Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV)

Abstract Background: Patient education is an essential part of cardiovascular patients' care targeting self-management behavior to reduce risk factors and subsequent events. Herein, a short and reliable tool to assess patients' knowledge in Brazil is warranted. Objectives: To translate, culturally-adapt and psychometrically validate the Portuguese version of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV). Methods: The Portuguese CADE-Q SV - translated and culturally-adapted - was reviewed by five bilingual experts in cardiovascular disease. This version was then pre-tested in 21 patients, and clarity of items was checked using a Likert-type scale ranging from 1 = not clear to 10 = very clear. It was then psychometrically tested in 200 cardiovascular patients (41%women; mean age = 58.4 ± 11.6 years old). The internal consistency was assessed using Kuder-Richardson-20 (KR-20) and Cronbach's alpha, test-retest reliability through intraclass correlation coefficient (ICC), factor structure using confirmatory factor analysis, and construct validity regarding educational level, family income, and time of diagnosis. Results: All questions were considered clear by patients (clarity range:7.8-9.6). KR-20 was 0.70. All ICC values were > 0.70. Factor analysis revealed 6 factors, all internally consistent. Construct validity was supported by significant differences in total scores by educational level and family income (p < 0.001). The overall mean was 13.08 ± 2.61. The area with the highest knowledge was risk factors and the lowest was psychosocial risk. Conclusions: The Portuguese CADE-SV was demonstrated to have good validity and reliability. This tool can be applicable in clinical and research settings, assessing cardiovascular patients' knowledge as part of an education programming.

**背景**：患者教育是心血管疾病患者护理的核心组成部分，旨在引导患者养成自我管理行为，以降低危险因素及后续不良事件的发生风险。目前巴西亟需一款简短且可靠的工具，用于评估心血管患者的疾病认知水平。
**研究目的**：对冠状动脉疾病教育问卷简版（Coronary Artery Disease Education Questionnaire Short Version, CADE-Q SV）的葡萄牙语版本进行翻译、文化调适，并开展心理测量学验证。
**研究方法**：首先由5名心血管疾病领域的双语专家对翻译并完成文化调适后的葡萄牙语版CADE-Q SV进行评审。随后对21例患者进行预测试，采用1（完全不清晰）至10（非常清晰）的李克特（Likert）量表评估条目清晰度。之后纳入200例心血管患者（女性占比41%，平均年龄58.4±11.6岁）开展心理测量学验证：采用克德-理查森20系数（Kuder-Richardson-20, KR-20）与克朗巴赫α系数（Cronbach's alpha）评估内部一致性；采用组内相关系数（intraclass correlation coefficient, ICC）评估重测信度；采用验证性因子分析（confirmatory factor analysis）探究因子结构；并通过受教育水平、家庭收入及确诊时长分析结构效度。
**研究结果**：所有条目均被患者评为清晰，清晰度评分区间为7.8~9.6。KR-20系数为0.70，所有ICC值均大于0.70。因子分析共提取6个内部一致性良好的因子。结构效度分析显示，不同受教育水平与家庭收入的患者总得分存在显著差异（p<0.001）。研究整体平均得分为13.08±2.61，患者对危险因素相关知识的掌握程度最高，而对心理社会风险相关知识的掌握程度最低。
**研究结论**：葡萄牙语版CADE-Q SV具备良好的效度与信度，可应用于临床与科研场景，作为教育项目的一部分用于评估心血管患者的疾病认知水平。