Abstract
BackgroundTB outbreaking in schools is extremely complex, and presents a major challenge for public health. Understanding the knowledge, attitudes and practices among student TB patients in such settings is fundamental when it comes to decreasing future TB cases. The objective of this study was to develop a Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ), and evaluate its psychometric properties.MethodsThis study was conducted in three stages: item construction, pilot testing in 10 student TB patients and psychometric testing, including reliability and validity. The item pool for the questionnaire was compiled from literature review and early individual interviews. The questionnaire items were evaluated by the Delphi method based on 12 experts. Reliability and validity were assessed using student TB patients (n = 416) and healthy students (n = 208). Reliability was examined with internal consistency reliability and test-retest reliability. Content validity was calculated by content validity index (CVI); Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA); The Public Tuberculosis Knowledge, Attitudes and Practices Questionnaire (PTB-KAPQ) was applied to evaluate criterion validity; As concerning discriminant validity, T-test was performed.ResultsThe final STBP-KAPQ consisted of three dimensions and 25 items. Cronbach’s α coefficient and intraclass correlation coefficient (ICC) was 0.817 and 0.765, respectively. Content validity index (CVI) was 0.962. Seven common factors were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 66.253%. The resulting CFA model of the STBP-KAPQ exhibited an appropriate model fit (χ2/df = 1.74, RMSEA = 0.082, CFI = 0.923, NNFI = 0.962). STBP-KAPQ and PTB-KAPQ had a strong correlation in the knowledge part, and the correlation coefficient was 0.606 (p < 0.05). Discriminant validity was supported through a significant difference between student TB patients and healthy students across all domains (p < 0.05).ConclusionsAn instrument, “Knowledge, Attitudes and Practices Questionnaire among Student Tuberculosis Patients (STBP-KAPQ)” was developed. Psychometric testing indicated that it had adequate validity and reliability for use in KAP researches with student TB patients in China. The new tool might help public health researchers evaluate the level of KAP in student TB patients, and it could also be used to examine the effects of TB health education.
Highlights
TB outbreaking in schools is extremely complex, and presents a major challenge for public health
This study was aimed at developing Knowledge, Attitudes and Practices (KAP) Questionnaire among Student Tuberculosis (TB) Patients (STBP-KAPQ), and evaluated its psychometric properties
Item pool's three sources: (1) WHO “A guide to develop KAP surveys” (World Health Organization 2008) [29]; Collecting as many terms as possible that were considered essential knowledge for student TB patients by referring to books on health, health-related magazines, and leaflets distributed by hospitals and government institutes, such as “China TB prevention and control work guide (2008 edition)”, “school TB prevention and control work manual”. (2) A review of published research on KAP definitions and concepts, and on its measurement
Summary
TB outbreaking in schools is extremely complex, and presents a major challenge for public health. Tuberculosis (TB) has existed for millennia and remains a major global health problem. It caused ill-health in millions of people each year and was one of the top 10 causes of death worldwide, ranking above HIV/AIDS as one of the leading causes of death from an infectious disease [9]. In Shaanxi Province of China, from 2011 to 2015, the number of student TB patients was always higher than 1300 annually, accounted for 6.17-6.78% of total TB cases [10, 11]. A total of 44 student TB patients were found and diagnosed during TB outbreak in a middle school in Jinan, Shandong Province from April 2013 to November 2014 [12]. Even in many lower TB burden countries, such as Britain and the United States, epidemic of student TB has been reported [15, 16]
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