Cross-cultural adaptation and validation of the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).

Introduction: Cirrhosis is common in Malaysia, but no questionnaire in the local language (Malay) has been developed to assess patients' knowledge of this disease. This study aimed to adapt and validate the Malay Adult cirrhosiS Knowledge Questionnaire (ASK-QM).

Materials and methods: ASK-QM was translated from English to Malay according to international guidelines. It was validated among cirrhotic patient who understand Malay language from two major liver centers in Klang Valley, Malaysia (University of Malaya and Hospital Selayang) from January 2021 to March 2022, at week 0 and 2. Patients with hepatic encephalopathy were excluded.

Results: 121 out of 132 patients with cirrhosis agreed to participate (response rate=91.7%). The overall median score of the ASK-QM was 54.5 [38.6-68.2] and the difficulty factor was 0.5 (range: 0.1-0.8 for each domain). Confirmatory factor analysis showed a good model fit with results of Comparative fit index (CFI) ranging from 0.836 to 1.000, whilst, the Tucker-Lewis index (TLI) ranged from 0.690 to 1.004 across all four domains. The root mean square error of approximation (RMSEA) value was reported from 0.000 to 0.100. For standardized root mean squared residual (SRMR) was from 0.008 to 0.015. Patients with tertiary education scored higher compared to those without (63.6 [45.5-77.3] vs 52.3 [36.4-63.6], p<0.05). The overall Kuder-Richardson (KR) coefficient was 0.761 indicating adequate internal consistency. Test-retest among 82 out of 121 patients (response rate=67.7%) demonstrated adequate reliability with eighteen out of 22 items having Wilcoxon signed-rank test values that were statistically not significant, p>0.005.

Conclusion: The ASK-QM was found to be a valid and reliable questionnaire for evaluating knowledge of liver cirrhosis amongst Malay-speaking adults.