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Development and Psychometric Testing of a Questionnaire to Assess Knowledge of and Stages of Change Related to a Low‐Sodium Diet in Heart Failure Patients

Heart failure (HF) is a chronic and public health concern with increasing prevalence in the United States. A low‐sodium diet is often recommended for HF patients to help manage symptoms. Few questionnaires exist to help clinicians gain insight into reasons why sodium adherence is often poor. Therefore, a questionnaire with two domains was created to assess these reasons in HF patients; the domains included knowledge of a low‐sodium diet (nine items) and stage of change (nine items). The knowledge domain included questions regarding sodium recommendations for HF patients, food sorting into high‐ and low‐sodium categories, and nutrition label reading. The response options for the stage of change domain mirrored the transtheoretical model of change and included questions about limiting sodium in the diet and incorporating more low‐sodium foods. This questionnaire was then tested for validity (content and face validity), feasibility (time to complete questionnaire), and reliability (internal consistency of each of the two domains). The questionnaire deemed valid as 70% agreement was reached regarding questionnaire content by 11 experts, registered dietitians working with HF patients. Face validity was attained (100% agreement) by asking 16 HF patients if the questionnaire was easy to understand and if the font size was easy to read. The questionnaire was determined to be feasible (<10 minutes to complete, n= 16). The questionnaire was then administered to an additional 84 in‐patient HF patients (total n=100). The sample was middle‐aged [62.8 ± 14.4 years (mean±SD)], 60% male, and 66% African American. The median (IQR) BMI of the sample was 31.0 (27.0, 42.8). Diabetes (41%), hypertension (76%), and obesity (41%) were common co‐morbidities. Using the Kuder‐Richardson formula 20 (kr20) for dichotomous responses, reliability of responses from the knowledge and stage of change domains was 0.76 and 0.80, respectively. A valid, feasible, and reliable questionnaire about the low‐sodium diet was created, which will enable dietitians to assess reasons for poor adherence to low‐sodium diets by HF patients and assist patients in reducing these barriers.