Table Of ContentDEVELOPMENT AND TESTING OF A MEASURE OF ALZHEIMER’S DISEASE
KNOWLEDGE IN A RURAL APPALACHIAN COMMUNITY
by
Lisa Kirk Wiese
A Dissertation Submitted to the Faculty of
The Christine E. Lynn College of Nursing
in Partial Fulfillment of the Requirements for the Degree of
Doctor of Philosophy
Florida Atlantic University
Boca Raton, Florida
December 2013
© Copyright Lisa Kirk Wiese
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DEVELOPMENT AND TESTING OF A MEASURE OF ALZHEIMER'S DISEASE
KNOWLEDGE IN A RURAL APPALACHIAN COMMUNITY
by
Lisa Kirk Wiese
This dissertation was prepared under the direction of the candidate's dissertation advisor,
Dr. Christine L. Williams, the Christine E. Lynn College of Nursing, and has been
approved by the members of her supervisory committee. It was submitted to the faculty
of the Christine E. Lynn College of Nursing and was accepted in partial fulfillment of the
requirements for the degree of Doctor of Philosophy.
SUPERVISORY COMMITTEE:
Christine L. Williams, DNSc.
Dissertation Advisor
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MOnIca Ross~h.D.
David Newman, Ph.D.
Marlaine Smith, RN, PhD, AHN-BC, FAAN
Dean, The Christine E. Lynn College of Nursing
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Barry T osson, Ph.D. Date
Dean, Graduate College
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ACKNOWLEDGEMENTS
This dissertation is a direct reflection of the impact that a committed mentor and
faculty can have on the life of a student, resulting in the promise of improved health for a
vulnerable population. It is with inexpressible thankfulness that I acknowledge my Chair,
Dr. Christine Williams, who sacrificed days, weeks, and months in coaching and
sustaining me so that I could reach the final pages of this paper. I am deeply grateful to
Dr. David Newman, without whose support and encouragement during the statistical
analyses I would not have achieved my goal. To my other committee members, Dr. Ruth
Tappen and Dr. Monica Rosselli, thank you for the numerous hours of reading and
having faith in me during dubious times. To the faculty at the Florida Atlantic University
Christine E. Lynn College of Nursing who uplifted me with your many acts of caring:
you exemplify Boykin and Schoenhofer’s (2001) philosophy. I am thankful for my
fellow doctoral students whose kindness propelled me forward on this path.
I thank my brother for tenderly caring for my nonagenarian mother as she
contends with Alzheimer’s disease. I thank my friends and family for understanding that
I could not be with them. I thank my husband Kurt who brought me my morning coffee
and made countless trips to the store and prepared countless meals. I thank my children
Erika and Kevin who bore their burdens and mine silently these last three years. I thank
my editor Ms. Gapinski who has been of invaluable service to me during this process.
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I thank my God and Savior who worked through all these persons and honored the
prayers of my family, friends, and women’s fellowship in order to see me through to
completion, as He promised in Philippians 1:6.
This dissertation is dedicated to my brother, Phillip Kirk, and my parents, Ora Lee
and Eugene, who through their exemplary strength, perseverance, and faith that is the
essence of West Virginians inspired me to pursue the goals of becoming a nurse and
making a difference.
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ABSTRACT
Author: Lisa Kirk Wiese
Title: Development and Testing of a Measure of Alzheimer’s Disease
Knowledge in a Rural Appalachian Community
Institution: Florida Atlantic University
Dissertation Advisor: Dr. Christine L. Williams
Degree: Doctor of Philosophy
Year: 2013
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
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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.
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DEVELOPMENT AND TESTING OF A MEASURE OF ALZHEIMER’S DISEASE
KNOWLEDGE IN A RURAL APPALACHIAN COMMUNITY
LIST OF TABLES ........................................................................................................... xvi
LIST OF FIGURES ........................................................................................................ xvii
CHAPTER ONE. INTRODUCTION ................................................................................. 1
Development and Testing of a Measure of Alzheimer’s Disease in a Rural
Appalachian Community ........................................................................................ 1
Background ............................................................................................................. 2
Significance ............................................................................................................. 5
Alzheimer’s Disease in the Appalachian Population .................................. 7
The Importance of Acknowledging Appalachian Culture .......................... 7
Appalachia, Rurality, and West Virginia .................................................. 10
Summary of Significance .......................................................................... 11
Statement of the Problem ...................................................................................... 12
Purpose of the Study ............................................................................................. 13
Theoretical Framework ......................................................................................... 13
The Concept Tree .................................................................................................. 16
Chapter Summary ................................................................................................. 19
CHAPTER TWO. LITERATURE REVIEW ................................................................... 20
Review of Relevant Research ............................................................................... 20
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Research Regarding Knowledge Assessment Tools ................................. 20
Summary of Research on Existing Measures ........................................... 32
Research Related to Rural Culture ........................................................................ 32
The Appalachian Subculture ..................................................................... 34
Research on AD in Appalachia ................................................................. 37
Gap in Knowledge .................................................................................... 38
Chapter Summary ................................................................................................. 39
CHAPTER THREE. METHODS AND PROCEDURES ................................................ 41
Definition of Terms and Research Variables ........................................................ 42
Research Design .................................................................................................... 44
Threats to Internal Validity ................................................................................... 44
History....................................................................................................... 45
Testing ....................................................................................................... 45
Instrumentation ......................................................................................... 46
Selection Bias ............................................................................................ 46
Threats to External Validity .................................................................................. 47
Setting and Population .......................................................................................... 47
Appalachia ................................................................................................ 48
Health Risks in Appalachia and West Virginia ........................................ 49
An Appalachian Exemplar ........................................................................ 50
Appalachian Health Beliefs ...................................................................... 51
AD Basic Knowledge Test Pilot Study, March, 2012 .......................................... 52
Quantitative Inquiry of the Pilot Study ................................................................. 53
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The Sociodemographic Survey Findings ................................................. 53
The Pilot Study Participant Responses ..................................................... 54
The Initial Interviews ................................................................................ 56
Think - Aloud and Laddering as a Method of Inquiry .............................. 57
Think - Aloud Inquiry ................................................................... 57
Think - Aloud Responses .............................................................. 59
Laddering Inquiry ......................................................................... 59
Qualitative Analysis of Think - Aloud and Laddering Data ..................... 61
In Vivo Category ........................................................................... 62
Descriptive Categories .................................................................. 63
Knowing Person ............................................................................ 63
Seeking .......................................................................................... 63
Trusting ......................................................................................... 64
Behavioring and Malfunctioning .................................................. 65
Reflections Regarding Qualitative Inquiry ............................................... 66
Lessons Learned from the Basic Knowledge Test Pilot Study ................. 66
Sampling ............................................................................................................... 67
Sample Size ............................................................................................... 68
Measurement ......................................................................................................... 68
BKAD Instrument Development .............................................................. 70
Item Construction ...................................................................................... 70
Sources for BKAD Test Development ..................................................... 71
The BKAD Content Domain Map ............................................................ 73
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Description:of the Christine E. Lynn College of Nursing and was accepted in partial Research during the late 1960s and 1970s typically depicted residents of .. the theoretical framework grounding the research were included. of mortality and premature mortality from cardiac disease, cancer, stroke, chronic.
