Measuring Children’s Knowledge of Acute Rheumatic Fever and Rheumatic Heart Disease

Development and Validation of RHD Knowledge Scale in Nepal

Bibliographic Data

ID13775127
AuthorsSandeepa Karki (0000-0002-2076-5604, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Shishir Paudel (0000-0003-3077-6697, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal, corresponding author), Ryukichi Hada (Manmohan Memorial Institute of Health Sciences), Rudra Prakash Hada (Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Prashant Khadka (0009-0002-6515-6770, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Gautham Shetty (Manmohan Memorial Institute of Health Sciences), Ganesh Shetty (Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Dhurba Khatri (0000-0001-5244-5536, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Yamuna Chhetri (0009-0005-5534-4876, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Shankar Prasad Khanal (0000-0002-9192-6057, Manmohan Memorial Institute of Health Sciences), Sakar Khanal (Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal), Bhagawan Koirala (0000-0001-5537-0031, Kathmandu Institute of Child Health, Hepali Heights, Budhanilkantha, Kathmandu, Nepal)
Year2025
Volume62
Pages469580251405997-469580251405997
Publication date2025-09-01
Open AccessYes
TypeARTICLE
VenueINQUIRY The Journal of Health Care Organization Provision and Financing (JOURNAL)
Journal identifiersISSN: 0046-9580 • E-ISSN: 1945-7243
PublisherSAGE Publishing (PUBLISHER • US)
DOI10.1177/00469580251405997
PMID41408758
OpenAlexW4417449271
LanguageEN
References cited30

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health challenges in low- and middle-income countries, including Nepal. This study aimed to develop and validate a tool to assess children's knowledge of ARF and RHD. A 14-item multiple-choice questionnaire was developed through expert consultation and a systematic translation and back-translation process. Content validity was evaluated by 10 experts using item-level and scale-level content validity indices (I-CVI and S-CVI) and the Content Validity Ratio (CVR). A cross-sectional survey of 207 students aged 11 to 16 years was conducted in public schools. Item difficulty and discrimination indices were calculated, and internal consistency was assessed using the Kuder-Richardson Formula 20 (KR-20). Known-groups validity was tested by comparing scores across grades and prior exposure to RHD screening programs. The scale demonstrated excellent content validity (S-CVI/Ave = 0.91) and good internal consistency (KR-20 = 0.772). Item difficulty indices ranged from 0.32 to 0.61, and discrimination indices from 0.23 to 0.36, both within ideal ranges. The mean knowledge score was 6.05 ± 3.43. Higher knowledge scores were observed among older students, those in higher grades, and those previously screened for RHD ( P < .05). The RHD Knowledge Scale is a valid and reliable instrument for assessing children's understanding of ARF and RHD. Although this study was limited to a single municipality and did not include test-retest reliability, the tool shows strong potential for adaptation and validation across different cultural, linguistic, and geographical contexts. Beyond research settings, this tool can serve as a practical means to integrate ARF and RHD education into school health programs and to monitor the effectiveness of nationwide prevention initiatives

Acute rheumatic fever · Consistency (knowledge bases · Content validity · Heart disease · Internal consistency · Internal validity · Public health · Scale (ratio · Autoimmune and Inflammatory Disorders Research · Rheumatoid Arthritis Research and Therapies · Streptococcal Infections and Treatments

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