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Pressure Ulcers: Development and psychometric evaluation of the Patient Knowledge of Pressure Ulcer Prevention Instrument (KPUP).

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Development and Psychometric Evaluation of:
The Patient Knowledge of Pressure Ulcer Prevention Instrument



Patients have a right to have a central part in the healthcare process is an important aspect of health care

  •  Benefits include enhanced motivation and knowledge

    about health and illness, and increased capacity to monitor and look after themselves2.

  • Patient involvement in pressure ulcer prevention tends to be limited as this aspect of care has been largely viewed as being in the domain of the trained health care professional3.

        •To evaluate the outcomes of a planned patient led pressure ulcer prevention clinical trial, a validated tool to measure patient knowledge is essential.

•  Following an extensive literature search the researcher was unable to find a validated tool and thus the development and psychometric evaluation of KPUP instrument was necessary. 

  • 2. METHODS•  Step 1 involved development of the questionnaire, to explore knowledge, attitudes and health behaviours, related to pressure ulcer prevention.•  To evaluate the psychometric characteristics of the KPUP, first content validity was undertaken.•  Ethical approval was received for the study.•  Two expert panels were surveyed to evaluate therelevance of each question in a Delphi procedure. Group 1 comprised of a group of researchers. Group 2 consisted of tissue viability nurses.•  Each item for appropriateness and relevance, using a Likert scale. Data were analysed, stored and presented using SPSS version 20.0 (SPSS Inc. Chicago, IL, USA).•  Items with a Content Validity Index of .78 or higher for 3 or more experts were considered acceptable.


    Data were analysed, stored and presented using SPSS version 20.0 (SPSS Inc. Chicago, IL, USA). The content validity index (CVI) was computed using the proportion of experts who agreed regarding:


    •The item was appropriate;
    •The item was relevant;
    •The proposed answer choices were appropriate.


    Items with a CVI of .78 or higher for 3 or more experts can be considered have good content validity4.


    For section 1, one item failed to reach a CVI of .78 or higher (CV1 = .71) for appropriateness, even though the CVI for relevance and answer appropriateness was .97 and .94 respectively, and thus, this question was excluded. All other items had good CVI scores (appropriateness .89-.97, relevance .88-.97 and answer appropriateness .81-.94).


    For section 2, all items had good CVI scores (appropriateness .89-.97, relevance .86-.97 and answer appropriateness .86-.97).


    For section 3, the CVI was calculated for appropriateness and relevance, yielding scores of .94-1.0, and .92-1.0 respectively, indicating good CVI scores for each item in this section



    The Delphi procedure facilitated the assessment of the content validity of the KPUP. Results show that the KPUP has good content validity and thus may now be used in phase two of the instrument development, which is to undertake psychometric evaluation of the instrument among a cohort of 200 older persons



    International pressure ulcer prevention guidelines recommend structured education programmes for educating older adults to prevent pressure ulceration. The development of a reliable and valid instrument to assess patient’s knowledge of, and attitudes to behaviours towards pressure ulcer prevention is an important in order to evaluate the impact of education programmes on patients.



    1.World Health Organisation. Right to Health. (World Health Organisation, Geneva, 2012).Available: ttp://www.who.int/mediacentre/factsheets/fs323/en/index.html#.UPrSuSNE5mw.email.
    2.European Commission. Eurobarometer Qualitative study: Patient involvement. (ed. Directorate-General for Communication) (European Commission, Brussels, 2012).
    3.Coulter, A., Parsons, S. & Askham, J. Where are the patients in decision-making about their own care? (ed. World Health Organization 2008 and World Health Organization on behalf of the European Observatory on Health Systems and Policies) (WHO Regional Office for Europe, Copenhagen, Denmark, 2008).
    4.Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what's being reported? Critique and recommendations. Research in Nursing & Health, 29(5), 489-497. doi:10.1002/nur.20147

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