Development and validation of a structured survey questionnaire on knowledge, attitude, preventive practice, and treatment-seeking behaviour regarding dengue among the resident population of Sabah, Malaysia: an exploratory factor analysis

Abstract

Background Several studies have reported a significant association of knowledge, attitude and preventive practice (KAP) regarding dengue infection among community’s resident in endemic areas. In this study we aimed to assess and develop a reliable and valid KAP survey on the subject of dengue that is suitable for the resident population of Sabah, Malaysia. Methods A community-based cross-sectional study was conducted from October 2019 to February 2020 involving 468 respondents. Information on the socio-demographic characteristics of the participants (six items), their KAP (44, 15 and 18 items on knowledge, attitude and practice, respectively) and treatment-seeking behaviour (five items) towards dengue was collected using a structured questionnaire. Data analysis was performed using SPSS and R software in the R Studio environment. The knowledge section was analysed by two-parameter logistic item response theory (2-PL IRT) using ltm package. The construct validity and reliability of items for sections on attitude, practice and treatment-seeking behaviour were analysed using psy package. Results For the knowledge section, only 70.5% (31/44) of items were within or close to the parameter acceptable range of −3 to + 3 of difficulty. In terms of discrimination, 65.9% (29/44) of items were within or close to the acceptable range of 0.35 to 2.5, and 24 items (54.5%) failed to fit the 2-PL IRT model (P < 0.05) after assessing by goodness-of-fit analysis. Only eight items were reliable and retained in the attitude section with a Kaiser–Meyer–Olkin (KMO) test value of > 0.7, while based on the communalities, 11 items in the attitude section were excluded due to very low h2, factor loading values and low correlation with the total (< 0.5). The practice section was found suitable for factor analysis because the KMO value was > 0.7. The communalities of the practice section showed that seven items had low h2 values (< 0.3), which were therefore excluded from further analysis, and only 11 items were retained. Conclusions The KAP items retained in the final version of the survey were reliable and valid to be use as a questionnaire reference when conducting future similar studies among the population of Sabah.

Knowledge, Attitude, and Prevention Practice on Dengue and Dengue Seroprevalence in a Dengue Hotspot in Sabah, East Malaysia

“…A questionnaire designed for one demographic may not be appropriate to another in a different country or region with differing socio-cultural, healthcare, economic, and political circumstances, resulting in discrepancies in the ndings. Prior to the actual data collection, a pilot study and EFA were conducted, and the resulting KAP items were kept in the nal version of the survey questionnaires, indicating a reliable and valid questionnaire for the Sabah population (15).…”

“…Information on the socio-demographic characteristics of the residents and their KAP towards dengue was collected using a structured questionnaire developed by the researchers. Prior to the actual data collection, a pilot study and exploratory factor analysis (EFA) study involving 30 and 468 residents respectively was conducted to validate the questionnaire written in native Sabah creole (15). There are three sections to the questionnaire.…”

Different domains of dengue research in the Philippines: A systematic review and meta-analysis of questionnaire-based studies

“…An Rs of value 0.70 or greater is generally accepted and indicates good reliability [ 100 ]. Despite the need to determine reliability during pretesting only a small minority of studies have reported Cronbach’s alpha coefficients during the pilot study and thereby confirmed the adequacy of internal consistencies of these scales [ 29 ].…”

“…In regard to validity there are several subtypes, namely face, content, criterion and construct validity [ 101 ]. The underlying construct of the items should be analysed by factor analysis to predict the discriminant and convergent validity [ 29 , 102 ]. In this systematic review, the majority of articles reported neither the results of a pilot study nor those of a pretest questionnaire–if these were indeed actually undertaken.…”

“…Furthermore, the collective scopes have not been discussed previously in the context of researching a pattern for guidance. In addition, the accuracy of findings from questionnaire-based studies is a matter of concern, as the accuracy of results depends largely on the reliability of the questionnaires used in the survey [ 29 ]. A comprehensive review of questionnaire-based dengue-related studies is required to highlight the findings from all relevant previously published work on the behavioural and practice aspects related to dengue prevention, to assess the validity and reliability of questionnaires used in such research, as well as to draw broad conclusions.…”