Cultural Adaptation and Psychometric Validation of a Cardiac Knowledge Questionnaire for Chinese Immigrants

Background: Disease-related knowledge deficits are common in Chinese immigrants living in Western countries, putting them at risk of disease progression and mortality, particularly those with a coronary heart disease (CHD) diagnosis. However, no measurement instrument is available to assess CHD-related knowledge in this population. Objectives: The aim of this study was to culturally adapt and examine the psychometric properties of the short version of Coronary Artery Disease Education Questionnaire (CADE-Q SV) (simplified Chinese version) in Chinese immigrants with CHD. Methods: Mandarin-speaking people recruited from medical centers and cardiology clinics across metropolitan Sydney completed the 20-item CADE-Q SV (5 domains; potential scores: 0-20). Internal consistency was assessed using Cronbach alpha. A subgroup (n = 40) repeated the survey 2 weeks later for test-retest reliability by intraclass correlation coefficient. Factor structure (confirmatory factor analysis) and discriminant (known-groups) validation using education and English proficiency (univariate general linear model) were also undertaken. Results: Participants (n = 202) had a mean (SD) age of 66.08 (10.93) years, 45.1% were male, and the mean (SD) total CADE-Q SV score was 13.07 (4.57). Reliability and consistency were good (intraclass correlation coefficient > 0.70; Cronbach alpha coefficients > 0.70, for total and per domain, respectively). The 5-domain structure was validated by confirmatory factor analysis. The scale demonstrated discriminant validity, with low education (P < .001) and low English proficiency (P = .017) associated with lower knowledge scores. Conclusion: The CADE-Q SV (simplified Chinese version) can be used as a valid and reliable instrument, either paper based or digital, to evaluate the CHD-related knowledge of Chinese immigrants. This scale can be adapted to other migrant populations in the future.