Kidney transplant is the best treatment for most end-stage renal disease (ESRD) patients, but proportionally few ESRD patients receive kidney transplant. To make an informed choice about whether to pursue kidney transplant, patients must be knowledgeable of its risks and benefits. To reliably and validly measure ESRD patients’ kidney transplant knowledge, rigorously tested measures are required. This article describes the development and psychometric testing of the Knowledge Assessment of Renal Transplantation (KART).
We administered 17 transplant knowledge items to a sample of 1294 ESRD patients. Item characteristics and scale scores were estimated using an Item Response Theory graded response model. Construct validity was tested by examining differences in scale scores between patients who had spent less than 1 and 1 hour or longer receiving various types of transplant education.
Item Response Theory modeling suggested that 15 items should be retained for the KART. This scale had a marginal reliability of 0.75 and evidenced acceptable reliability (>0.70) across most of its range. Construct validity was supported by the KART’s ability to distinguish patients who had spent less than 1 and 1 hour or longer receiving different types of kidney transplant education, including talking to doctors/medical staff (effect size [ES], 0.61; P < 0.001), reading brochures (ES, 0.45; P < 0.001), browsing the internet (ES, 0.56; P < 0.001), and watching videos (ES, 0.56; P < 0.001).
The final 15-item KART can be used to determine the kidney transplant knowledge levels of ESRD patients and plan appropriate interventions to ensure informed transplant decision making occurs.
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
2Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA.
3Terasaki Research Institute, University of California, Los Angeles, Los Angeles, CA.
4Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
Received 20 March 2018. Revision received 17 May 2018.
Accepted 27 May 2018.
The authors declare no conflicts of interest.
This study was funded by NIDDK R01DK088711-01A1 (awarded to Amy D Waterman), HRSA R39OT26843-01-02 (awarded to Amy D Waterman), and HRSA R39OT29879 (awarded to Amy D Waterman). R.D.H. was supported in part by NIA P30-AG02168.
J.D.P. conceived of the study design, conducted psychometric analyses, and lead the manuscript drafting. R.D.H. consulted on the study design, conducted psychometric analyses, and critically reviewed the article. S.K. and J.L.B. conducted statistical analyses and critically reviewed the article. A.D.W. conceived of the study design, designed the transplant knowledge items, conducted data analyses, and critically reviewed the article.
Correspondence: John D Peipert, PhD, Northwestern University Feinberg School of Medicine, 625 N Michigan, Suite 2700, Chicago, IL 60611. (firstname.lastname@example.org).