A unique double tango: Construct validation and reliability analysis of risk perception, attitude and practice (RPAP) questionnaire on dengue infection.

Mohd ‘Ammar Ihsan Ahmad Zamzuri,Rahmat Dapari,Rozita Hod,Mohammad Faid Abd Rashid,Mohd Nazrin Jamhari,Noor Khalili Mohd Ali,Muhamad Hazizi Muhamad Hasani,Mohd Rohaizat Hassan,Hasanain Faisal Ghazi,Mohammed Abdelfatah Mosa Alhoot

doi:10.1371/journal.pone.0256636

Abstract

Introduction/backgroundDengue fever remains a public health threat despite being preventable. A solution to the constant problem of dengue infection will require active intervention and a paradigm shift. Assessing perceived risk and correlating it with the attitude and practice of the community will help in designing appropriate measures. However, possible instruments for these assessments come with limitations.ObjectiveThe aim is to develop and validate a new scoring-based questionnaire, using dual statistical approaches to measure risk perception, attitude, and practices (RPAP) related to dengue in the community.MethodsThe RPAP questionnaire was developed bilingually using the International Society for Pharmacoeconomics and Outcome Research (ISPOR) guidelines. Content analysis was reviewed scrupulously by four expert panels. The initial 35-item scale was tested among 253 Malaysian respondents recruited non-probabilistically via multiple online platforms. Two statistical methods were employed to measure the construct validity: Exploratory Factor Analysis (EFA) as part of the Classical Test Theory (CTT) measurement, while Rasch Measurement Analysis (Rasch) was performed for the Item Response Theory (IRT) measurement. All results were cross-validated with their counterpart to ensure stability. Confirmatory Factor Analysis (CFA) was used to obtain a model fit index.Results29 questions were retained after the final analysis. Both EFA and Rasch analysis detect multidimensionality. Nine latent factors were extracted from EFA, while only eight factors remained in the final model following CFA: 1) perceived susceptibility; 2) perceived severity; 3) perceived barrier; 4) perceived benefit; 5) cues to action; 6) self-efficacy; 7) attitude; and 8) practice. All items had adequate factor loadings and showed good internal consistency. The final model after CFA achieved a good fit with an RMSEA value of 0.061, SRMR of 0.068, PNFI of 0.649, and GFI of 0.996.ConclusionThe RPAP questionnaire contains 29 items and is a reliable and accurate psychometric instrument for measuring the risk perception of dengue fever, attitude, and practice of the community in dengue prevention. The Rasch measurement provides additional rigour to complement the CTT analysis. This RPAP questionnaire is suitable for use in studies related to dengue prevention in the community.

Highlights

Dengue is a vector-borne disease that remains a significant public health problem
Nine latent factors were extracted from Exploratory Factor Analysis (EFA), while only eight factors remained in the final model following Confirmatory Factor Analysis (CFA): 1) perceived susceptibility; 2) perceived severity; 3) perceived barrier; 4) perceived benefit; 5) cues to action; 6) self-efficacy; 7) attitude; and 8) practice
The final model after CFA achieved a good fit with an Root mean square error of approximation (RMSEA) value of 0.061, SRMR of 0.068, Parsimony Normed Fit Index (PNFI) of 0.649, and Goodness of fit index (GFI) of 0.996

Summary

Introduction

Dengue is a vector-borne disease that remains a significant public health problem. The World Health Organisation (WHO) estimated that nearly 390 million dengue infections occur per year with increasing mortality rates worldwide [1]. Explain its ability to effectively transmit dengue virus (DENV), from the ability of the egg to survive a lengthy drought [4, 5] to the transovarial mode of DENV transmission [6, 7]. This vector naturally breeds in human habitat, unlike vectors for other diseases such as malaria. A local epidemiological study has elucidated the socio-ecological factors that contribute to ongoing disease transmission. Low levels of participation in community-based dengue prevention programmes, such as Communication for Behavioural Impact (COMBI) [11], contributed to worsening the problem [3]

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Conclusion