Development and Validation of a Questionnaire Assessing Fears and Beliefs of Patients with Knee Osteoarthritis: The Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ)

Mathilde Benhamou,Isabelle Boutron,Philippe Ravaud,Serge Poiraudeau,François Rannou,Marie Dalichampt,Gabriel Baron,Sophie Alami,Steve Milanese

doi:10.1371/journal.pone.0053886

Abstract

ObjectiveWe aimed to develop a questionnaire assessing fears and beliefs of patients with knee OA.DesignWe sent a detailed document reporting on a qualitative analysis of interviews of patients with knee OA to experts, and a Delphi procedure was adopted for item generation. Then, 80 physicians recruited 566 patients with knee OA to test the provisional questionnaire. Items were reduced according to their metric properties and exploratory factor analysis. Reliability was tested by the Cronbach α coefficient. Construct validity was tested by divergent validity and confirmatory factor analysis. Test–retest reliability was assessed by the intra-class correlation coefficient (ICC) and the Bland and Altman technique.Results137 items were extracted from analysis of the interview data. Three Delphi rounds were needed to obtain consensus on a 25-item provisional questionnaire. The item-reduction process resulted in an 11-item questionnaire. Selected items represented fears and beliefs about daily living activities (3 items), fears and beliefs about physicians (4 items), fears and beliefs about the disease (2 items), and fears and beliefs about sports and leisure activities (2 items). The Cronbach α coefficient of global score was 0.85. We observed expected divergent validity. Confirmation factor analyses confirmed higher intra-factor than inter-factor correlations. Test–retest reliability was good, with an ICC of 0.81, and Bland and Altman analysis did not reveal a systematic trend.ConclusionsWe propose an 11-item questionnaire assessing patients' fears and beliefs concerning knee OA with good content and construct validity.

Highlights

Fear is an emotional response generated during dangerous or painful experiences and can include potentially useful survival mechanisms such as escape and avoidance behaviours [1,2]
137 items were extracted from analysis of the interview data
The item-reduction process resulted in an 11-item questionnaire

Summary

Introduction

Fear is an emotional response generated during dangerous or painful experiences and can include potentially useful survival mechanisms such as escape and avoidance behaviours [1,2]. Emotion-based fear may be a relevant factor in some people, reason-based beliefs are important to all people. All adults have measurable beliefs about diseases or their management that involve thoughts about the pathology or process responsible for the disease [6]. Beliefs are derived by processing information from multiple sources, including personal experiences, family, acquaintances, societal attitudes, media, literature, internet research, and encounters with the health care system [7]. Beliefs encompass ongoing reasoning and are amenable to change in response to new information and new experiences [8]

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Conclusion