Introduction
The Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) serves as a critical tool for addressing patient comprehension in cardiovascular care, particularly as atrial fibrillation (AF) remains a complex cardiac arrhythmia that requires patients to actively participate in lifelong management and adherence to complex medication regimens. Consequently, assessing how well patients understand their condition, its treatment, and associated risks has become paramount for preventing severe complications such as ischemic stroke. To address this clinical need, the creators designed this tool as an efficient instrument to evaluate patient education and pinpoint specific knowledge gaps. Lien Desteghe and colleagues originally developed and validated the JAKQ in 2016; since then, healthcare providers have utilized it to guide targeted educational interventions. Armed with over 120 citations in peer-reviewed scientific literature, this instrument has consistently demonstrated its clinical utility and psychometric validity across diverse cardiovascular care settings.
This article delves into the JAKQ‘s core features, complex structure, and practical research applications. Furthermore, it aims to provide researchers, authors of scientific literature, and clinicians with actionable insights for enhancing patient assessment, optimizing anticoagulant therapy tracking, and improving overall care in cardiology and electrophysiology units.
Key Features of the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ)
Purpose and Use
The primary purpose of the JAKQ is to objectively assess patients’ knowledge concerning atrial fibrillation, its underlying treatments, and essential self-management strategies. By pinpointing precise educational deficits, clinicians can design tailored patient education programs. Ultimately, this leads to more effective care pathways, superior medication adherence, and minimized thromboembolic risks. The questionnaire provides crucial insights into how well a patient understands critical concepts, such as the mechanism of arrhythmia and the importance of daily oral anticoagulation (OAC) compliance.
Target Population
Validation studies confirm The JAKQ‘s effectiveness for adults aged 18 and older, encompassing several key demographic stages:
- Young adults (18–24 years)
- Middle-aged adults (25–44 years)
- Older adults (45–64 years)
- Seniors (65+ years)
The creators specifically designed it for patient populations diagnosed with atrial fibrillation, particularly those navigating the complexities of long-term anticoagulant administration.
Structure
The full questionnaire consists of 16 multiple-choice items structured dynamically based on the patient’s current treatment profile. The unique structural flow ensures high relevance across two primary clinical domains: cardiology and patient health knowledge. Because of this branch-like architecture, the instrument organizes the sub-domains into three distinct categories as follows:
- Atrial Fibrillation Knowledge: 8 general questions answered by all patients.
- Oral Anticoagulation Therapy Knowledge: 5 general OAC items completed by patients on therapeutic regimens.
- Treatment-Specific Knowledge: 3 specialized items tailored according to the specific drug type, dividing patients into either Vitamin K Antagonist (VKA)-specific knowledge or Non-Vitamin K Antagonist Oral Anticoagulant (NOAC)-specific knowledge streams.
Importantly, patients who are not receiving long-term OAC complete only the initial 8 general AF questions. Consequently, OAC-treated patients complete exactly 16 items in total, rather than a truncated subset.
Scoring Method
Each of the 16 multiple-choice questions features one correct answer, two distinct distractors, and a standardized “I do not know” option. The points are distributed strictly through binary scoring:
- Correct answer: 1 point
- Incorrect answer / “I do not know”: 0 points
To interpret the instrument, clinicians divide the total JAKQ score by the exact number of completed questions and subsequently expressed as a final percentage. Higher percentages directly indicate better patient knowledge. Notably, formal clinical cut-off scores are not provided in the literature; instead, scores are interpreted dimensionally to identify specific baseline educational deficits.
Administration Format
Because the JAKQ is designed with a highly optimized user experience, it functions as a brief, self-administered tool requiring no special training or expert certification to distribute. Healthcare teams can easily administer the questionnaire across multiple modern formats:
- Paper-based formats
- Digital (online) platforms
It typically takes only 5 to 10 minutes for patients to complete. This rapid completion window makes it highly practical for busy outpatient cardiology clinics and large-scale, multi-center research studies.
Application of the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ)
The JAKQ exhibits diverse utility across clinical, academic, and pharmacological research domains:
- Monitoring: Clinicians can reliably track a patient’s long-term retention of educational counseling over time.
- Treatment Planning: Medical teams utilize baseline scores to structure individualized educational sessions, focusing solely on the patient’s highlighted deficits.
- Research Endpoint: The questionnaire functions as a valuable outcome measure in clinical trials evaluating the impact of digital health tools, smartphone apps, and nurse-led clinics on AF management.
Languages and availability
The JAKQ was developed through a collaborative effort between Hasselt University and Jessa Hospital in Belgium. To support diverse healthcare settings and facilitate accurate patient assessment across different cultural backgrounds, the questionnaire has been translated and validated for clinical use in the following languages:
The JAKQ questions and full answers are proprietary, not in the public domain, and need official permission for use. To obtain the instrument and secure the required formal user agreement, researchers and clinicians must contact Hasselt University directly at jakq.uhasselt@gmail.com.
Reliability and Validity
The JAKQ enjoys recognition as a moderately reliable and valid instrument for tracking patient comprehension. In the original psychometric validation study, the questionnaire demonstrated strong content, face, construct, and discriminant validity. It is remarkably sensitive to educational interventions, proving its worth in pre- and post-test study designs. Statistically, its internal consistency across the subscales is supported by localized Cronbach’s alpha values:
- Cronbach’s α = 0.674 for the 8 general AF questions
- Cronbach’s α = 0.604 for the OAC/VKA subscale questions
- Cronbach’s α = 0.522 for the OAC/NOAC subscale questions
Validation evidence comes from diverse contexts, including:
- The original validation study link.
- Study on using the JAKQ for targeted patient education published by Oxford Academic study link.
- Validation of the English version study link.
- Validation of the Mandarin Chinese version study link.
- Validation of the Polish version study link.
Limitations and Considerations
Despite its strengths, the JAKQ has a few limitations:
- Self-report measure: Results may be influenced by personal interpretation, reading comprehension levels, or underlying cognitive barriers.
- Cultural Bias: Nuances in regional healthcare delivery systems can affect how patients interpret questions regarding medication management.
- Age Restrictions: The tool is valid strictly for adults aged 18 and older, rendering it unsuitable for pediatric or adolescent populations.
- Narrow Focus: The questionnaire concentrates exclusively on cognitive knowledge; as a result, it does not assess other vital clinical parameters, such as physical symptoms, quality of life, or direct clinical outcomes. Furthermore, it exhibits moderate internal consistency across its specific OAC treatment subscales.
Other Versions And Related Questionnaires
Beyond the standard 16-item configuration, researchers have expanded the tool’s foundational architecture into other medical fields, resulting in specialized adaptations such as the JAKQ-VTE for venous thromboembolism. Additionally, researchers frequently deploy the JAKQ alongside complementary cardiovascular and psychometric instruments to capture a multidimensional view of patient health:
- AFKS: Atrial Fibrillation Knowledge Scale.
- KAFSP: Knowledge of Atrial Fibrillation and Stroke Prevention Questionnaire.
- AKT: Anticoagulation Knowledge Tool.
- AFEQT: Atrial Fibrillation Effect on Quality-of-Life.
Additional Resources
- The Original Validation Study link.
- For inquiries or to request the official user agreement, contact Hasselt University at jakq.uhasselt@gmail.com, or email the first author, Lien Desteghe, at lien.desteghe@uhasselt.be / liendesteghe@gmail.com.
Frequently Asked Questions (FAQ)
- Who can use the JAKQ?
Clinicians, researchers, and healthcare providers use the JAKQ for adult patients aged 18 and older who have been diagnosed with atrial fibrillation. - How long does it take to complete the JAKQ?
Patients typically take 5 to 10 minutes to complete the JAKQ, which makes it highly feasible for use in fast-paced clinical environments and vast research settings. - How is the JAKQ administered?
Healthcare teams can seamlessly administer the questionnaire via paper-based forms or digital online platforms, offering clinical teams superb infrastructural flexibility. - Is there any cost to using the JAKQ?
The JAKQ is not in the public domain and strictly requires official permission. You cannot download it freely, and you must secure a formal user agreement from Hasselt University before any use.
A Word from ResRef about the Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ)
The Jessa Atrial Fibrillation Knowledge Questionnaire (JAKQ) is a brief, AF-specific knowledge questionnaire for patients with atrial fibrillation, especially those receiving oral anticoagulation therapy. It showed content validity, face validity, construct validity, discriminatory ability, sensitivity to education, and moderate internal consistency in the original validation study. It is useful for identifying knowledge gaps and guiding tailored patient education, but it is not a diagnostic instrument and no official cut-off scores were reported. The full questions and answers are not in the public domain and require access through Hasselt University via a formal user agreement.
References
- Desteghe L, Engelhard L, Raymaekers Z, Kluts K, Vijgen J, Dilling-Boer D, Koopman P, Schurmans J, Dendale P, Heidbuchel H. Knowledge gap in patients with atrial fibrillation using oral anticoagulation therapy: An evaluation of an educational tool. Int J Cardiol. 2016 Dec 15;225:238-246. link.
- Lien Desteghe, Lara Engelhard, Johan Vijgen, Pieter Koopman, Dagmara Dilling-Boer, Joris Schurmans, Michiel Delesie, Paul Dendale, Hein Heidbuchel, Effect of reinforced, targeted in-person education using the Jessa Atrial fibrillation Knowledge Questionnaire in patients with atrial fibrillation: A randomized controlled trial, European Journal of Cardiovascular Nursing, Volume 18, Issue 3, 1 March 2019, Pages 194–203, link.
- Desteghe L, Engelhard L, Raymaekers Z, Kluts K, Vijgen J, Dilling-Boer D, Koopman P, Schurmans J, Dendale P, Heidbuchel H. Knowledge gaps in patients with atrial fibrillation revealed by a new validated knowledge questionnaire. Int J Cardiol. 2016 Nov 15;223:906-914. link.
- Chang S, Xu W, Wu S, Desteghe L, Zhang F, Zhang J. An instrument to measure atrial fibrillation knowledge in Chinese patients: validation of the Jessa Atrial fibrillation Knowledge Questionnaire. Front Pharmacol. 2023 Jun 13;14:1148524. link.
- Janion-Sadowska A, Sadowski M, Konieczyńska M, Skonieczny G, Metzgier-Gumiela A, Chrapek M, Sobieraj E, Bryk AH, Dębski M, Podolec P, Małecka B, Desteghe L, Heidbuchel H, Undas A. Polish regional differences in patient knowledge on atrial fibrillation and its management as well as in patterns of oral anticoagulant prescription. Kardiol Pol. 2019 Jan 24;77(4):437-444. link.
