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Validation of the educational needs assessment tool as a generic instrument for rheumatic diseases in seven European countries
  1. Mwidimi Ndosi1,
  2. Ann Bremander2,
  3. Bente Hamnes3,
  4. Mike Horton4,
  5. Marja Leena Kukkurainen5,
  6. Pedro Machado6,
  7. Andrea Marques6,
  8. Jorit Meesters7,
  9. Tanja A Stamm8,
  10. Alan Tennant4,
  11. Jenny de la Torre-Aboki9,
  12. Theodora P M Vliet Vlieland7,
  13. Heidi A Zangi10,
  14. Jackie Hill1
  1. 1Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  2. 2Research and Development Center, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden
  3. 3Department of Patient Education, Hospital for Rheumatic Diseases, Lillehammer, Norway
  4. 4Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  5. 5The Finnish Society of Rheumatology Nurses, Helsinki, Finland
  6. 6Rheumatology Department, Coimbra University Hospital, Coimbra, Portugal
  7. 7Department of Rheumatology and Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
  8. 8Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
  9. 9Department of Rheumatology, Alicante's General and University Hospital, Alicante, Spain
  10. 10 Department of Rheumatology, National Resource Center for Rehabilitation in Rheumatology (NRRK), Diakonhjemmet Hospital, Oslo, Norway
  1. Correspondence to Dr Mwidimi Ndosi, Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Postal Address: 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; M.E.Ndosi{at}


Objectives To validate the educational needs assessment tool (ENAT) as a generic tool for assessing the educational needs of patients with rheumatic diseases in European Countries.

Methods A convenience sample of patients from seven European countries was included comprising the following diagnostic groups: ankylosing spondylitis, psoriatic arthritis, systemic sclerosis, systemic lupus erythematosus, osteoarthritis (OA) and fibromyalgia syndrome. Translated versions of the ENAT were completed through surveys in each country. Rasch analysis was used to assess the construct validity of the adapted ENATs including differential item functioning by culture (cross-cultural DIF). Initially, the data from each country and diagnostic group were fitted to the Rasch model separately, and then the pooled data from each diagnostic group.

Results The sample comprised 3015 patients; the majority, 1996 (66.2%), were women. Patient characteristics (stratified by diagnostic group) were comparable across countries except the educational background, which was variable. In most occasions, the 39-item ENAT deviated significantly from the Rasch model expectations (item–trait interaction χ2 p<0.05). After correction for local dependency (grouping the items into seven domains and analysing them as ‘testlets’), fit to the model was satisfied (item–trait interaction χ2 p>0.18) in all pooled disease group datasets except OA (χ2=99.91; p=0.002). The internal consistency in each group was high (Person Separation Index above 0.90). There was no significant DIF by person characteristics. Cross-cultural DIF was found in some items, which required adjustments. Subsequently, interval-level scales were calibrated to enable transformation of ENAT scores when required.

Conclusions The adapted ENAT is a valid tool with high internal consistency providing accurate estimation of the educational needs of people with rheumatic diseases. Cross-cultural comparison of educational needs is now possible.

  • Rheumatoid Arthritis
  • Health services research
  • Outcomes research

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