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  • br Results br Discussion br Conclusions br

    2019-04-24


    Results
    Discussion
    Conclusions
    Disclosures
    Conflict of interest
    Financial support
    Introduction Stroke is one of the top five common causes of mortality in Malaysia with a rate at 8.43/100,000 hedgehog inhibitor [1,2]. Stroke impact is not limited to physical disabilities that stroke patients experience but also burdens family caregivers. Therefore, it is important to highlight stroke prevention measures for primary or secondary prevention. In addition to the biomedical approach, stroke prevention must be emphasized via stroke education [3–5]. Stroke can be prevented by modifying unhealthy lifestyles such as poor dietary patterns, obesity, smoking, excessive alcohol intake, uncontrolled diabetes, hypercholesterolemia, and lack of exercise [6]. Previous studies proved that healthy lifestyles are very important mechanisms to prevent stroke occurrence or to reduce recurrent events. Thus, stroke prevention that highlights lifestyle modification at either primary or secondary prevention should begin with delivering knowledge to the community, patients, and family caregivers.
    Materials and methods The SKT instrument was adapted from a study by Sullivan and Dunton [7] consisting of 20 items on stroke risk factors, signs and symptoms, prevention, prevalence, treatment, and rehabilitation. The 20 multiple choice question (MCQ) items were constructed in a five-alternative multiple choice format which consisted of one correct option, three distracters, and an “I don’t know” option to reduce the tendency to guess. MCQ format was chosen since it has the ability to broadly sample content domain within a reasonable time limit. Each correct answer was given one (1) mark and a wrong answer was given no (0) mark. Possible scores ranged from 0 to 20. Higher score indicates good knowledge.
    Results The purpose of this study was to follow a systematic validation procedure for a stroke knowledge instrument to evaluate potential applications in any stroke education program [24]. A series of steps comprising content and face validation, item analysis, and reliability checking of the SKT were completed. The validation process resulted in 20 items that had acceptable content coverage, improved clarity, and relevant difficulty levels, and were appropriate to be included in the final SKT version.
    Discussion It is hoped that the Malay version SKT contributes towards stroke education assessment and evaluation meant to measure stroke patients’ knowledge levels. Furthermore, this tool can also be used to identify individual learning needs of stroke patients and their caregivers. Validity is defined as the extent to which an instrument measures what hydrophobic is supposed to measure [13,14]. Reliability, on the other hand, refers to the consistency and repeatability of an instrument [13,14]. The item analysis on SKT knowledge items showed that most items had appropriate values of difficulty and discrimination indices. The difficulty indices showed that 70% of the items were between acceptable and excellent and 30% of the items were considered poor items. On the discrimination index, 75% of the items were considered acceptable, 20% were difficult, and 5% were easy. Compared to initial content validation, experts had also rated similar items to number five as unsuitable to be included in the final version due to its difficulty level [7]. However, the researchers decided to retain the questions since the items reflected the overall picture of the knowledge on stroke. Although reliability testing is necessary, it was not a sufficient component of the instrument validity. This is because reliability may change when it is conducted with a different population. Reliability was regarded as the ability of an instrument to consistently measure an attribute over time. The researchers had used KR-20 to establish the internal consistency reliability of knowledge test as it is preferable for use with measures with dichotomous variables (e.g., 1 for correct response and 0 for incorrect response [7,25]) while Cronbach’s alpha coefficient is indicated for determining the internal consistency reliability of a measure with variables scored such with Likert scales [27,28].