Cardiac instrument development in a low-literacy population: The revised Chest Discomfort Diary

• Authors: Laura Kimble, Emory University; Sandra B Dunbar, Emory University; Deborah B. McGuire, University of Pennsylvania; Anindya De, Emory University; Sharon Fazio, Emory University; Ora Strickland, Emory University
• Journal Title: Heart & Lung: The Journal of Acute and Critical Care
• Volume: Volume 30, Number 4
• Publisher: Elsevier: 12 months | 2001-07-01, Pages 312-320
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1067/mhl.2001.116136
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Nursing
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Nursing; Respiratory System; Cardiovascular System & Cardiology; FUNCTIONAL HEALTH LITERACY; CHRONIC STABLE ANGINA; QUESTIONNAIRE; SYMPTOMS; PAIN

Abstract

OBJECTIVE: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary (CDD-R), in a sample of patients with chronic angina selected from a population known to have low literacy. DESIGN: The study design was descriptive and correlational. SAMPLE: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sample included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-American, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading levels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. RESULTS: Descriptions of the location (left chest, 66.6%), character (pressure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consistent with clinical descriptions of "typical angina." Other physical symptoms such as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walking (55.5%) was the activity most frequently described as difficult to perform because of chest pain, with sublingual nitroglycerin (77.7%) the most frequently used and most effective chest pain relief strategy. CONCLUSION: The CDD-R adequately measured multiple characteristics of anginal chest pain. Further research is needed to establish construct validity of the CDD-R and to determine the feasibility of using the instrument to monitor changes over time in patients' chronic angina.