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Reliability was evaluated in terms of internal consistency and test—retest reliability. Internal consistency was evaluated using Cronbach's alpha and the confidence interval was determined according to the Fan and Thompson method, 22 and compared with other estimates described by Viladrich and Doval.

Concordance of the responses to each question was analyzed using the kappa index. Bland—Altman and intraclass correlation coefficient were used to analyze concordance in the total questionnaire score.. To evaluate concurrent validity, the NAKQ scores and each teacher's self-assessment of their knowledge of the disease sufficient vs insufficient and their direct contact with asthma asthmatic teachers or those with asthmatics among their close contacts with teachers vs no direct contact with the disease.

NAKQ score was studied according to age, sex, teaching experience, academic training and educational level in which they were working.

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Mann—Whitney, Kruskall—Wallis and Spearman's rho were used.. Sensitivity to change was evaluated in a study of a random sample of teachers from schools in San Sebastian, selected using the same methodology. The Wilcoxon-signed rank test was used to compare the questionnaire scores, the McNemar test to compare the percentage of items answered correctly, and the Mann—Whitney U -test to compare baseline score and score at 3 months between the intervention group and the control group.

Effect size and mean standardized response were studied to evaluate any increase in questionnaire score after intervention.. Of the 22 selected schools, 3 refused to participate, so these were replaced with schools from the reserve list. In the end, 24 schools 10 public primary education, 6 public secondary education and 8 private were included, and teachers who met the inclusion criteria participated..

The percentage of participation was Characteristics of the participants are shown in Table General Characteristics of Teachers Participating in the Study.. Mean score on the NAKQ questionnaire was The floor and ceiling effect percentages were 2. On average, The percentage of correct results for each item ranged from SD: standard deviation.. Internal consistency analysis gave a high Cronbach's alpha coefficient of 0. Significant differences were observed in the concurrent validity of the NAKQ score, depending on the personal contact of teachers with asthma and their self-assessed knowledge of the disease Table 2.

Scores were lower for teachers with no contact with asthmatics Lower scores were found in teachers who considered their knowledge of asthma to be insufficient SD: standard deviation; n: sample size.. An intraclass correlation coefficient of 0. Using Bland—Altman methodology, the average difference between the scores in the 2 questionnaire submissions was 0. For each item, the percentage of concordance between the 2 items ranged from Bland—Altman graph.

SD: standard deviation; CI: confidence interval.. These and other findings suggest that there are large gaps in knowledge that could affect the course of the disease in patients. However, if an educational intervention program is to be designed, new data obtained from validated tools will be necessary.. Score outcomes were similar to those of other studies in subjects with average knowledge, and no significant floor or ceiling effects were found, suggesting that the questionnaire is capable of detecting especially low or especially high levels of knowledge..

Score reliability was measured in 2 ways, according to conventional test theory. The statistical interpretation of this test is an estimate of the proportion of real variance contained in the total variance observed in the scores obtained. Compared to other studies, this value is similar to the 0. No significant differences were found between the Cronbach's alpha obtained in our study and by Praena Crespo et al. This Cronbach's alpha suggests high score reliability.

In general, values higher than 0. Values close to 1 would indicate redundancy of items. Secondly, a test—retest design with an interclass correlation coefficient for the total score between the 2 completions, interpreted similarly to the Cronbach's alpha, obtained an excellent internal consistency value of 0.

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Praena Crespo et al. The test—retest analysis showed adequate reproducibility, confirming that scores were consistent over repeated applications of the questionnaire. A better method for determining the degree of concordance is the kappa index, which takes into account by subtraction concordance due to chance.

In our case, the kappa indexes for each question showed excellent consistency between repeated applications kappa between 0. The original validation study did not report concordance values.

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With respect to the validity of the scores obtained for quantifying asthma knowledge, the main advantage of our study design lies in its attempt to verify whether teachers with more contact with asthmatic patients or those who felt they had sufficient knowledge of asthma returned higher scores concurrent validity. This was confirmed by the results, although the difference between groups with high knowledge and those with low knowledge was less than in the 2 previous reliability and validity studies, possibly because the high knowledge population parents of asthmatic children and a high educational level was a highly selected group.

Another important aspect of validity, sensitivity to change, was evaluated using scores obtained before and after an educational intervention in a random sample of teachers in schools in San Sebastian, Spain. A significant increase was observed in the level of asthma knowledge Ours is the third study to analyze the reliability of NAKQ scores and their validity for measuring asthma knowledge: in our case, we assessed the Spanish version of the questionnaire in teachers. In all 3 studies, the reliability and validity results are satisfactory, and this certainly provides evidence that the NAKQ in these populations is reliable and measures what it aims to measure: asthma knowledge in these populations.

However, the potential publication bias and the possibility that studies with poor results were not published must be taken into account. Notwithstanding, in our population, our scores were both reliable with little random error and valid really measure what we want to measure.. The limitations of this study are associated with sample selection and the characteristics of the study population.

To control for selection bias, a randomized sample of public and private schools in the study area was determined, thus ensuring results that could be extrapolated to the original population, unlike other studies that used non-probabilistic sampling. No data are available on the sociodemographic characteristics of the teachers who did not complete the questionnaire. This prevented us determining whether there is any bias between the population that participated and the population that did not.

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Teachers who participated may have been more aware of asthma issues, and thus may have had greater knowledge. However, this possibility can be ruled out, as With regard to the population characteristics, the geographical limitations and linguistic peculiarities may mean that the results are not generally applicable. However, given the practically universal knowledge of Spanish among the subjects, it is unlikely that our results cannot be applied to teachers from other regions in Spain, no matter how different..

Another possible limitation derives from the collection of self-reported data that may affect the internal validity of the study. Both the diagnosis of asthma in teachers or in close family members and the assessment that they made of their knowledge is self-declared, thus exposing the study to bias in the evaluation of the concurrent validity of the questionnaire. Indeed, the reason for conducting this study was the lack of validated instruments for assessing asthma knowledge among teachers, making it difficult to evaluate the criterion validity in this context.. Our study confirms that this questionnaire is a valid and reliable tool for the scientific community to use in the evaluation of asthma knowledge among teachers in Spanish schools, and one that may be useful for planning and evaluating educational interventions aimed at improving this knowledge and for helping to optimize asthma control in Spanish schoolchildren..

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To conclude, our results provide quality data to show stakeholders that scores obtained with the Spanish version of the NAKQ are reliable and valid for measuring the level of asthma knowledge among teachers in Spanish schools.. All authors are responsible for the study and participated in its concept and design, analysis and interpretation of results, writing and correction of the manuscript and are in agreement with its content.. The authors declare that they have no conflict of interests.. The following are the supplementary data to this article:. Arch Bronconeumol. ISSN: Open Access Option.

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Issue 3. Pages March Download PDF. Corresponding author. This item has received. Article information. Table 1. Table 2. Show more Show less. Analysis Evaluation of internal consistency Cronbach's alpha. Test—retest reliability was evaluated in 2 randomly selected centers by the kappa index, Bland—Altman method and intraclass correlation coefficient. The Paul Noble. Example sentences including notorio. These examples have been automatically selected and may contain sensitive content. Read more…. El Mundo del Siglo Veintiuno Pese a que los precios se encuentran bajos, ya no resultan tan atractivos como los de la pasada semana, lo que ha hecho que el volumen de negocios no resultase notorio.