Validation of a Patient Knowledge Questionnaire for Pulmonary Hypertension

Overview

This methodological study aims to develop and validate a questionnaire named DICTA (Questionnaire for the Assessment of Patient Knowledge in Pulmonary Arterial Hypertension). The study will be conducted in four phases: (1) questionnaire development based on guidelines and literature; (2) content validation by expert judges; (3) semantic validation with patients; and (4) psychometric testing in a sample of up to 200 patients with confirmed pulmonary arterial hypertension (PAH). In addition to validation, the study will collect clinical and functional data from medical records, including risk stratification using the COMPERA 2.0 method, number of hospitalizations, and quality of life scores assessed by CAMPHOR, SF-36, and MBG. The study will analyze the relationship between patient knowledge (as measured by DICTA) and these outcomes. The final instrument is expected to support patient education strategies and contribute to improved clinical management of PAH.

This is a methodological study with a quantitative approach, developed in four main phases, aimed at constructing and validating a questionnaire to assess the knowledge of patients with pulmonary arterial hypertension (PAH). The study will be conducted at a reference outpatient center in Brazil and will follow established methodological guidelines for the development and validation of health-related instruments. Phase 1 - Questionnaire Development: The initial version of the questionnaire, named DICTA, will be created based on the 2022 ESC/ERS Guidelines for PAH, a review of the scientific literature on patient knowledge in chronic diseases, and validated instruments in other conditions (e.g., chronic kidney disease, inflammatory bowel disease, rheumatoid arthritis). Items will cover the following domains: basic concepts, signs and symptoms, diagnosis and exams, available treatments and their mechanisms, adherence and self-care, and side effect management. Items will be multiple-choice with the option "I don't know". Phase 2 - Content Validation: At least five expert judges with experience in PAH, health education, and instrument development will evaluate each item for clarity, relevance, representativeness, and appropriateness using a 4-point Likert scale. The Content Validity Index (CVI) will be calculated for each item (I-CVI) and for the total instrument (S-CVI). Items with I-CVI ≥ 0.78 will be retained. Phase 3 - Semantic Validation: A sample of at least 10 patients diagnosed with PAH will be asked to complete the questionnaire while verbalizing their understanding ("think-aloud" technique). Revisions will be made based on participant feedback to ensure clarity and comprehension. Phase 4 - Pilot Study and Psychometric Analysis: The refined DICTA questionnaire will be applied to a sample of up to 200 patients with confirmed PAH. Psychometric analysis will include internal consistency (Cronbach's alpha) and, if applicable, test-retest reliability (intraclass correlation coefficient - ICC). Exploratory factor analysis may be used to assess internal structure. In addition to validation, the study will collect clinical and functional data from medical records, including: Risk stratification using COMPERA 2.0 methodology Number of hospitalizations related to PAH Quality of life scores measured by: CAMPHOR (Cambridge Pulmonary Hypertension Outcome Review) SF-36 (Short Form Health Survey) MBG (Medida de Bem-Estar Global) The relationship between knowledge scores (DICTA) and these outcomes will be analyzed, aiming to explore whether higher patient knowledge is associated with better risk status, lower hospitalization rates, and higher quality of life. This instrument is expected to help identify educational gaps, support targeted health education strategies, and contribute to improved clinical outcomes and shared decision-making in the care of PAH patients.