Revisiting renal transplant MTAC questionnaire on immunosuppressive medications knowledge in post kidney transplant recipients: item generation & content validation / Nik Aisyah Najwa Nik Mustaffa Shapri

Objectives: Kidney transplant recipients who have better knowledge of immunosuppressants have higher adherence to immunosuppressants and are associated with better overall treatment outcomes. Questionnaires are commonly used to evaluate kidney transplant recipients’ immunosuppressant knowledge either as the primary or surrogate measured endpoints to educational interventions both in practice and clinical research. Several questionnaires are available to evaluate immunosuppressant knowledge, but allshowed insufficient content validity. The questionnaire used in Renal Transplant Medication Therapy Adherence Clinic (RTMTAC) is not yet validated. This study aims to revise the content of the RTMTAC questionnaire (RTMTACq). Method & study design: Firstly, preliminary items were generated based on domains and sub domains that were previously identified. Secondly, the items’ content was validated in a 3-round Delphi study by an expert panel of 11 renal pharmacists. The experts rated the items’ relevance, comprehensibility, and comprehensiveness. Items with ≥ 75% of experts’ agreement were considered relevant. Finally, the relevant items were translated into the dual language of Bahasa Malaysia and English through a forward-backward translation process by 3 external translators and 2 researchers. Results: A total of 24 preliminary items were generated. From 17 experts approached, 12 (71%) agreed to participate and 11 out of the 12 (92%) completed the 3-round Delphi study. In Round 1 Delphi study, 20 out of 24 preliminary items were relevant and 9 new items were suggested. In Round 2, 13 preliminary items were rated of which 8 were relevant. In Round 3, 5 preliminary items were rated and 1 was relevant. The final experts’ revision produced 27 items. Conclusion: This study laid the foundation for a validated questionnaire on immunosuppressive medications in kidney transplant recipients through the identification of a set of relevant and comprehensive items. A content validated RTMTACq consisting of 27 items were produced. Future studies should continue with face validity assessment through cognitive interviews with kidney transplant recipients. Accurate evaluation of immunosuppressant knowledge through a validated questionnaire will help to formulate tailored educational interventions for better treatment outcomes