Abstract
Background: This study assessed the validity and reliability of healthcare workers’ knowledge, attitudes, and practices instrument for uncomplicated malaria (HKAPIUM) for evaluation of healthcare workers’ knowledge, attitudes, and practices (KAP) on uncomplicated malaria management in primary healthcare (PHC) facilities in Plateau state, Nigeria. Methods: Relevant variables from literature, malaria treatment guidelines for Nigeria, and World Health Organization (WHO) were used to generate and present the items for the draft HKAPIUM scale, which was first screened by six experts before administered to 121 respondents who filled and returned immediately. The data were sorted and analyzed using Rasch measurement model (Bond & Fox software®). Results: The outcome of the initial screening showed high items content validity indices (I-CVI) (0.83–1.00) and high scale-CVI (S-CVI) {universal agreement (UA) within the experts (S-CVI/UA) (0.67–0.89) and the average CVI [S-CVI/Ave (0.94–0.98)]} for relevance, clarity, simplicity, and comprehensiveness. The Rasch analysis outputs showed good items’ reliability for the three factors (KAP) > 0.9 with high separation index values of > 2.0; however person reliability were poor (< 0.6) which were confirmed by their low separation values. Goodness of fit statistics indicated nine items not fitting the model based on the suggested fit index values of 0.6 to 1.5, and ± 2 for mean square (MNSQ) and standardized Z-score (Zstds) respectively, and 0.3 to 0.7 for “point-measure correlation coefficients” (PTMEA Corr). Deletion of misfit items resulted in the items and persons’ reliabilities falling above the minimum accepted limit of 0.6, with their separation values were all in the range of 1 and 2 which were acceptable. Similarly, fit index values for MNSQ infit and outfit, and Zstd parameters items in the new scale were all within the acceptable range of 0.6 to 1.5, and ±2 respectively, in addition to the positive PTMEA Corr as further confirmation of the items’ fitness to the model. Conclusion: The reduction of 27-items draft HKAPIUM scale to 18 items was successful with good reliability and fitness to the model.
Highlights
The use of public primary healthcare (PHC) facilities in Nigeria which is the closest source of healthcare to the rural communities has been shown to be poor, and this has been linked to many factors including lack of drugs in the public PHC facilities and bad healthcare practices including diagnostic practices, prescription and dispensing practices rendered by the PHC workers (Onwujekwe et al, 2010; Abdulraheem et al, 2012). Uzochukwu et al (2002) had reported high level of irrational drug prescription in the south-eastern Nigeria by healthcare workers in healthcare facilities where drug revolving fund programs were implemented to augment drugs availabilities
Goodness of fit statistics indicated nine items not fitting the model based on the suggested fit index values of 0.6 to 1.5, and ± 2 for mean square (MNSQ) and standardized Z-score (Zstds) respectively, and 0.3 to 0.7 for “point-measure correlation coefficients” (PTMEA Corr)
The average content validity index (CVI) (S-CVI) for relevance, clarity, simplicity, and comprehensiveness for the scale based on the results of the universal agreement (UA) within the experts (S-CVI/UA) and the average CVI (S-CVI/ Ave) approaches were in the ranges of 0.67–0.89 and 0.94–0.98, respectively (Table 1)
Summary
The use of public primary healthcare (PHC) facilities in Nigeria which is the closest source of healthcare to the rural communities has been shown to be poor, and this has been linked to many factors including lack of drugs in the public PHC facilities and bad healthcare practices including diagnostic practices, prescription and dispensing practices rendered by the PHC workers (Onwujekwe et al, 2010; Abdulraheem et al, 2012). Uzochukwu et al (2002) had reported high level of irrational drug prescription in the south-eastern Nigeria by healthcare workers in healthcare facilities where drug revolving fund programs were implemented to augment drugs availabilities. In order to maintain a standardized approach and ensure quality during assessment of healthcare workers’ KAP on uncomplicated malaria in PHC facilities, there was a need for the development and validation of KAP instrument. This was necessitated by scanty information on validated relevant scales for such study. This study assessed the validity and reliability of healthcare workers’ knowledge, attitudes, and practices instrument for uncomplicated malaria (HKAPIUM) for evaluation of healthcare workers’ knowledge, attitudes, and practices (KAP) on uncomplicated malaria management in primary healthcare (PHC) facilities in Plateau state, Nigeria
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