Inclusion criteria for survey items.

<p>Inclusion criteria for survey items.</p

Development and Validation of a Cross-Cultural Knowledge, Attitudes, and Practices Survey Instrument for Chronic Kidney Disease in a Swahili-Speaking Population

<div><p>Introduction</p><p>Non-communicable diseases are a growing global burden, and structured surveys can identify critical gaps to address this epidemic. In sub-Saharan Africa, there are very few well-tested survey instruments measuring population attributes related to non-communicable diseases. To meet this need, we have developed and validated the first instrument evaluating knowledge, attitudes and practices pertaining to chronic kidney disease in a Swahili-speaking population.</p><p>Methods and Results</p><p>Between December 2013 and June 2014, we conducted a four-stage, mixed-methods study among adults from the general population of northern Tanzania. In stage 1, the survey instrument was constructed in English by a group of cross-cultural experts from multiple disciplines and through content analysis of focus group discussions to ensure local significance. Following translation, in stage 2, we piloted the survey through cognitive and structured interviews, and in stage 3, in order to obtain initial evidence of reliability and construct validity, we recruited and then administered the instrument to a random sample of 606 adults. In stage 4, we conducted analyses to establish test-retest reliability and known-groups validity which was informed by thematic analysis of the qualitative data in stages 1 and 2. The final version consisted of 25 items divided into three conceptual domains: knowledge, attitudes and practices. Each item demonstrated excellent test-retest reliability with established content and construct validity.</p><p>Conclusions</p><p>We have developed a reliable and valid cross-cultural survey instrument designed to measure knowledge, attitudes and practices of chronic kidney disease in a Swahili-speaking population of Northern Tanzania. This instrument may be valuable for addressing gaps in non-communicable diseases care by understanding preferences regarding healthcare, formulating educational initiatives, and directing development of chronic disease management programs that incorporate chronic kidney disease across sub-Saharan Africa.</p></div

Mean score for knowledge domain by known-groups.

<p>*Reference group for p-value</p><p>Mean score for knowledge domain by known-groups.</p

Demographic and social characteristics of the survey respondents.

<p>*Other Tribal Ethnicities represented in our groups include Maasai, Luguru, Kilindi, Kurya, Mziguwa, Mnyisanzu, Rangi, Jita, Nyambo and Kaguru</p><p># Includes housewives and students</p><p>† Professional includes any salaried position (e.g. nurse, teacher, government employee, etc.) and retired persons</p><p>††For comparison of urban and rural</p><p>Demographic and social characteristics of the survey respondents.</p

Action Cycle Outlining the Iterative Process for Developing and Piloting the Cross-Cultural Survey Instrument.

<p>Action Cycle Outlining the Iterative Process for Developing and Piloting the Cross-Cultural Survey Instrument.</p

a-c, Polychoric correlation matrices for the three domains of knowledge, attitudes, and practices based on results of the 606 adults who completed the piloted survey instrument.

<p>*The response scale consisted of <i>Yes</i>, <i>No</i>, <i>Do not know</i> and <i>Unsure</i> with <i>Do not know</i> and <i>Unsure</i> coded as one response.</p><p>†The response scale consisted of <i>Yes</i> and <i>No</i></p><p>‡The response scale consisted of <i>Very Unlikely</i>, <i>Unlikely</i>, <i>Likely</i> and <i>Very Likely</i></p><p>††Item 26 was removed from the final version of the instrument</p><p>a-c, Polychoric correlation matrices for the three domains of knowledge, attitudes, and practices based on results of the 606 adults who completed the piloted survey instrument.</p