Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims

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Abstract

Background

Hajj pilgrimage faces numerous challenges including a high prevalence of respiratory tract infection as well as its prevention strategies. The aim of this study was to develop and validate a questionnaire to evaluate knowledge, attitude and practice (KAP) towards respiratory tract infections (RTIs) prevention among Malaysian Hajj pilgrims.

Methods

This study was conducted among Malaysian Umrah pilgrims in Malaysia from Kuala Lumpur and Kelantan. The questionnaire then underwent a series of validation process that included content, face validity and exploratory part. Item response theory (IRT) analysis was utilized for the validation of the knowledge domain. The attitude and practice were validated using the exploratory factor analysis (EFA).

Results

The validation process resulted in a questionnaire that comprised of four main sections: demography, knowledge, attitude, and practice. Following IRT analysis of the knowledge domain, all items analyzed were within the acceptable range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was 0.72 and 0.84 for attitude and practice domain respectively and Bartlett’s test of Sphericity for both domains were highly significant ( P < 0.001). The factor analysis resulted in two factors with total of 12 items in attitude domain, and 2 factors with total of 13 items in the practice domain with satisfactory factor loading (> 0.3). The Cronbach’s alpha for reliability of the knowledge, attitude and practice domains all showed acceptable values of > 0.6 (0.92, 0.77 and 0.85).

Conclusion

The findings of this validation and reliability study showed that the developed questionnaire had a satisfactory psychometric property for measuring KAP of Malaysian Hajj pilgrims.

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Most cited references 20

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The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation

Christina Jones, Jakob D Jensen, Courtney Scherr … (2014)

The Health Belief Model (HBM) posits that messages will achieve optimal behavior change if they successfully target perceived barriers, benefits, self-efficacy, and threat. While the model seems to be an ideal explanatory framework for communication research, theoretical limitations have limited its use in the field. Notably, variable ordering is currently undefined in the HBM. Thus, it is unclear whether constructs mediate relationships comparably (parallel mediation), in sequence (serial mediation), or in tandem with a moderator (moderated mediation). To investigate variable ordering, adults (N = 1,377) completed a survey in the aftermath of an 8-month flu vaccine campaign grounded in the HBM. Exposure to the campaign was positively related to vaccination behavior. Statistical evaluation supported a model where the indirect effect of exposure on behavior through perceived barriers and threat was moderated by self-efficacy (moderated mediation). Perceived barriers and benefits also formed a serial mediation chain. The results indicate that variable ordering in the Health Belief Model may be complex, may help to explain conflicting results of the past, and may be a good focus for future research.

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Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement.

Maria Orlando Edelen, Bryce B Reeve (2007)

Health outcomes researchers are increasingly applying Item Response Theory (IRT) methods to questionnaire development, evaluation, and refinement efforts. To provide a brief overview of IRT, to review some of the critical issues associated with IRT applications, and to demonstrate the basic features of IRT with an example. Example data come from 6,504 adolescent respondents in the National Longitudinal Study of Adolescent Health public use data set who completed to the 19-item Feelings Scale for depression. The sample was split into a development and validation sample. Scale items were calibrated in the development sample with the Graded Response Model and the results were used to construct a 10-item short form. The short form was evaluated in the validation sample by examining the correspondence between IRT scores from the short form and the original, and by comparing the proportion of respondents identified as depressed according to the original and short form observed cut scores. The 19 items varied in their discrimination (slope parameter range: .86-2.66), and item location parameters reflected a considerable range of depression (-.72-3.39). However, the item set is most discriminating at higher levels of depression. In the validation sample IRT scores generated from the short and long forms were correlated at .96 and the average difference in these scores was -.01. In addition, nearly 90% of the sample was classified identically as at risk or not at risk for depression using observed score cut points from the short and long forms. When used appropriately, IRT can be a powerful tool for questionnaire development, evaluation, and refinement, resulting in precise, valid, and relatively brief instruments that minimize response burden.

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Mass gathering and globalization of respiratory pathogens during the 2013 Hajj

Z.A. Memish, A. Assiri, A Turkestani … (2015)

Every year, more than 10 million pilgrims arrive in the Kingdom of Saudi Arabia for the Hajj or Umrah. Crowding conditions lead to high rates of respiratory infections among the pilgrims, representing a significant cause of morbidity and a major cause of hospitalization. Pre- and post-Hajj nasal specimens were prospectively obtained from a paired cohort (692 pilgrims) and from nonpaired cohorts (514 arriving and 470 departing pilgrims) from 13 countries. The countries of residence included Africa (44.2%), Asia (40.2%), the United States (8.4%) and Europe (7.2%). Nasal specimens were tested for 34 respiratory pathogens using RT-PCR. A total of 80 512 PCRs were performed. The prevalence of viruses and bacteria increased, from 7.4% and 15.4% before the Hajj to 45.4% and 31.0% after the Hajj, respectively, due to the acquisition of rhinovirus, coronaviruses (229E, HKU1, OC43), influenza A H1N1, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. We did not identify Middle East respiratory coronavirus carriage. At arrival, the prevalence of several viruses was clearly dependent on the pilgrim's country of origin. After Hajj participation, these viruses were isolated among pilgrims from all countries, with few exceptions. No significant differences were observed between paired and nonpaired cohort results. Our results strongly suggest that, given the particularly crowded conditions during the rituals, an international mass gathering such as the Hajj may contribute to the globalization of respiratory pathogens after the cross-contamination of pilgrims harbouring pathogens that easily spread among participants. Influenza and pneumococcal vaccination, face mask use and hand hygiene should be considered in the context of the Hajj.

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Author and article information

Contributors

Mohammed Dauda Goni: dmgoni@yahoo.com

Nyi Nyi Naing: syedhatim@unisza.edu.my

Habsah Hasan: drhabsah@usm.my

Nadiah Wan-Arfah: wanwaj@unisza.edu.my

Zakuan Zainy Deris: zakuan@usm.my

Wan Nor Arifin: wnarifin@usm.my

Tengku Mohammad Ariff Raja Hussin: tg_mariff@unisza.edu.my

Abdulwali Sabo Abdulrahman: abwalisabo@gmail.com

Aisha Abubakar Baaba: mandybaaba@gmail.com

Muhammad Rafie Arshad: rafie@usm.my

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 2 March 2020

Publication date PMC-release: 2 March 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 189

Affiliations

[1 ]ISNI 0000 0001 2294 3534, GRID grid.11875.3a, Department of Medical Microbiology and Parasitology, School of Medical Sciences, , Universiti Sains Malaysia, ; 16150 Kubang Kerian, Kelantan Malaysia

[2 ]GRID grid.449643.8, Faculty of Medicine, , Universiti Sultan Zainal Abidin, ; Medical Campus, 20400 Kuala Terengganu, Malaysia

[3 ]GRID grid.449643.8, Faculty of Health Sciences, , Universiti Sultan Zainal Abidin, ; Gong Badak Campus, 21300 Kuala Nerus, Terengganu Malaysia

[4 ]ISNI 0000 0001 2294 3534, GRID grid.11875.3a, Unit of Biostatistics and Research Methodology, School of Medical Sciences, , Universiti Sains Malaysia Health Campus, ; 16150 Kubang Kerian, Kelantan Malaysia

[5 ]ISNI 0000 0004 1757 0587, GRID grid.444465.3, Centre for Language Studies and Generic Development, , Universiti Malaysia Kelantan, ; Locked Bag 01, 16300 Bachok, Kelantan Malaysia

[6 ]ISNI 0000 0001 2294 3534, GRID grid.11875.3a, School of Computer Science, , Universiti Sains Malaysia, ; 11800 Penang, Malaysia

Article

Publisher ID: 8269

DOI: 10.1186/s12889-020-8269-9

PMC ID: 7050115

PubMed ID: 32114986

SO-VID: 59d10eea-e62b-4a27-9c65-bb5f7e566801

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 December 2018

Date accepted : 24 January 2020

Funding

Funded by: Universiti Sultan Zainal Abidin Special Research Grant Scheme

Award ID: UniSZA/2017/SRGS/16

Award Recipient : Nyi Nyi Naing

Custom metadata

ScienceOpen disciplines: Public health

Keywords: item response theory,exploratory factor analysis,reliability,knowledge attitude and practice,respiratory tract infections and hajj

Data availability:

ScienceOpen disciplines: Public health

Keywords: item response theory, exploratory factor analysis, reliability, knowledge attitude and practice, respiratory tract infections and hajj

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Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims

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Abstract

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European Respiratory Society: COVID-19

Most cited references 20

The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation

Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement.

Mass gathering and globalization of respiratory pathogens during the 2013 Hajj

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