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Validation and psychometric properties of the Maltese version of the Duke Anticoagulation Satisfaction Scale (DASS)

Authors Riva N, Borg Xuereb C, Ageno W, Makris M, Gatt A

Received 22 May 2019

Accepted for publication 10 July 2019

Published 28 August 2019 Volume 2019:12 Pages 741—752

DOI https://doi.org/10.2147/PRBM.S216617

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Igor Elman


Nicoletta Riva,1 Christian Borg Xuereb,2 Walter Ageno,3 Michael Makris,4 Alex Gatt1

1Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta; 2Department of Gerontology and Dementia Studies, Faculty for Social Wellbeing, University of Malta, Msida, Malta; 3Department of Medicine and Surgery, University of Insubria, Varese, Italy; 4Sheffield Haemophilia and Thrombosis Centre, University of Sheffield, Sheffield, UK

Correspondence: Nicoletta Riva
Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, MSD 2080, Malta
Tel +356 2 545 2518
Fax +356 2 545 0000
Email nico.riva@hotmail.it

Purpose: Assessing treatment satisfaction can guide specific interventions to improve anticoagulation adherence and reduce adverse outcomes. We aimed to assess the psychometric properties (reliability and validity) of the Maltese translation of the Duke Anticoagulation Satisfaction Scale (DASS).
Patients and methods: The DASS explores three dimensions (limitations, hassles/burdens, psychological impact). The translation process included forward and backward translations. Reliability was evaluated through internal consistency and reproducibility. Validity was evaluated through floor/ceiling effect, convergent/discriminant validity, construct validity, and known-group validity.
Results: The Maltese version of the DASS, administered to 174 patients on warfarin for different clinical indications, showed good reliability (Cronbach’s alpha 0.87; intraclass correlation coefficient for test–retest 0.73). Floor effect was identified mainly in the limitations and hassles/burdens subscales. Significant positive correlations were found between the DASS total score and its subscales (limitations 0.80, hassles/burdens 0.85, psychological impact 0.68). Female sex, shorter warfarin treatment duration (≤5 years), previous hospitalization and history of bleeding were associated with lower satisfaction.
Conclusion: Psychometric properties of the Maltese DASS were comparable to the original English version. The Maltese version of the DASS is a valid and reliable instrument that can be used by health care professionals to assess the level of satisfaction of Maltese-speaking anticoagulated patients.

Keywords: atrial fibrillation, psychometrics, quality of life, surveys and questionnaires, venous thromboembolism, warfarin


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