Date of Award

11-2021

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr Robyna Khan

Second Advisor

Syed Iqbal Azam

Third Advisor

Dr Mohsin Nazir

Department

Community Health Sciences

Abstract

Background: Advance directives are legal documents that are written or drawn when the person has full mental capacity, noting down the requirements of health care when/if loses the capacity to make decisions. The concept has not been explored in Pakistan hence a valid instrument is not available that addresses the needs of an LMIC. We aimed to develop and validate a tool to assess knowledge, attitude, and perceptions about advance directives of adult population coming to tertiary care hospitals of Karachi, Pakistan.
Methodology: We carried out validation study in three tertiary care hospitals of Karachi. The study was initiated by adapting from an American tool, modified in accordance with Pakistani context, and re-developed into a knowledge, attitude, and perceptions tool. Estimated sample size of 389 using purposive sampling technique was calculated. Translation into Urdu language and then back translation was done. We checked the tool relevancy using content validity index. STATA software 16 was used for consistency reliability (Cronbach’s alpha) and factorial analysis to assess unique variances and high factor loadings among items and components.
Results: The mean age of the participants was 33.5 (SD= 13.2) with females (56.6%), English version was used by 57.7%. A 22.1% reported to have low education, 88.9% of the participants had no health insurance and no health coverage by employers (20.1%). 13.0% had the knowledge about ADs, 51.1% favored the idea of advance directives if the discussion is initiated by care providers. All the components of the survey performed well with overall good reliability (α = 0.75) and for individual main components including family support decisions (α = 0.64), socio- cultural and religion (α = 0.72), physical health awareness experience (α = 0.93), knowledge (α = 0.99), attitude (α = 0.75), and perceptions (α = 0.64).
Conclusion: This was the first validation study done in low and middle income countries that was able to develop a reliable and validated tool with the efforts done to make it contextual and comprehensive for both English and Urdu versions. Further interventional studies required to promote more awareness.

First Page

1

Last Page

92

Download

Share

COinS