Development and psychometric evaluation of an instrument to assess venous leg ulcer lifestyle knowledge among nurses

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Development and psychometric testing of an instrument to assess venous leg ulcer lifestyle knowledge.


Nurses often lack knowledge to provide adequate leg ulcer advice. No valid and reliable instruments are available to assess knowledge on venous leg ulcer advice among nurses.


The instrument was developed based on a literature review and patient cases. Content validity was evaluated in a Delphi procedure by nine leg ulcer experts. Item-analysis, construct validity and stability were assessed. A sample of 350 nurses and student nurses participated. Data collection took place between February and April 2009.


The instrument included four topics: (1) Compression therapy, (2) Physical activity/leg exercises, (3) Leg elevation and (4) Pain management. Multiple-choice questions were developed to assess factual knowledge. Patient cases were developed to assess more complex cognitive skills. Content validity was established. The quality of the response alternatives varied between 0·01 and 0·68. The difficulty index for questions evaluating factual knowledge ranged from 0·12 to 0·78. Patient cases’ questions had a difficulty index between 0·07 and 0·60. The score of participants with (theoretically expected) more expertise was significantly higher than the score of participants with (theoretically expected) less expertise. The intraclass correlation coefficients ranged between 0·71 and 0·77. Eleven questions had moderate kappa-values (0·41–0·60), and in eight questions, there was fair agreement (0·30–0·40).


An instrument with an acceptable content validity and construct validity was developed. The instrument can be applied in nursing education, nursing practice and nursing research to evaluate venous leg ulcer advice knowledge.

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