Identification and Validation of an Instrument to Measure Physicians‘and Nurses' Knowledge, Attitudes, and Practices Regarding Antibiotic Resistance and Antimicrobial Stewardship

Abstract

Background: In Italy, the presence of a suitable instrument to measure the knowledge, attitudes, and practices of intensive care physicians and nurses with respect to antibiotic resistance and antimicrobial stewardship could not be identified Objectives: To validate the Italian version of the Ashiru-Oredope tool used by the European Centre for Disease Prevention and Control (ECDC) in 2019 to investigate intensive care nurses' and physicians' knowledge, attitudes, and practices (KAP) regarding antibiotic resistance. Methods: Content validity was assessed using the Item-Content Validity Index (I-CVI), Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score, Scale Level-Content Validity Index/Average (S-CVI/Ave) score, and Average Content Validity Ratio (CVR). Multiple correspondence analysis (MCA) was then carried out together with cluster analysis (CA) to check the correspondence of the items with the eight subdivision domains of the scale. Results: The final version consisted of 55/60 deemed relevant items, with Item-Content Validity Index (I-CVI) scores ranging from 0,625 to 1. The Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score was 0.43; the Scale Level-Content Validity Index/Average (S-CVI/Ave) 0.90. The mean CVR of the scale was 0.43. The inter-rater reliability (Cohen's K) was between good and excellent. The combination of MCA and CA confirmed the correspondence of the items with the domains. Conclusion: The Italian version is a reliable and valid instrument for investigating antibiotic resistance and antimicrobial stewardship among Italian intensive care nurses and physicians.