Quality of available cardiovascular disease knowledge tools: a systematic review

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Most people can reduce their CVD risk through lifestyle improvements and medication. Having low health literacy is a barrier to CVD prevention and management and is associated with worse health outcomes. Knowledge is a key component of health literacy, but there is no standard way for clinicians to assess this to tailor education about CVD. The aim of this review was to identify available CVD knowledge tests and evaluate their quality. Methods: Electronic database searches were conducted using Medline, CINAHL, PsycINFO and PsycTESTS between inception and October 2022. Identified tools were assessed using the Psychometric Grading Framework (PGF) to assess the quality of included tests. Results: A total of 28 studies were identified, of which 18 were original test development papers and 10 were language translation papers. The five most common domains were CVD risk factors, nutrition, heart physiology, physical activity, and treatment options. Three papers achieved an A grading on the PGF. Only one test provided a guide to classify patients based on the results. Conclusions: This review identified 15 additional knowledge assessment tools compared to previous research, including some available in multiple languages. Clinicians can access a wide range of CVD knowledge assessment tools to understand and respond to patient knowledge levels, but some are higher quality than others. Alternative tools may be needed to assess specific risk factor and condition knowledge. Further work is needed to tailor CVD knowledge tests for populations lower health literacy, and to validate the tests against health outcomes to improve clinical practice.