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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886 EISSN: 1998-4022
Vol. 54, Num. 3, 2006, pp. 316-317

Neurology India, Vol. 54, No. 3, July-September, 2006, pp. 316-317

Letter To Editor

Authors' reply

Department of Neurology, Royal Brisbane and Women's Hospital, Herston Road, Brisbane, Queensland 4029, Australia
Correspondence Address:Department of Neurology, Royal Brisbane and Women's Hospital, Herston Road, Brisbane, Queensland 4029, Australia, Email: jeyarajpandian@yahoo.co.in

 

Code Number: ni06105

Sir,

I appreciate the curiosity shown and the comments received for our original article published recently in Neurology India.[1] A great deal of attention has been focussed on the survey instrument that was used in the study. As stated in the paper, we adapted and modified the questionnaire from our previous survey among general public in Northwest India.[2] Before using the questionnaire we did translate and back translate the contents of the questionnaire from English to the relevant local vernacular languages. A separate copy of the questionnaire was used for this particular study.

I fully agree with the concern that was raised regarding the inter-rater reliability and validity of the questionnaire. Using existing questionnaires or instruments save time and effort. It also avoids the need to establish the reliability and validity of the instrument.[3] If an existing instrument meets 80% or more of the needs of a researcher, it can be used with minor modifications after pre-testing.[3] Pre-testing is designed to address the content validity of the questionnaire.[4] If the question is ambiguous or misunderstood, the answers obtained in the study will not be useful. Pre-testing will typically pick up most of the serious problems in comprehension of an instrument.[4] The questionnaire in the present study was pre-tested in a sample of 25 patients and relevant changes were made to various terms that are used for "stroke" in the local languages Punjabi and Hindi.[1] Other Researchers have also followed similar methodology of pre-testing the questionnaire both in stroke and epilepsy without focussing on reliability and validity.[5],[6],[7],[8]

The demographic data is clearly shown in [Table - 1] (Interviewees). We did not adapt the educational status from the western culture. The educational categories that we had used are relevant to the study cohort. For the purpose of statistical analysis we had put together illiterates and the primary education group. Education was a significant factor in multivariable analysis, for knowing the organ affected in stroke and the knowledge of warning symptoms of stroke. The results are not going to change even if we re-group into illiterates vs. others.

Only when the patient′s were unable to participate in the interview (aphasia, loss of consciousness etc.) the relative was interviewed. Moreover, in the sub-group analysis (patients vs. relatives) we did not find any difference in the knowledge of stroke between the two groups.

It is almost impossible to carry out a perfect survey and every study has its own limitations. India is a vast country with diverse socio-cultural practices. Our findings can not be extrapolated to other parts of our country. Similar studies are needed from other states, in order to design population specific educational programs about stroke.

References

1.Pandian JD, Kalra G, Jaison A, Deepak SS, Shamsher S, Singh Y, et al . Knowledge of stroke among stroke patients and their relatives in Northwest India. Neurol India 2006;54:152-6.  Back to cited text no. 1    
2.Pandian JD, Jaison A, Deepak SS, Kalra G, Shamsher S, Lincoln DJ, et al . Public awareness of warning symptoms, risk factors and treatment of stroke in Northwest India. Stroke 2005;36:644-8.  Back to cited text no. 2    
3.Dawson B, Trapp RG. Survey research. In : Dawson B, Trapp RG, editors. Basic and Clinical Biostatistics. 4th ed, Lange Medical Books: Sydney; 2004. p. 280-301.  Back to cited text no. 3    
4.Anthony D. Validity and Reliability. In : Anthony D, editor. Understanding advanced statistics. A guide for nurses and health care researchers. 1st ed, Churchill Livingston: London; 1999. p. 29-44.  Back to cited text no. 4    
5.Sug Yoon S, Heller RF, Levi C, Wiggers J, Fitzgerald PE. Knowledge of stroke risk factors, warning symptoms and treatment among an Australian urban population. Stroke 2001;32:1926-30.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, et al . Public perception of stroke warning signs and knowledge of potential risk factors. JAMA 1998;279:1288-92.  Back to cited text no. 6    
7.Radhakrishnan K, Pandian JD, Santoshkumar T, Thomas SV, Deetha TD, Sarma PS, et al . Prevalence, knowledge, attitude and practice of epilepsy in Kerala, South India. Epilepsia 2000;41:1027-35.  Back to cited text no. 7    
8.Pandian JD, Santosh D, Santoshkumar T, Sarma PS, Radhakrishnan K. High School Students' knowledge, attitude and practice toward epilepsy in Kerala, Southern India. Epilepsy Behav (In press).  Back to cited text no. 8    

Copyright 2006 - Neurology India

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