Abstract 32: Is the Seattle Angina Questionnaire suitable for Chinese patients?
Background: The Seattle Angina Questionnaire (SAQ) has been widely used in China since it was introduced in 1996. However, the validity and reliability of the translated SAQ has never been assessed in published papers. Even worse, when we use the translated SAQ in clinical studies, we found some patients have difficulty upon understanding some items due to the translation and cultural inadaptation. In this study, we are going to find out if the SAQ is suitable for Chinese patients. Methods: Step one: to assess the psychometric properties of SAQ, 1787 angina patients’ data of our previous cross-section study was used. Exploratory Factor Analysis (EFA) was used to evaluate the construct validity, and internal consistency (Cronbach’s alpha coefficient) was used to evaluate the reliability, and t-test was used to discriminate patients with different Canadian Cardiovascular Society Classification (CCSC) levels. Step two: to find out which item is unsuitable, semi-structured individual patient interview was used. Patients were asked to complete a copy of SAQ first, and then were asked did they encounter difficulties on understanding the items and why. Results: Step one: Cronbach’s alpha coefficient was 0.885, but 0.605 for the quality of life domain. EFA showed 4 factors and couldn’t match the original five domains. More than 50% of patients give the same answer “mostly satisfied” to item 6-8 about treatment satisfaction, and these items can’t detect the differences among patients with different CCSC levels. Item 5 “bothersome of taking pills” is highly correlated with Quality of life domain other than the treatment satisfaction domain it is intended to measure. The correlation between item 6 and 8 is 0.816, which shows a redundancy. The reliability and validity of the translated SAQ is not satisfied. Step two: 92 out of 112 invited patients participated in the interview, 39 (42.39%) couldn’t understand item 10, and 7 (7.61%) of item 6. As to item 10, “feeling of the current angina if long-lasting”, patients were confused of the answer “level of satisfaction”, which result a low internal consistency of Qol. As to item 6, “everything is done for treatment”, 75 (81.52%) patients thought it’s the same meaning with item 8 “satisfaction with current treatment.” Maybe influenced by Confucian, patients chose “satisfaction” even their angina getting worse. Among the 1787 patients, 131 (7.33%) patients took nitros when angina attacked; however, 234(13.09%) patients took Chinese herbal medicine. So they couldn’t answer item 4 “frequency of nitros taken for angina” correctly. Conclusions: The currently used SAQ is unsuitable for Chinese patients. It doesn’t completely capture the characteristics and conditions of Chinese patients. Further study is needed to adapt both, the translation and culture of the SAQ.