge Questionnaire (HDKQ). Using proportionate cluster sampling, 788 undergraduate students at Universiti Sains Malaysia, Malaysia, were recruited and completed the HDKQ. Item analysis and confirmatory factor analysis (CFA) were used for the psychometric evaluation. Construct validity of the measurement model was included. Results: Most of the students were Malay (48%), female (71%), and from the field of science (51%). An acceptable range was obtained with respect to both the difficulty and discrimination indices in the item analysis results. The difficulty index ranged from 0.12–0.91 and a discrimination index of ? 0.20 were reported for the final retained 23 items. The final CFA model showed an adequate fit to the data, yielding a 23-item, one-factor model [weighted least squares mean and variance adjusted scaled chi-square difference = 1.22, degrees of freedom = 2, P-value = 0.544, the root mean square error of approximation = 0.03 (90% confidence interval = 0.03, 0.04); close-fit P-value = > 0.950]. Conclusion: Adequate psychometric values were obtained for Malaysian undergraduate university students using the 23-item, one-factor model of the adapted HDKQ.

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How to Cite

1.
Bee Chiu Lim, Yee Cheng Kueh, Wan Nor Arifin, Kok Huan Ng. Psychometric Properties of the Heart Disease Knowledge Scale: Evidence from Item and Confirmatory Factor Analyses. Malays J Med Sci [Internet]. 2016 Jun. 30 [cited 2026 Nov. 11];23(4):33–45. Available from: https://ejournal.usm.my/mjms/article/view/mjms_vol23-no4-2016_5

References

American Heart Association. Heart Disease and Stroke Statistics – At a glance [Internet]; 2015 [cited 29 Aug 2015]. Available from: http://www.heart.org/idc/groups/ahamah-public/@wcm/@sop/@smd/documents/downloadable/ucm_470704.pdf.

The Heart Foundation of Malaysia. The Heart Foundation of Malaysia [Internet]; 1999–2015 [cited 31 Aug 2015]. Available from: http://www.yjm.org.my/index.cfm?menuid=2.

Department of Statistics Malaysia. Statistics on causes of death Malaysia 2008. Putrajaya: Department of Statistics Malaysia; 2010.

Ministry of Health Malaysia. Health facts 2013. Putrajaya: Health Informatics Centre Planning and Development Division; 2013.

Aglony M, Acevedo M, Ambrosio G. Hypertension in adolescents. Expert Rev Cardiovasc Ther. 2009;7(12):1595–1603. doi: http://dx.doi.org/10.1586/erc.09.150

Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295(13):1549–1555. doi: http://dx.doi.org/10.1001/jama.295.13.1549

Din-Dzietham R, Liu Y, Bielo MV, Shamsa F. High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation. 2007;116:1488–1496. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.106.683243

Rampal L, Ng KC, Nur Izzati I, Farah Izzati Z, Mohammad Nazrul I, Faisal I, et al. Prevalence of hypertension among Malay adolescents in Putrajaya secondary schools, Malaysia, 2010. Malaysian Journal of Medicine and Health Sciences. 2011;7(2):53-60.

Muntner P, Jiang H, Cutler JA, Wildman RP, Whelton PK. Trends in blood pressure among children and adolescents. JAMA. 2004;291:2107–2113. doi: http://dx.doi.org/10.1001/jama.291.17.2107

Strong JP, Malcom GT, McMahan CA, Tracy RE, Newman III WP, Herderick EE, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the pathobiological determinants of atherosclerosis in youth study. JAMA. 1999;281(8):727–735. doi: http://dx.doi.org/10.1001/jama.281.8.727

Berenson GS. Cardiovascular risk begins in childhood: A time for action. Am J Prev Med. 2009;37 (Supplement 1):S1–S2. doi: http://dx.doi.org/10.1016/j.amepre.2009.04.018

Hunt DP. The concept of knowledge and how to measure it. Journal of Intellectual Capital. 2003;4(1):100–113. doi: http://dx.doi.org/10.1108/14691930310455414

Homko CJ, Santamore WP, Zamora L, Shirk G, Gaughan J, Cross R, et al. Cardiovascular disease knowledge and risk perception among underserved individuals at increased risk of cardiovascular disease. J Cardiovasc Nurs. 2008;23(4):332–337. doi: 10.1097/01.JCN.0000317432.44586.aa. http://dx.doi.org/10.1097/01.JCN.0000317432.44586.aa

Chan CW, Lopez V, Chung JW. A survey of coronary heart disease knowledge in a sample of Hong Kong Chinese. Asia Pac J Public Health. 2011;23(3):288–297. doi: http://dx.doi.org/10.1177/1010539509345869

Gautam YR. A study of assessing knowledge and health beliefs about cardiovascular disease among selected undergraduate students using health belief model. [PhD Degree]. [Carbondale]: Southern IIlinois University; 2012.

Vanhecke TE, Miller WM, Franklin BA, Weber JE, McCullough PA. Awareness, knowledge, and perception of heart disease among adolescents. Eur J Cardiovasc Prev Rehabil. 2006;13:718–723. doi: http://dx.doi.org/10.1097/01.hjr.0000214611.91490.5e

Collins KM, Dantico M, Shearer NB, Mossman KL. Heart disease awareness among college students. Journal of Community Health. 2004;29(5):405– 420. doi: http://dx.doi.org/10.1023/B:JOHE.0000038655.19448.b2

Wagner J, Lacey K, Chyun D, Abbott G. Development of a questionnaire to measure heart disease risk knowledge in people with diabetes: The heart disease fact questionnaire. Patient Educ Couns. 2005;58:82–87. doi: http://dx.doi.org/10.1016/j.pec.2004.07.004

Yadav KD, Wagle RR. Knowledge and attittude regarding major risk factors of cardiovascular diseases among 15–19 year old students of Khatmandu district. Health Prospect. 2012;11:7–10. doi: http://dx.doi.org/10.3126/hprospect.v11i0.7422

Vaidya A, Aryal UR, Krettek A. Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: A popoulationbased cross-sectional study from Jhaukhel-Duwakot health demographic surveillance site. BMJ Open. 2013;3:e002976. doi: http://dx.doi.org/10.1136/bmjopen-2013-002976

Winham DM, Jones KM. Knowledge of young African Amercian adults about heart diease: A cross sectional survey. BMC Public Health. 2012;11:248–258. doi: http://dx.doi.org/10.1186/1471-2458-11-248

Amin AM, Hamza M, Azmi S. Factors associated with the general public knowledge and awareness of cardiovascular diseases and its risk factors in Penang – Malaysia. ISOR Journal of Pharm. 2014;4(6):21– 27. doi: http://dx.doi.org/10.9790/3013-040601021027l.

Muhamad R, Yahya R, Mohamed Yusoff H. Knowledge, attitude and practice on cardiovascular disease among women in north-eastcoast Malaysia. International Int J Collab Res Intern Med Public Health [Internet]; 2012 [cited 31 Aug 2014];4(1):85– 98. Available from: http://iomcworld.com/ijcrimph/ijcrimph-v04-n01-08.htm.

Bergman HE, Reeve BB, Moser RP, Scholl S, Klein WMP. Development of a comprehensive heart disease knowledge questionnaire. Am J Health Educ. [Internet]. 2011 [cited 26 Aug 2014];42(2):74–87. Available from: http://files.eric.ed.gov/fulltext/EJ918449.pdf.

Raykov T, Marcoulides GA. Introduction to psychometric theory. New York: Taylor and Francis Group; 2011.

Streiner DL, Norman, GR. Health measurement scales: A practical guide to their development and use. 4th ed. New York: Oxford University Press; 2008. doi: http://dx.doi.org/10.1093/acprof:oso/9780199231881.001.0001

Fletcher RH, Fletcher SW, Wagner EH. Clinical epidemiology: The essentials. 3rd ed. Maryland: Williams & Wilkins; 1996.

Romero DC, Sauris A, Rodriguez F, Delgado D, Reddy A, Foody JM. Vivir Con Un Corazón Saludable: a Community-Based Educational Program Aimed at Increasing Cardiovascular Health Knowledge in High-Risk Hispanic Women. J Racial Ethn Health Disparities. 2015;3(1):99–107. doi: http://dx.doi.org/10.1007/s40615-015-0119-6

Muthen LK, Muthen BO. Mplus user’s guide. 7th ed. Los Angeles, CA: Muthen & Muthen; 1998–2012.

Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York, NY: McGraw-Hill; 1994.

Kline P. The handbook of psychological testing. London: Routledge; 1993.

Linn RL, Grolund NE. Measurement and assessment in teaching. 7th ed. New Jersey: Prentice-Hall; 1995.

Ebel RL, Fresbie DA. Essentials of educational measurement. 5th ed. New Jersey: Prentice-Hall; 1991.

Abdul Rahim AF. What those numbers mean a guide to item analysis; 2010 [cited 19 Aug 2015]. Available from: http://www.medic.usm.my/dme/index.php?option=com_content&task=view&id=54&Itemid=86 .

Hair JFJ, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. 7th ed. New Jersey: Pearson Prentice Hall; 2010.

Yu CY. Evaluating cutoff criteria of model fit Indices for latent variable models with binary and continuous outcomes. [PhD Degree]. [Los Angeles, CA]: University of California; 2002.

Kline RB. Principles and practice of structural equation modeling. 3rd ed. New York: The Guilford Press; 2011.

Schermelleh-Engel K, Moosbrugger H, Muller H. Evaluating the fit of structural equation models:Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online [Internet]. 2003 [cited 26 August 2015];8(2):23–74. Available from: http://www.dgps.de/fachgruppen/methoden/mpr-online/issue20/art2/mpr130_13.pdf.

Wang J, Wang X. Structural equation modeling applications using Mplus. Chichester, West Sussex, United Kingdom: John Wiley & Sons Ltd.; 2012. doi: http://dx.doi.org/10.1002/9781118356258

Bryne BM. Structural equation modeling with AMOS basic concepts, applications, and programming. 2nd ed. New York: Taylor and Francis Group, LLC.; 2010.

Brown TA. Confirmatory factor analysis for applied research. New York: The Guilford Press; 2006.

Zurawsk RM. Making the most of exams: Procedures for item analysis. [Internet] 1996–1999. [cited 29 Aug 2015]. Available from: http://faculty.mansfield.edu/lfeil/201/item-analysis-explained.htm.

Muthen BO. Mplus technical appendices. Los Angeles, CA: Muthen & Muthen; 1998–2004.

Ford JK, MacCallum RC, Tait M. The application of exploratory factor annalysis in applied psychology: A critical review and analysis. Pers Psychol. 1986;39(2):291–314. doi: http://dx.doi.org/10.1111/j.1744-6570.1986.tb00583.x

Wilson M, Allen DD, Li JC. Improving measurement in health education and health behaviour research using item response item response modelling: Comparison with the classical test theory approach. Health Educ Res. 2006;21:119–132. doi: http://dx.doi.org/10.1093/her/cyl053