Development and testing of a measure of Alzheimer’s disease knowledge in a rural Appalachian community

Rural West Virginia has a very high percentage of older adults. The age-related
disease of Alzheimer’s threatens the health of older Appalachians, yet research on
Alzheimer’s disease (AD) in this population is scarce. In order to improve screening
rates for cognitive impairment, Appalachians need to understand their vulnerability. The
first step would be to assess their knowledge about AD but a suitable AD knowledge test has not been developed. The purpose of this study was to test the reliability and validity of a new measure of knowledge about AD that is culturally congruent, and to examine factors that may predict AD knowledge in this rural population. A correlational
descriptive study was conducted with 240 participants from four samples of older adults
in south central rural Appalachian West Virginia using surveys and face-to-face
interviews. Results from tests for stability, reliability including Rasch modeling,
discrimination and point biserial indices, and concurrent, divergent, and construct validity were favorable. Findings were that although more diversity in test item difficulty is needed, the test discriminated well between persons with higher and lower levels of
education [F(2, 226) = 170.51, p = .001]. Using multiple regression, the predictors of AD
knowledge included caregiver status, miles from a healthcare provider, gender, and
education; (R2=.05, F(4,187) = 2.65, p =. 04). Only years of education accounted for a
significant proportion of unique variance in predicting the total BKAD score (t = 2.14, p
=. 03). Implications include the need for further tool refinement, testing for health
literacy, coordination with recent statewide efforts to educate the public regarding AD,
and community based participatory research in designing culturally effective education
programs that will ultimately increase screening and detection of Alzheimer’s disease in
rural populations.