Document Type : Original Article(s)


1 Department of Nursing and Midwifery, School of Nursing, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Associate Professor, Department of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

3 Assistant Professor, Department of Nursing and Midwifery, Nursing Care Research Centre in Chronic Diseases, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Assistant Professor, Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


BACKGROUND: Coronary artery disease (CAD) is a leading cause of cardiovascular death worldwide. Therefore, assessing knowledge in patients with CAD needs a specific tool. This study aims to carry out the Persian validation of the Coronary Artery Disease Education Questionnaire Short Version (CADE-Q SV) for education of patients undergoing cardiac rehabilitation (CR).
METHODS: This study was a cross-sectional study. First, the original version of the CADE-Q SV was translated from English into Farsi using the standard approach. The face validity and content validity were measured using quantitative and qualitative approaches. The confirmatory factor analysis (CFA) was done to examine the construct validity. The reliability of the questionnaire was investigated through test-retest reliability and by calculating Cronbach's alpha coefficient. SPSS software was used to analyze the data, and the R package lavaan, to approve the CFA.
RESULTS: The result of quantitative face validity showed that the minimum score was 4.42. The minimum scores for quantitative content validity were 0.83 for content validity index (CVI) and 0.66 for content validity ratio (CVR); therefore, all the items were approved. According to the results of the CFA, the comparative fit index (CFI) was reported to be 0.969, indicating a good fit for the items. The Cronbach’s alpha coefficient for the whole instrument was 0.679, and the test-retest correlation was measured to be > 0.4, after a 2-week interval.
CONCLUSION: In total, it can be concluded that the CADE-Q SV has good psychometric properties and proper reliability. It can be utilized in medical and CR centers.


  1. Bertelsen JB, Refsgaard J, Kanstrup H, Johnsen SP, Qvist I, Christensen B, et al. Cardiac rehabilitation after acute coronary syndrome comparing adherence and risk factor modification in a community-based shared care model versus hospital-based care in a randomised controlled trial with 12 months of follow-up. Eur J Cardiovasc Nurs 2017; 16(4): 334-43.
  2. Mohammadpourhodki R, Rahnama M, Abdollahimohammad A, Shashraki Vahed A, Shamsizadeh M, Shahdadi H. Comparison of effect of nursing education and peer educationmethods on self-efficacy in patients with myocardial infarction. Mod Care J 2018; 15(1): e56012.
  3. Sanchez Delgado JC, Pinzón S, Angarita Fonseca A. Content validity of the scale of barriers to cardiac rehabilitation. Universidad y Salud 17(2): 170-16, 2015.
  4. Beust de Lima J. CADE-Q SV: Practical and relevant in the assessment of patients with cardiovascular diseases regarding their health condition. Arquivos Brasileiros de Cardiologia 2018; 111(6): 850-1.
  5. Mozafari A, Baharvand A, Mohebi S, Hejazi SF. Impact of cardiac rehabilitation on depression after percutaneous coronary intervention. Journal of Health and Hygiene 2016; 7(3): 356-64. [In Persian].
  6. Vahdani F, Abedini S, Mohseni S, Nikparvar M. Nutritional behaviors of cardiovascular diseases prevention in women referred to health care centers in Minab town, 2016. Journal of Preventive Medicine 2016; 3(4): 59-66. [In Persian].
  7. Sarrafzadegan N, Mohammmadifard N. Cardiovascular disease in Iran in the last 40 years: Prevalence, Mortality, morbidity, challenges and strategies for cardiovascular prevention. Arch Iran Med 2019; 22(4): 204-10.
  8. Hamedani B, Shahsavari H, Amaniyan S, Sieloff C, Vaismoradi M. Development and psychometric evaluation of the Cardiac Rehabilitation Adherence Tool (CRAT). J Cardiovasc Dev Dis 2019; 6(3): 25.
  9. Claes J, Cornelissen V, McDermott C, Moyna N, Pattyn N, Cornelis N, et al. Feasibility, acceptability, and clinical effectiveness of a technology-enabled cardiac rehabilitation platform (Physical Activity Toward Health-I): Randomized controlled trial. J Med Internet Res 2020; 22(2): e14221.
  10. Zhou Y, Li J, Du S, Du X, Fu C, Cao C, et al. Cardiac rehabilitation knowledge in patients with coronary heart disease in Baoding city of China: A cross-sectional study. Int J Nurs Sci 2017; 4(1): 24-8.
  11. Bakhshayeh S, Sarbaz M, Kimiafar K, Vakilian F, Eslami S. Barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation programs. Physiother Theory Pract 2021; 37(1): 158-68.
  12. Ghisi GL, Grace SL, Thomas S, Evans MF, Oh P. Development and psychometric validation of the second version of the Coronary Artery Disease Education Questionnaire (CADE-Q II). Patient Educ Couns 2015; 98(3): 378-83.
  13. Steca P, Greco A, Cappelletti E, D'Addario M, Monzani D, Pancani L, et al. Cardiovascular management self-efficacy: Psychometric properties of a new scale and its usefulness in a rehabilitation context. Ann Behav Med 2015; 49(5): 660-74.
  14. Lim BC, Kueh YC, Arifin WN, Ng KH. Psychometric properties of the heart disease knowledge scale: evidence from item and confirmatory factor analyses. Malays J Med Sci 2016; 23(4): 33-45.
  15. Ghisi GLM, Sandison N, Oh P. Development, pilot testing and psychometric validation of a short version of the coronary artery disease education questionnaire: The CADE-Q SV. Patient Educ Couns 2016; 99(3): 443-7.
  16. Ghisi GL, Durieux A, Manfroi WC, Herdy AH, Carvalho T, Andrade A, et al. Construction and validation of the CADE-Q for patient education in cardiac rehabilitation programs. Arq Bras Cardiol 2010; 94(6): 813-22.
  17. Ghisi GLM, Chaves GSS, Loures JB, Bonfim GM, Britto R. Validation of the Brazilian-Portuguese Version of a Short Questionnaire to Assess Knowledge in Cardiovascular Disease Patients (CADE-Q SV). Arq Bras Cardiol 2018; 111(6): 841-9.
  18. Ghisi GLM, Oh P. Validation of the French-Canadian Version of a Short Questionnaire to Assess Knowledge in Cardiac Patients (CADE-Q SV). Can J Nurs Res 2021; 844562120986001. [Epub ahead of print].
  19. Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis. 7th Upper Saddle River, NJ; Prentice Hall; 2021.
  20. Waltz CF, Strickland O, Lenz ER. Measurement in nursing and health research. 5th New York, NY: Springer Publishing Company; 2017.
  21. Brown TA. Confirmatory factor analysis for applied research. 2nd New York, NY: Guilford Publications; 2014.
  22. Taber KS. The Use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ 2018; 48(6): 1273-96.
  23. Maroufi Z, Heravi Karimooi M, Rejeh N, Sharifnia H, Montazeri A. Translation and psychometric properties of the Iranian version Coronary Artery Disease Education Questionnaire (CADE-Q). Payesh 2018; 17(1): 95-103. [In Persian].
  24. Ghisi GL, Oh P, Thomas S, Benetti M. Assessment of patient knowledge of cardiac rehabilitation: Brazil vs Canada. Arq Bras Cardiol 2013; 101(3): 255-62.
  25. Epstein J, Santo RM, Guillemin F. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. J Clin Epidemiol 2015; 68(4): 435-41.