Abstract
Objectives: Validated knowledge–attitude–practice (KAP) questionnaires are essential to design and evaluate intervention programs on antibiotic use. Recently, we validated the first KAP questionnaire on antibiotics in Spain. Cross-cultural adaptation and validation of research tools increase their universal usefulness. Here, we aimed to validate the questionnaire in a developing country with different socioeconomic characteristics from that of Spain. Methods: We translated the previously developed KAP-questionnaire into Arabic and French, tailored it and then validated it in adult population in Lebanon. The item content validity index (I-CVI), scale content validity index (S-CVI/Ave) and modified Kappa (k*) were calculated. The construct validity of the questionnaire was evaluated using confirmatory factorial analysis (CFA, N = 1460) and its reliability was assessed using intraclass correlation coefficients (ICC, N = 100) and Cronbach’s alpha statistic. Results: ICV-I (>0.78), k* (equal to ICV-I for all items) and S-CVI/Ave (≥0.95) confirmed the questionnaire content validity. Pilot testing (N = 40) and face validity showed the understandability of the questionnaire by the population. Test–retest reliability analysis (N = 100) yielded ICC ≥ 0.59 for all knowledge and attitude items, showing the capacity of the questionnaire to generate reproducible results. CFA evidenced adequate fit of the chosen model, thus establishing the construct validity of the questionnaire (root mean squared error approximation = 0.053, standardized root mean square residual = 0.045, comparative fit index = 0.92 and Tucker–Lewis index = 0.90). The questionnaire showed an acceptable internal reliability (Cronbach’s alpha = 0.62) and was highly accepted in Lebanon (response rate = 96% and item response rates ≥ 94%). Conclusions: The validity of the KAP-questionnaire on antibiotics in Arabic and French was demonstrated in Lebanon.
Highlights
Knowledge–attitudes–and–practices (KAP) modelled questionnaires are extensively used in studies about the use of antibiotics [1,2,3]
We have recently reported on the development and validation of the first KAP questionnaire on the use of antibiotics by the general adult population in Spain [10]
item content validity index (I-CVI) values ranged between 0.78 and 1.00, indicating that the panel of nine experts found that the items of the questionnaire translated into Arabic and French are clear, understandable, and related to KAP on antibiotic use
Summary
Knowledge–attitudes–and–practices (KAP) modelled questionnaires are extensively used in studies about the use of antibiotics [1,2,3]. Using these instruments, researchers uncover erroneous knowledge of the population on antibiotics, assess attitudes towards those drugs and evaluate the adequateness of practices of antibiotic use [4]. Antibiotic resistance is a multi-faceted international public health issue that has been exacerbated by antibiotic misuse. It has challenged modern therapies and imposed devastating economic loses [7]. Seven hundred thousand individuals die each year due to infections with antibiotic-resistant bacteria and the attributed mortality rate is projected to reach 10 million by 2050, exceeding that of major diseases including cancer [8]
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