Measuring Children’s Knowledge of Acute Rheumatic Fever and Rheumatic Heart Disease: Development and Validation of RHD Knowledge Scale in Nepal

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health challenges in low- and middle-income countries, including Nepal. This study aimed to develop and validate a tool to assess children’s knowledge of ARF and RHD. A 14-item multiple-choice questionnaire was developed through expert consultation and a systematic translation and back-translation process. Content validity was evaluated by 10 experts using item-level and scale-level content validity indices (I-CVI and S-CVI) and the Content Validity Ratio (CVR). A cross-sectional survey of 207 students aged 11 to 16 years was conducted in public schools. Item difficulty and discrimination indices were calculated, and internal consistency was assessed using the Kuder-Richardson Formula 20 (KR-20). Known-groups validity was tested by comparing scores across grades and prior exposure to RHD screening programs. The scale demonstrated excellent content validity (S-CVI/Ave = 0.91) and good internal consistency (KR-20 = 0.772). Item difficulty indices ranged from 0.32 to 0.61, and discrimination indices from 0.23 to 0.36, both within ideal ranges. The mean knowledge score was 6.05 ± 3.43. Higher knowledge scores were observed among older students, those in higher grades, and those previously screened for RHD (P < .05). The RHD Knowledge Scale is a valid and reliable instrument for assessing children’s understanding of ARF and RHD. Although this study was limited to a single municipality and did not include test–retest reliability, the tool shows strong potential for adaptation and validation across different cultural, linguistic, and geographical contexts. Beyond research settings, this tool can serve as a practical means to integrate ARF and RHD education into school health programs and to monitor the effectiveness of nationwide prevention initiatives.