DEVELOPING THE KOREAN EDUCATIONAL NEEDS ASSESSMENT TOOL (KOREAN-ENAT) IN RHEUMATOID ARTHRITIS: A CROSS-CULTURAL VALIDATION USING RASCH ANALYSIS

Abstract

Background The Educational Needs Assessment Tool (ENAT) is a 39-item patient-completed questionnaire designed to help patients identify and prioritize their educational needs. It was originally developed in the UK and validated in 7 rheumatic diseases including rheumatoid arthritis (RA).1

Objectives This study aimed to undertake cross-cultural adaptation and validation of the ENAT in RA for use in Korea.

Methods The study involved two main phases: (1) Cross-cultural adaptation of the ENAT from English into Korean and (2) validation of the Korean-ENAT. The first phase followed an established process of cross-cultural adaptation of self-report measures.2 For the second phase, patients with RA completed the Korean-ENAT at the outpatient clinic of a university hospital and Rasch measurement computer program, WINSTEPS, was used to analyze the data. Fit to the model was determined by the observed data Infit and Outfit statistics (≥0.50 and ≤1.50); where a value of 1.00 suggests a perfect fit to the model expectations. The unidimensionality of the scale was determined by item (and person) separation index ≥2.00 and reliability ≥0.80.

Results An adequate conceptual equivalence was achieved following the adaptation process. A total of 123 patients completed the Korean-ENAT. Their mean ± SD age was 46.7±12.3, disease duration 53.7±71.2 months and the majority (81.3%) were female. Thirty-five of the 39 items displayed good fit to the model. The 4 items deviating from the model had Infit and Outfit >1.50. The item separation index (5.26) and item reliability index (0.97) provided evidence for good reliability of items. All the 7 domains of the Korean-ENAT were found to fit the Rasch model. The internal consistency of the Korean-ENAT was high and unidimensionality was confirmed (Person separation index =3.41 reliability index =0.92; item separation index =16.82 and reliability index =1.00).

Conclusions Using a standard process in cross-cultural adaptation, the ENAT was adapted into Korean and Rasch analysis confirmed that the construct validity, reliability, and unidimensionality of the Korean-ENAT. The Korean-ENAT provides valid and reliable estimates of educational needs of people with RA in Korea.