Cultural adaptation and validation of the Oral Anticoagulation Knowledge Tool in Arabic-speaking Iraqi patients

While oral anticoagulants (OACs) are critical for managing thromboembolic diseases, their use carries significant bleeding risks, underscoring the importance of patient comprehension for safety and therapeutic success. Existing tools to measure this knowledge often lack cultural adaptation for Arabic-speaking populations or are restricted solely to vitamin K antagonists. This cross-sectional study aimed to translate, culturally adapt, and psychometrically validate the Oral Anticoagulation Knowledge Tool (AKT) for Arabic-speaking Iraqi patients. The study included 280 adult cardiovascular outpatients in Baghdad (140 prescribed warfarin and 140 prescribed direct oral anticoagulants [DOACs]). Following rigorous forward-backward translation, the adapted tool demonstrated excellent content validity, with a scale content validity index of 0.89, retaining all original items. Principal component analysis confirmed the multidimensional nature of clinical knowledge, extracting eight components from the DOAC cohort and 10 from the warfarin cohort. Educational attainment emerged as the most significant predictor of knowledge scores across both therapeutic modalities ( p = 0.003 for DOACs; p = 0.006 for warfarin). The DOAC scale demonstrated acceptable internal consistency ( α = 0.700), whereas the full warfarin scale exhibited low overall reliability ( α = 0.512), although its specific clinical subdomains showed strong independent reliability ( α ranging from 0.695 to 0.972). Ultimately, the Arabic AKT proved to be a culturally congruent and psychometrically sound instrument when used as a domain-specific formative index for identifying knowledge gaps.