Cardiac instrument development in a low-literacy population: The revised Chest Discomfort Diary

OBJECTIVE: The purpose of this study was to pilot test a self-administered chest pain questionnaire, a revised version of the Chest Discomfort Diary ( CDD-R), in a sample of patients with chronic angina selected from a populat ion known to have low literacy. DESIGN: The study design was descriptive and correlational. SAMPLE: The study used a convenience sample of 27 subjects with documented history of coronary artery disease and angina. Characteristics of the sampl e included a mean age of 56.3 years (SD, 12.4 years), 88.9% African-America n, and 56.3% male, and 59.3% had a history of acute myocardial infarction. Approximately 28% had achieved a 9th-grade education or less, and reading l evels ranged from 4th grade to 12th grade. Subjects completed the CDD-R, a 36-item instrument reflecting multiple dimensions of anginal chest pain. RESULTS: Descriptions of the location (left chest, 66.6%), character (press ure, 59.2%), and precipitants of chest pain (walking, 51.8%) were consisten t with clinical descriptions of "typical angina." Other physical symptoms s uch as shortness of breath (88.8%) and fatigue (85.1%) were reported. Walki ng (55.5%) was the activity most frequently described as difficult to perfo rm because of chest pain, with sublingual nitroglycerin (77.7%) the most fr equently used and most effective chest pain relief strategy. CONCLUSION: The CDD-R adequately measured multiple characteristics of angin al chest pain. Further research is needed to establish construct validity o f the CDD-R and to determine the feasibility of using the instrument to mon itor changes over time in patients' chronic angina.