Development and Validation of Knowledge and Attitude Questionnaire on Health Issues and Accessibility to Primary Healthcare Services of Adolescents With Intellectual Disabilities (KA-IDA)
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Abstract
Introduction: Adolescents with intellectual disabilities experience greater health problems and encounter more challenges to receiving appropriate primary healthcare than their peers. This study aimed to develop and validate a questionnaire assessing primary healthcare providers' knowledge and attitudes regarding the health issues and accessibility of intellectually disabled adolescents to primary healthcare services. Materials and methods: The development and validation processes were applied to this questionnaire. In addition to qualitative research, content validation, face validation and pretesting were also incorporated into the development process. During the validation phase, item response theory (IRT), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were implemented. A cross-sectional study was conducted among 444 healthcare providers recruited via multistage sampling from 20 primary health clinics in Kelantan. Results: The development phase produced 49 knowledge items and 52 attitude items. In the validation phase, the knowledge section utilized the two-parameter logistic IRT, while EFA and CFA were applied to the attitude section. Knowledge items had adequate difficulty, and items with discrimination values above 2.5 were retained for their significance and expert recommendations. EFA revealed a three-factor model composed of cognitive, affective, and behavioral. CFA confirmed this model with a good fit (χ2 [df = 347] = 639.34, p < 0.001; CFIrobust = 0.92; TLIrobust = 0.91; RMSEArobust = 0.07; SRMR = 0.06). Conclusion: The Knowledge and Attitude Questionnaire on Health Issues and Accessibility to Primary Healthcare Services of Adolescents with Intellectual Disabilities (KA-IDA) demonstrated strong reliability and valid psychometrics comprising 38 knowledge items and 28 attitude items.
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Patel DR, Cabral MD, Ho A, Merrick J. A clinical primer on intellectual disability. Translational pediatrics. 2020;9(Suppl 1):S23-s35. doi: 10.21037/tp.2020.02.02.
Liao P, Vajdic C, Trollor J, Reppermund S. Prevalence and incidence of physical health conditions in people with intellectual disability – a systematic review. PLOS ONE. 2021;16(8):e0256294. doi: 10.1371/journal.pone.0256294.
Olusanya BO, Wright SM, Nair MKC, Boo NY, Halpern R, Kuper H, et al. Global burden of childhood epilepsy, intellectual disability, and sensory impairments. Pediatrics. 2020;146(1). doi: 10.1542/peds.2019-2623.
SWD. Statistics Report 2021. 2021 ed. Putrajaya: Department of Social Welfare; 2022.
APA. Diagnostic and statistical manual of mental disorders : DSM-5. vol Accessed from https://nla.gov.au/nla.cat-vn6261708. Arlington, VA: American Psychiatric Association; 2013.
Jansen DE, Krol B, Groothoff JW, Post D. People with intellectual disability and their health problems: a review of comparative studies. Journal of Intellectual Disability Research. 2004;48(2):93-102. doi: 10.1111/j.1365-2788.2004.00483.x.
Straetmans JM, van Schrojenstein Lantman-de Valk HM, Schellevis FG, Dinant GJ. Health problems of people with intellectual disabilities: the impact for general practice. British Journal of General Practice. 2007;57(534):64-6.
Sappok T, Diefenbacher A, Winterholler M. The Medical Care of People With Intellectual Disability. Deutsches Ärzteblatt International. 2019;116(48):809-16. doi: 10.3238/arztebl.2019.0809.
Reddihough D, Leonard H, Jacoby P, Kim R, Epstein A, Murphy N, et al. Comorbidities and quality of life in children with intellectual disability. Child: care, health and development. 2021;47(5):654-66. doi: 10.1111/cch.12873.
Boardman L, Bernal J, Hollins S. Communicating with people with intellectual disabilities: a guide for general psychiatrists. Advances in Psychiatric Treatment. 2018;20(1):27-36. doi: 10.1192/apt.bp.110.008664.
Shady K, Phillips S, Newman S. Barriers and facilitators to healthcare access in adults with intellectual and developmental disorders and communication difficulties: An integrative review. Review Journal of Autism and Developmental Disorders. 2022. doi: 10.1007/s40489-022-00324-8.
Mohd FN, Said AH, Ahmad MS, Ridzwan AN, Muhammad AI, Mat Naji AS. Exploring the barriers and expectations towards health care services among parents/caretakers of people with intellectual disability in Kuantan, Malaysia: A qualitative study. Journal of International Society of Preventive and Community Dentistry. 2023;13(6):477-84. doi: 10.4103/jispcd.JISPCD_89_23.
Lam WY, Gunukula SK, McGuigan D, Isaiah N, Symons AB, Akl EA. Validated instruments used to measure attitudes of healthcare students and professionals towards patients with physical disability: a systematic review. J Neuroeng Rehabil. 2010;7:55. doi: 10.1186/1743-0003-7-55.
Morin D, Crocker AG, Beaulieu-Bergeron R, Caron J. Validation of the attitudes toward intellectual disability: ATTID questionnaire. Journal of intellectual disability research : JIDR. 2013;57(3):268-78. doi: 10.1111/j.1365-2788.2012.01559.x.
Saldana J. Thinking qualitatively: Methods of mind. SAGE publications; 2014.
Edelen MO, Reeve BB. Applying item response theory (IRT) modeling to questionnaire development, evaluation, and refinement. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2007;16 Suppl 1:5-18. doi: 10.1007/s11136-007-9198-0.
Jackson DL. Sample size and number of parameter estimates in maximum likelihood confirmatory factor analysis: A Monte Carlo investigation. Structural Equation Modeling. 2001;8(2):205-23. doi: 10.1207/S15328007SEM0802_3.
IBM Corp S. Statistics for windows, version 26.0. Armonk, NY: IBM Corp. 2019.
Core RT. Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical. Computing. 2008.
Team R. RStudio: integrated development for R. (No Title). 2015.
De Ayala R. Item response theory and Rasch modeling. The reviewer’s guide to quantitative methods in the social sciences. 2018:145-63.
Baker FB. The basics of item response theory. ERIC; 2001.
Hair JF, Black WC, Babin BJ, Anderson RE, Tatham RL. Multivariate data analysis 6th Edition. Pearson Prentice Hall. New Jersey. humans: Critique and reformulation; 2006.
DeVellis RF, Thorpe CT. Scale development: Theory and applications. Sage publications; 2021.
Hair JF. Multivariate data analysis. Marketing and Professional Sales; 2009.
Costello AB, Osborne J. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical assessment, research, and evaluation. 2005;10(1):7. doi: https://doi.org/10.7275/jyj1-4868.
Thompson B. Exploratory and confirmatory factor analysis: Understanding concepts and applications. vol 000. Washington, DC: Sage Publications; 2004.
Pett MA, Lackey NR, Sullivan JJ. Making sense of factor analysis: The use of factor analysis for instrument development in health care research. Sage; 2003.
Floyd FJ, Widaman KF. Factor analysis in the development and refinement of clinical assessment instruments. Psychological assessment. 1995;7(3):286. doi: 10.1037/1040-3590.7.3.286.
Munder T, Wilmers F, Leonhart R, Linster HW, Barth J. Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients. Clinical Psychology & Psychotherapy. 2010;17(3):231-9. doi: https://doi.org/10.1002/cpp.658.
Baistaman J, Awang Z, Afthanorhan A, Rahim MMA. Developing and validating the measurement model for financial literacy construct using confirmatory factor analysis. Humanities & Social Sciences Reviews. 2020;8(2). doi: 10.18510/hssr.2020.8247.
Ngah H, Mohd Hairon S, Hamzah NA, Noordin S, Shafei MN. Development and validation of knowledge, attitude, and practice questionnaire: Toward safe working in confined spaces. International journal of environmental research and public health. 2022;19(3):1242. doi: 10.3390/ijerph19031242.
Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, et al. Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims. BMC Public Health. 2020;20(1):189. doi: 10.1186/s12889-020-8269-9.
Thompson B. Research news and comment: AERA editorial policies regarding statistical significance testing: three suggested reforms.Educational Researcher. 1996;25(2):26-30. doi: 10.3102/0013189X025002026.
Hill CD, Edwards MC, Thissen D, Langer MM, Wirth RJ, Burwinkle TM, et al. Practical issues in the application of item response theory: a demonstration using items from the pediatric quality of life inventory (PedsQL) 4.0 generic core scales. Medical Care. 2007;45(5):S39-S47. doi: 10.1097/01.mlr.0000259879.05499.eb.
Morera OF, Stokes SM. Coefficient α as a measure of test score reliability: Review of 3 popular misconceptions. American journal of public health. 2016;106(3):458-61. doi: 10.2105/ajph.2015.302993.
Pituch K, Stevens J. Applied multivariate statistics for the social sciences: Analyses with SAS and IBM’s SPSS, sixth edition. 2015.
Sovey S, Osman K, Mohd-Matore ME. Exploratory and confirmatory factor analysis for disposition levels of computational thinking instrument among secondary school students. European Journal of Educational Research. 2022;11(2):639-52. doi: 10.12973/eu-jer.11.2.639.
Rosseel Y: Lavaan: Latent Variable Analysis. Retrieved from https://CRAN.R-project.org/package=lavaan (2018). Accessed.
Brown TA. Confirmatory factor analysis for applied research. Guilford publications; 2015.
Zahiruddin WM, Arifin WN, Mohd-Nazri S, Sukeri S, Zawaha I, Bakar RA, et al. Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia. BMC Public Health. 2018;18:1-12. doi: 10.1186/s12889-018-5234-y.
Raykov T. Estimation of congeneric scale reliability using covariance structure analysis with nonlinear constraints. British Journal of Mathematical and Statistical Psychology. 2001;54(2):315-23. doi: 10.1348/000711001159582.