|Year : 2014 | Volume
| Issue : 2 | Page : 87-90
Psychometric properties of a questionnaire assessing nursing professionals' knowledge regarding etiology and prevention of viral hepatitis B and C
Anita Thakur1, Deepak Sharma2
1 Departmentsof Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Web Publication||11-Jun-2014|
Department of Community Medicine, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Viral hepatitis B and C are a global public health problem. For better targeting their detection and prevention, nursing professionals' should have adequate knowledge and skills. Aims and Objectives: This study aimed at developing a "viral hepatitis questionnaire" and then validating it among nursing professionals' working in a Medical College of North India. Materials and Methods: A fifteen-item questionnaire was developed by the principal investigator. This was based on a systematic search in database namely "PubMed" "IndMed" "Directory of Open Access journals" and "Google scholar". It was then administered to 318 nursing professionals'. The psychometric properties of the questionnaire were assessed in terms of construct validity and reliability. Results: The average age of the study subjects was 23.4 years (SD = 17.2, range = 18 years-54 years). Sampling adequacy as measured by Kaiser-Meyer-Olkin (KMO) test was 0.82. This indicated relevance of the factorial model. Varimax rotation revealed that all items had achieved the required loading of 0.3. The internal consistency ranged from 0.81 to 0.87. The intra class correlation coefficient ranged from 0.67 to 0.71. Conclusion: " Viral hepatitis questionnaire" (VHQ) appears to be a reliable and valid measure of assessing nursing professionals' knowledge about viral hepatitis B and C. Its periodic use can serve the purpose of assessing nursing professionals' training needs. It is further recommended that it should be tested among nursing staff in different healthcare facilities of India, in order to assess its wider performance.
Keywords: Reliability, viral hepatitis B and C, validity
|How to cite this article:|
Thakur A, Sharma D. Psychometric properties of a questionnaire assessing nursing professionals' knowledge regarding etiology and prevention of viral hepatitis B and C. CHRISMED J Health Res 2014;1:87-90
|How to cite this URL:|
Thakur A, Sharma D. Psychometric properties of a questionnaire assessing nursing professionals' knowledge regarding etiology and prevention of viral hepatitis B and C. CHRISMED J Health Res [serial online] 2014 [cited 2019 Jun 17];1:87-90. Available from: http://www.cjhr.org/text.asp?2014/1/2/87/134267
| Introduction|| |
Viral hepatitis is a global public health problem. It is caused by five main types of hepatitis viruses. These are referred to as type A, B, C, D and E. Among these, the greatest concern in terms of burden of illness and death is of hepatitis type B and C. It is highly contagious and is transmitted between people through various body fluids like blood, semen and vaginal fluids. Unprotected sex, unsafe blood transfusions, and unsafe use of needles predispose to its infection. On the basis of the HBV carrier rate, South Asia including India has been grouped in countries having intermediate endemicity. ,,
Hepatitis B and C infections are the recognized occupational risks for nursing professionals. The risk of infection in the workplace is related to the degree of contact with blood, infected body fluids and the contaminated medical instruments used. Universal works precautions are an effective and feasible means of preventing transmission of HBV and HCV infections.  Worldwide, studies conducted among nursing professionals have reported their inadequate knowledge regarding hepatitis B and C. ,,
The knowledge of nursing professionals regarding viral hepatitis is hard to define. This is probably due to the fact that there is a lack of an appropriate standardized instrument to measure the same. A validated and reliable instrument can assist hospital managers to evaluate the adequacy of nursing professional's current knowledge status. An intervention in the form of teaching training programs can be done. Post intervention knowledge scores can then also be measured to assess the training adequacy. With this background we set out to develop a "viral hepatitis questionnaire (VHQ)", and then validate it among nursing professionals working in a medical college of North India.
| Materials and Methods|| |
Nursing professionals studying and working at Indira Gandhi Medical College, Shimla, Himachal Pradesh, formed the sampling pool for the current study. Sample size was calculated using the formula, n = Z 2 (1-α/2) pq/d 2 (where Z (1-α/2) = 1.96 at 95% confidence; P = Knowledge regarding Hepatitis B and C, q = 1-p; and d = Absolute allowable error, which was 5%). It was presumed that 50% of them had correct knowledge of the etiology and prevention of viral hepatitis B and C. Thus, the sample size worked out to be 384.
The study period was from March 2009 to May 2009. Nursing professionals were interviewed in their respective departments where they were posted. Prior permission was sought from the in-charge of the concerned department. Interviews were conducted by two surveyors who had previous experience of data collection. Informed consent was obtained from each study subject. Data was analyzed using Epi info software for windows (CDC Atlanta).
Item generation of the questionnaire
To develop a contextual framework for the VHQ questionnaire, the principal investigator did a systematic search for articles through web- based search engines. These included PubMed (http://www.ncbi.nlm.nih.gov/pubmed), indMed (http://indmed.nic.in/), Directory of Open Access journals (http://www.doaj.org/) and Google scholar (http://scholar.google.co.in/). Key words for the search included: "hepatitis B" "hepatitis C" "knowledge" and "prevention". The studies obtained were then screened for their relevance. A fifteen-item questionnaire was developed including questions on etiology and prevention. The responses of each items in the questionnaire was listed as 1: Strongly disagree 2: Disagree 3: Neutral 4: Agree 5: Strongly agree.
Construct validity and reliability
Construct validity was assessed using "principal components analysis" (PCA) with varimax rotation. The quality of the factor analysis model was assessed using Kaiser-Meyer-Olkin (KMO) test. Items were retained in a given factor if they had a factor loading ≥0.3. , The internal consistency of each dimension of the instrument was assessed using Cronbach's alpha.  The test-retest reliability was assessed after six weeks of completing the initial study.  The same questionnaire was re-administered to 24 study participants by a follow-up interviewer. He was blinded to their initial study questionnaire results.
| Results|| |
The average response rate was 83% (318/384). Among the study participants, 61.6% (196/318) were nursing students, 30.8% (98/318) were nursing staff and the remaining 7.5% (24/318) were nursing matrons. The average age of the study subjects was 23.4 years (SD = 17.2, range = 18 years-54 years) [Table 1].
Construct validity and reliability
Sampling adequacy was measured by KMO test and was found to be 0.82. This indicated the relevance of the factorial model. The varimax rotation revealed four factors with eigen values >1. The screen test indicated a 2-factor solution that accounted for 69.2% of the total variance. All 15 items achieved the required loading of 0.3. There were no cross-loadings between factors [Table 2].
|Table 2: Factor scores and subscales, internal consistency, and intra class correlation coefficient|
Click here to view
The fifteen item scale yielded Cronbach's α coefficient ranging from 0.81 to 0.87. Test-retest reliability indicated stability of the instrument. The intra class correlation coefficient of the individual dimensions in the scale ranged from 0.67 to 0.71. This indicated moderate to excellent reliability [Table 2].
| Discussion|| |
Having good knowledge of etiology and prevention of hepatitis B and C is one of the core requirements of patient care. The current study aimed at developing and validating a "viral hepatitis instrument" for nursing professionals. Similar to our study, Ghasemi et al.  developed and validated a "hepatitis B questionnaire" among medical specialists of Iran. It was reported that the tool has high reliability and validity. However, the items of their tool were different from ours to a large extent. They included themes like sero-conversion rates, rate of needle stick injury and its reporting, post-exposure prophylaxis etc.  On the other hand, in our tool we focussed on including items on etiological factors and prevention.
To conclude, our study instrument can be used as a clinical teaching tool for the nursing professionals. The scores can serve the purpose of an evaluation tool for descriptive (to provide baseline data), prospective and intervention research among them. To further validate this newly developed questionnaire, it is recommended that the tool should be tested out among nursing professionals in different hospitals across different states of India.
There are some strengths of the present study. The items in the questionnaire were devised using an exhaustive search for the contextual framework. A good test-retest result, construct validity and reliability are likely to predict its wider acceptability and usage. This study has a limitation of not receiving inputs from the nursing professionals during the process of developing the questionnaire.
| References|| |
|1.||Zaidi AK, Awasthi S, deSilva HJ. Burden of infectious diseases in South Asia. BMJ 2004;328:811-5. |
|2.||Hepatitis B. Available from URL: http://www.apiindia.org/medicine_update_2013/chap53.pdf [Last accessed on 2013 Dec 25]. |
|3.||Ganju SA, Goel A. Prevalence of HBV and HCV infection among health care workers (HCWs). J Commun Dis 2000;32:228-30. |
|4.||Knight VM, Bodsworth NJ. Perceptions and practice of universal blood and body fluid precautions by registered nurses at a major Sydney teaching hospital. J Adv Nurs 1998;27:746-51. |
|5.||Alam M. Knowledge, attitudes and practices among health care workers on needle stick injuries. Ann Saudi Med 2002;22:396-9. |
|6.||Moghimi M, Marashi SA, Kabir A, Taghipour HR, Faghihi-Kashani AH, Ghoddoosi I, et al. Knowledge attitudes of Iranian surgeons about blood borne disease. J Surg Res 2009;151:80-4. |
|7.||Streiner DL, Norman GF. Health measurement scales: A practical guide to their development and use. 2 nd ed. New York: Oxford University Press; 1996. |
|8.||Kaiser H. An index of factorial simplicity Psychometrika 1974;39:31-6. |
|9.||Scientific advisory committee instrument review criteria. Medical Outcomes Trust Bulletin I-IV. Boston 1995;3:1-4. |
|10.||Guyatt GH, Kirshner B, Jaeschke R. Measuring health status: What are the necessary measurement properties? J Clin Epidemiol 1992;45:1341-5. |
|11.||Ghasemi S, Kabir A, Ansari Jafari M, Jalali M, Amini A, Faghihi-Kashani AH, et al. Psychometric properties of a standardized questionnaire of knowledge, attitude, and practice of Iranian medical specialists about viral hepatitis. Hepat Mon 2012;12:e7650. |
[Table 1], [Table 2]