Knowledge, Attitude and Practice on the Provision of Long-acting Reversible Contraception Among Primary Healthcare Workers in Malaysia: Questionnaire Development and Validation
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Abstract
Long-acting reversible contraception (LARC) is a pivotal strategy in mitigating unintended pregnancies. However, its utilisation in Malaysia remains low. Healthcare workers significantly influence clients' adoption of LARC but existing questionnaires were not adequately validated. This study aimed to develop and validate a new questionnaire to measure the knowledge, attitude and practice of LARC provision among local primary healthcare workers. Materials and methods: The questionnaire development involved a comprehensive literature review, discussion with healthcare workers and consultations with experts. Validation procedures included content validity, cognitive interviews and psychometric evaluation of internal structure. The knowledge section was analysed using a two-parameter logistic item response theory (2-PL IRT) analysis. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to assess both attitude and practice sections. A total of 444 healthcare workers involved in the study were randomly selected from health clinics throughout Kelantan, Malaysia. Results: Following IRT analysis, 15 items in the knowledge section displayed satisfactory difficulty and discrimination values. The construct validity analyses of the attitude section revealed 13 items that loaded onto three factors: ‘client-related’, ‘method-related resources’, and ‘method-related limitations’. In the practice section, the construct validity analyses revealed nine items that loaded onto two factors: counselling and clinical evaluation. The final model exhibited acceptable model fitness, with all items having good factor loading (>0.32) and all factors having acceptable composite reliability (Raykov’s rho>0.60). Conclusion: The questionnaire was shown to have acceptable psychometric properties and reliability, making it a robust instrument.
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