Validation of Knowledge Questionnaire for Patients With Liver Cirrhosis

Jeyamani Ramachandran, Richard J. Woodman, Kate R. Muller, Rachel Wundke, Rosemary McCormick, Billingsley Kaambwa, Alan J. Wigg

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Background & Aims: There is no validated questionnaire to assess disease knowledge and self-management in patients with liver cirrhosis. We developed and validated a Cirrhosis Knowledge Questionnaire (CKQ). Methods: We created a preliminary CKQ comprising 10 questions relevant to self-management of cirrhosis, based on publications and clinical experiences. The CKQ was given to a pilot sample of 17 patients with decompensated cirrhosis to assess its face validity. In consultation with experts, we developed a second version of CKQ, comprising 14 multiple choice questions, and administered it to 116 patients with cirrhosis participating in a Chronic Liver Failure Program. The dimensionality of the construct was assessed using exploratory factor analysis and internal consistency was assessed with Cronbach's alpha. Known-group validity of the resulting instrument was assessed by comparing the performance of the CKQ in 69 patients with decompensated cirrhosis (mean age, 62 ± 13 years; 109 responses), with (n = 42) vs without (n = 67) case management. Results: A 3-factor model with 7 questions related to variceal bleeding, ascites, and hepatic encephalopathy was considered the optimal dimensionality with excellent internal consistency (Cronbach's alpha = 0.82). The mean knowledge score was higher in patients with case management (5.6 ± 1.1) than in patients without case management (4.3 ± 2.1) (P = .002). Conclusions: We developed and validated a questionnaire with 7 questions on ascites, variceal bleeding, and hepatic encephalopathy to assess knowledge and self-management in patients with liver cirrhosis. Studies are needed to confirm its dimensionality and assess association of scores with patient outcomes.

Original languageEnglish
Pages (from-to)1867-1873.e1
JournalClinical Gastroenterology and Hepatology
Issue number8
Early online date4 Dec 2019
Publication statusPublished - Jul 2020


  • Cirrhosis
  • Knowledge Questionnaire
  • Self-management
  • Validation


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