| Objective:The purpose of this study was to construct a knowledge,attitude and practice(KAP)scale for the detection of BRCA genes in patients with ovarian cancer,to test the reliability and validity of the questionnaire,and thus to provide a scientific and effective tool for health care workers to investigate the status quo of the cancer.Also,by surveying these patients’ current situation of their KAP of BRCA gene detection and analyzing the influencing factors behind it,the study intended to provide some information and evidence for relevant training in medical facilities and clinical intervention studies in the future.Methods:1.Development of an item pool:Based on KAP theory,construct an initial item pool of the questionnaire by analyzing literature,referring to relevant guidelines and conducting clinical practice and focus group discussions.2.The Delphi method and reliability and validity test:According to the Delphi methods,the experts answered the questionnaire in two rounds,and then the items were screened and modified to form the pre-questionnaire.By using convenience sampling,241 patients with ovarian cancer from a cancer hospital in Shandong Province were collected for pre-investigation.By conducting item analysis,correlation analysis and factor analysis,the items were screened again to form a formal questionnaire on knowledge,attitude and practice of BRCA gene test in patients with ovarian cancer.Finally,the reliability and validity of the questionnaire was tested.3.Survey of ovarian cancer patients and analysis of influencing factors:A total of 654 patients with ovarian cancer from a cancer hospital in Shandong were selected by using convenience sampling.Then we investigated the status quo of these patients and analyzed the influencing factors behind by using a self-designed general data questionnaire,a KAP questionnaire for BRCA gene testing,a perceived social support questionnaire and a stigma questionnaire.4.Statistical methods:Excel 2017 was used to establish the database,and SPSS26.0 software and AMOS24.0 software were used for the statistical analysis of data.All the tests were two-sided tests,with p<0.05 as statistically significant..The items were screened by descriptive statistics,Delphi method,item analysis and factor analysis,the reliability of the questionnaire was assessed by internal consistency and test-retest reliability,and the content validity was tested by expert evaluation method.Construct validity were tested by confirmatory factor analysis(CFA)using AMOS24.0.Influencing factors were analyzed by independent sample t test,single factor analysis of variance,and multivariate linear regression analysis.Results:1.Delphi inquiry:In terms of two rounds of expert inquiry,the positivity coefficients were 100%,the authority coefficients were 0.860,and the coordination coefficients of Kendall’s W were 0.154 and 0.168 respectively,both of which were statistically significant(p<0.01).2.Item filtering:①The item pool of the questionnaire based on KAP theory contains 3 dimensions and 43 items.There are 17 items in the knowledge dimension,15 in the attitude/belief dimension and 11 in the behavior dimension.②After two rounds of expert inquiry,5 items were deleted,8 were revised,1 was added and 1 was merged with another one,thus forming 38 items.③According to the pre-survey results,items were screened again,with 1 items deleted in item analysis and 1 item deleted in exploratory factor analysis.Finally,the formal questionnaire consists of 36 items.3.Reliability and validity:(1)Reliability test:The Cronbach’s a coefficients of the questionnaire and each dimension were 0.932,0.926,0.906 and 0.895 respectively,and the test-retest reliability of the questionnaire and each dimension were 0.948,0.878,0.835 and 0.908 respectively.(2)Validity test:①Content validity:The I-CVI for each item was between 0.85 and 1,and the questionnaire-level S-CVI was 0.938;②Construct validity:By using the exploratory factor analysis,the values of the KMO test and the Bartlett’ s test of sphericity were shown to be 0.933 and 4837.858 respectively,with p<0.001,Three common factors were extracted by principal component analysis,with the cumulative variance contribution rate being 55.029%.The results of confirmatory factor analysis showed that χ2/df=1.519,RMSEA=0.028,SRMR=0.033,GFI=0.930,AGFI=0.921,NFI=0.921,CFI=0.971,TLI=0.970,IFI=0.972.All parameters reached the standard values,the path coefficients were between 0.57 and 0.81,and the difference was statistically significant(p<0.001),suggesting a high degree of fitting between the model and dataand the appropriateness of the Fama-French three-factor model constructed.4.The status quo of the KAP of BRCA gene detection in patients with ovarian cancer and the influencing factors behind:The total score of ovarian cancer patients’ KAP was(101.720±19.751),with the scores in dimensions of knowledge,attitude and behavior being(2.631±0.735),(2.995±0.588)and(2.960±0.855)respectively.The pass rates of the total KAP score and for each dimension were 37.77%,34.10%,54.13%and 50.31%,respectively.The results of the regression analysis showed that the main influencing factors for ovarian cancer patients’ KAP were education level,engagement in trade,civil service,monthly family income,perceived social support and sense of stigma related to illness.Conclusions:The KAP questionnaire constructed in this study for the detection of BRCA genes in patients with ovarian cancer has a good reliability and validity and can be used as a tool to evaluate their KAP.Patients’ KAP level in this study was at or below the middle level,with the level of knowledge and behavior being relatively low and that of attitude being moderate.The main influencing factors behind are education,engagement in trade,service in public office,monthly family income,perceived social support and sense of s stigma related to illness.It is suggested that doctors and nurses should take various forms of training and intervention measures depending on factors affecting patients’ KAP level concerning gene detection,so as to promote the application of gene detection technology to clinical practice. |
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