Cross-cultural validation of the educational needs assessment tool into Chinese for use in severe knee osteoarthritis

Huiwen Zhao,1,* Zhe Dong,2,* Fei Xie,3,4 Guanxin Wang,2 Zhihua Wen,5 Lixia Zhang,5 Mwidimi Ndosi,6,7 Wen Luo1 1Joint Department, The 2nd Ward of Joint Surgery, Tianjin Hospital, Tianjin, China; 2Medical Examination Center, No 6 Hospital, Beijing, China; 3Nursing Experimental Teaching Center, Tianjin Hospital, Tianjin, China; 4College of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China; 5Joint Department, The 1st Ward of Joint Surgery, Tianjin Hospital, Tianjin, China; 6Department of Nursing, University of the West of England, Bristol, UK; 7Academic Rheumatology Unit, Bristol Teaching Hospitals, Bristol, UK *These authors contributed equally to this work Background: Patient education is an integral part of the management of osteoarthritis. The educational needs assessment tool (ENAT) was developed in the UK to help direct needs-based patient education in rheumatic diseases. Aim: The aim of the study was to adapt and validate the ENAT into Chinese, for use in severe knee osteoarthritis (KOA). Methods: This cross-cultural validation study took two phases: 1) adaptation of the ENAT into Chinese (CENAT) and 2) validation of the CENAT. The Construct validity was determined using factor analysis and criterion-related validity by comparing data from CENAT with data from different self-efficacy scales: patient–physician interactions scale (PEPPI-10), self-efficacy for rehabilitation outcome scale (SER), and the self-efficacy for exercise scale (SEE). Results: The sample comprised 196 patients, with mean age 63.6±8.7 years, disease duration was 11.5 years, and 57.1% were female. The CENAT was found to have high internal consistency. The CENAT had weak correlations with the Chinese versions of PEPPI r=0.40, SER r=0.40, and SEE r=0.39. There were no correlations with age r=-0.03 or disease duration r=-0.11. Conclusion: The ENAT translated well into Chinese and has evidence of validity in KOA. Future studies will further inform its usefulness in clinics, community, and online settings. Keywords: assessment, educational needs, knee osteoarthritis, instrument validatio