Psychometric Properties of a Developed Questionnaire to Assess Knowledge, Attitude and Practice Regarding Vitamin D (D-KAP-38)

Knowledge, attitude, and practice toward pediatric vitamin D deficiency among parents

Objective

To investigate the knowledge, attitude, and practice (KAP) towards pediatric vitamin D deficiency (VitD) among parents and explore the risk factors of their knowledge, attitude, and practice.

Methods

This cross-sectional study enrolled parents in our Hospital between November 2022 and January 2023.

Results

A total of 621 valid questionnaires were collected in this study. The knowledge, attitude, and practice scores were 6.13 ± 3.07 (theoretical score range: 0-13), 31.13 ± 6.20 (theoretical score range: 9-45), and 27.47 ± 4.21 (theoretical score range: 9-45), respectively; the mean knowledge score was <60%, indicating poor knowledge. Commercial and service industry workers and a monthly income ≥5,000 CNY were independently associated with sufficient knowledge (all P < 0.05). The knowledge score, ethnic minorities, divorced/widows, and spouses with a master's degree or above were independently associated with positive attitudes (all P < 0.05). The attitude score, female, non-urban, undergraduate education, commercial and service industry worker, and office worker were independently associated with proactive practice (all P < 0.05). Those characteristics could help design future KAP interventions on vitD deficiency.

Conclusions

This study demonstrated poor knowledge, positive attitude, and proactive practice regarding pediatric VitD deficiency among parents. Targeted interventions and educational programs should be developed to improve parental knowledge.

Association between vitamin D status, physical performance, sex, and lifestyle factors: a cross-sectional study of community-dwelling Kosovar adults aged 40 years and older

PURPOSE

Vitamin D status and its association with age-related decline in physical performance and strength have already been highlighted in various ways, but data on the situation in developing countries are scarce. This study aimed to investigate vitamin D status, its association with muscle mass and function, and other potential determinants such as age, sex, lifestyle factors (physical activity, dietary behavior), self-perceived health status, medication intake, education and financial situation in adults from Kosovo.

METHODS

This cross-sectional study included 297 participants (54.5% women), aged ≥ 40 years. Serum 25-hydroxyvitamin D (25(OH)D) concentration, hand grip strength and physical performance tests, body composition, vitamin D dietary intake and knowledge were assessed. The interaction between serum 25(OH)D status, lifestyle factors and muscle traits was investigated.

RESULTS

Vitamin D deficiency (< 50 nmol/L) was observed in 47.5% of the total population, of whom 14.7% of them were severely deficient (< 30 nmol/L). No associations were found between 25(OH)D concentration and age. Daily dietary intake of vitamin D was low (1.89 ± 0.67 µg) and 87.6% of individuals did not take vitamin D supplements. However, vitamin D supplementation was the only variable that added statistical significance (p < 0.05) to the prediction of vitamin D status (3.8%). On the other hand, age, medication intake and vitamin D level contributed significantly to the overall regression model, explaining 24.9% of the 30-s chair stand performance as an indicator of lower-body strength endurance.

CONCLUSION

Vitamin D deficiency is highly prevalent among community-dwelling adults in Kosovo and low serum 25(OH)D has been associated with low muscle strength. This implies an urgent need for the development of comprehensive prevention strategies, focusing on pharmacological (supplementation) but also on non-pharmacological strategies such as education, food fortification or lifestyle advices.

Maternal Awareness of Vitamin D Deficiency in Infants and Children Up to the Age of 6 Years: A Cross-sectional Study in Jordan

Vitamin D deficiency is a worldwide health problem. The current study aims to evaluate mothers' habits and knowledge regarding vitamin D deficiency in kids up to the age of 6. A questionnaire was made available online among mothers of children between 0 and 6 years. Most mothers (65.7%) were aged between 30 and 40 years. Sunlight was identified as the main source of vitamin D by most participants (89.1%), while fish and eggs were reported to be the main dietary sources of vitamin D by most participants (63.7% and 65.2%, respectively). Most participants identified the benefits of vitamin D, risk factors, and complications of vitamin D deficiency. The majority (86.4%) think they need more information on vitamin D deficiency in children. A moderate knowledge level was reported among more than half of the participants although there was inadequate knowledge in certain domains of vitamin D knowledge. More education is required for mothers about vitamin D deficiency.

The Knowledge and Determinants of Sexual Health and Sexual Transmitted Infections Among Women in Saudi Arabia: A Nationwide Survey

Background

Sexual health is a necessary part of any society because it significantly influences the quality of life. Women's knowledge regarding STIs and safe sex practices in Saudi Arabia has not been thoroughly investigated; therefore, this study aims to investigate and measure the knowledge and the determinants of sexual health and STIs among women in Saudi Arabia.

Methods

This study is a nationwide cross-sectional survey conducted through phone interviews in Saudi Arabia in 2021. This study included 1334 female participants aged 18 years or older.

Results

The study's results collectively show that women in Saudi Arabia have limited knowledge of sexual health and STIs. The primary causes are the lack of knowledge of different STIs-communicability, symptoms, and an overall lack of technical proficiency in the subject. The study analyzed factors associated with participants' knowledge of sexual health and sexually transmitted infections. Significant associations were found between knowledge and age, region, educational level, and family income. In the multivariable analysis, participants aged 20-29 had higher knowledge compared to those aged >60. Participants in the Eastern region had higher knowledge than those in the Southern region. Participants with less than a bachelor's degree had lower knowledge than those with a bachelor's degree or higher. Participants earning an average of 16,000 SAR to 19,999 SAR had higher knowledge than those with unstable monthly income.

Conclusion

The study found that women's understanding of sexual health and STIs in Saudi Arabia is low due to a lack of knowledge and awareness. Knowledge levels were correlated with educational levels; therefore, targeted health promotion initiatives are needed to increase understanding, particularly regarding condom use for HIV and STI prevention.

Osteoporosis and vitamin D consumption: knowledge and practice in different Arab countries

Despite the high prevalence of osteoporosis and vitamin D deficiency, the knowledge about osteoporosis and vitamin D-related practices were moderate in some countries in the Middle East and North Africa (MENA) region. Improving knowledge through awareness campaign and screening programs is essential to enhance vitamin D-related practices.

PURPOSE

Osteoporosis is the most common skeletal disease, which usually remains silent until fractures occur. Vitamin D deficiency impairs bone mineralization and increases the risk of osteoporosis. Despite being relatively sunny, the Middle East and North Africa (MENA) region has a high prevalence of osteoporosis and hypovitaminosis D. This study aims to assess the knowledge about osteoporosis and vitamin D-related practices and to determine the correlation between them in some countries of the MENA region.

METHODS

A cross-sectional study was performed in Lebanon, Syria, Egypt, Palestine, Iraq, Jordan, and Saudi Arabia. From each country, 600 participants were enrolled. The survey included four sections: sociodemographic information, past medical history, Osteoporosis Knowledge Assessment Tool to assess the knowledge about osteoporosis, and Practice Towards Vitamin D scale to assess vitamin D-related practices.

RESULTS

Our study found that 67.14% of respondents had moderate knowledge about osteoporosis and 42.31% had moderate vitamin D-related practices. Higher knowledge level was reported in the young, females, Syrians, singles, postgraduates, and healthcare employees (p < 0.05). Better vitamin D-related practices were detected in the elderly, males, Egyptians, married, and high school or below educational level (p < 0.05). The Internet was the most listed source of information. Adequate osteoporosis knowledge was associated with better vitamin D-related practices (p < 0.001).

CONCLUSION

Most participants, representing some countries of the MENA region, displayed moderate knowledge regarding osteoporosis and moderate vitamin D-related practices. Adequate knowledge about osteoporosis is essential to improve practices, so awareness campaigns and screening programs should be more frequently implemented.

Attitudes and practices related to smoking among university students in Thailand

Objective: To investigate attitudes and practices toward smoking among university students and to identify associated factors. Methods: A cross-sectional study was conducted among 1,299 students from five public universities in Thailand. Factor analysis and multiple regression were used for analysis. Results: A higher score of anti-smoking attitude was associated with female gender, majoring in science, living on campus, having a father with primary or secondary school, and those whose father was employed in the private sector. A more positive perceptions about smoking was associated with male gender, having a family income of 30,001-50,000 baht, and having a smoking friend. High positive preventive practice score was associated with those who came from rural areas, having a mother who was self-employed, and having a smoking family member. Conclusions: Although students showed strong anti-smoking attitudes, their preventive practices were poor. These findings should be taken into consideration when developing preventive smoking programs.

Development and validation of a knowledge, attitude, and practice questionnaire regarding cardiovascular diseases in an Iranian general population

Background

Studies on knowledge, attitude, and practice (KAP) can be valuable for public health to help to develop targeted educational programs and assess the effectiveness of intervention programs. The purpose of this study was to develop and examine the validity and reliability of a questionnaire on knowledge, attitude, and practice (KAP) regarding cardiovascular diseases (CVDs), their risk factors, and symptoms among an Iranian general population.

Methods

This cross-sectional study was conducted on an Iranian population older than 20 years referred to some of Tehran’s healthcare centers. An initial 62-item questionnaire was developed, and the face, content, and construct validities were assessed.

Results

In all, 300 adults with a mean age (SD) of 39.79 (12.1) years participated in this study. Based on the results of the content validity, a questionnaire with 30 essential items was designed. Exploratory factor analysis suggested a four-factor subscale with 29 finalized items (CVD-KAP29), and acceptable goodness of fit indices was demonstrated by confirmatory factor analysis. The Cronbach’s alpha and McDonald’s ω coefficients were higher than 0.60 for all domains except the nutrition and smoking subscales.

Conclusions

Results provided evidence of the validity of the CVD-KAP29 for KAP studies for cardiovascular diseases in the general population.

Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia

Background: The burden of foodborne illness is considered to be high across the world.  Based on the Knowledge-Attitude-Practice (KAP) model, physician's awareness is essential for conducting individualized treatments, thus reducing the burden of foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases. This study aims to develop and validate a KAP questionnaire for physicians to assess their awareness about the diagnosis and management of foodborne illness.   Methods The questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha, Saudi Arabia. Physicians (n=125) were opportunistically recruited from both public and private primary healthcare centers. The questionnaire's content and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate their KAPs on foodborne diseases.   Results: A total of 160 physicians from both public and private primary health care centers were approached to enrol 125 study participants into the survey (response rate 78.13%). Of the 31 items designed for assessing the KAP of physicians on foodborne illnesses, three items were excluded after Cronbach's α analysis. In total, 29 items were included in the final set of the questionnaire. Results of different validity and reliability analyses suggest the questionnaire has a high face and content validity as well as good reliability in internal consistency and stability.  Conclusions: This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician's awareness of foodborne disease. The awareness questionnaire, as a study instrument, had a favourable acceptance among physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.

Development, validation and reliability of a questionnaire for assessment of physician's knowledge, attitude and practices (KAPs) regarding foodborne diseases in the Kingdom of Saudi Arabia

Background: The burden of foodborne illness is considered to be high across the world.  Based on the Knowledge-Attitude-Practice (KAP) model, physician's awareness is essential for conducting individualized treatments, thus reducing the burden of foodborne illness. However, there have been no validated questionnaires specific to the awareness of physicians with foodborne diseases. This study aims to develop and validate a KAP questionnaire for physicians to assess their awareness about the diagnosis and management of foodborne illness.   Methods The questionnaire was developed in three phases: a comprehensive literature review, face and content validity, followed by a reliability test by internal consistency. A cross-sectional study was designed in Abha, Saudi Arabia. Physicians (n=125) were opportunistically recruited from both public and private primary healthcare centers. The questionnaire's content and validity were confirmed by experts in their corresponding fields. After signing the informed consent, the study participants received the questionnaire to evaluate their KAPs on foodborne diseases.   Results: A total of 160 physicians from both public and private primary health care centers were approached to enrol 125 study participants into the survey (response rate 78.13%). Of the 31 items designed for assessing the KAP of physicians on foodborne illnesses, three items were excluded after Cronbach's α analysis. In total, 29 items were included in the final set of the questionnaire. Results of different validity and reliability analyses suggest the questionnaire has a high face and content validity as well as good reliability in internal consistency and stability.  Conclusions: This study introduces a newly developed questionnaire with good reliability and validity values that can assess physician's awareness of foodborne disease. The awareness questionnaire, as a study instrument, had a favourable acceptance among physicians. It is a sound method for evaluating and measuring levels of foodborne disease-related awareness among physicians in Abha, Saudi Arabia.

Development and validation of a questionnaire measuring knowledge, attitudes, and practices (KAP) to healthy eating and activity patterns in school children (HEAPS)

BACKGROUND

Development of culturally appropriate and psychometrically sound instruments that measure knowledge and health behaviors of children will help to inform appropriate interventions.

AIM

To develop and test the validity and reliability of a questionnaire measuring knowledge, attitudes, and practices to healthy eating and activity patterns in school children in India.

METHODS

Review of literature, focus-group discussions, and theoretical constructs of the Health Belief Model guided the development of an item pool. Face and content validity were assessed by children and a panel of experts and the item content validity, item difficulty, and discrimination indices were calculated. Construct validity was determined using the principal axis method of exploratory factor analysis among a cross-sectional sample of children (n=252). Internal consistency (Cronbach α values >0.7) and test-retest reliability (intraclass correlation coefficient values >0.75) were estimated.

RESULTS

Item content validity index for clarity and relevance were satisfactory (>0.80) and internal consistency for knowledge (Kuder-Richardson 20 = 0.832), attitude (Cronbach's α = 0.912), and practice items (Cronbach's α = 0.769) were good. Four factors (children's eating habits, family dietary practices, and consumption of healthy and unhealthy foods) and two factors (moderate to vigorous activities and sedentary activities) explained 67.7% and 48.2% of the total variance in practice items. Intraclass correlation coefficient estimates ranged from good to excellent (0.72-0.99).

CONCLUSIONS

The results of the validity and reliability of the 84-item knowledge, attitudes, and practices to healthy eating and activity patterns in schoolchildren questionnaire were promising. The detailed description of the methodology employed may prove useful to researchers conducting similar studies in children.

Vitamin D Knowledge, Attitudes, and Behaviors in Young Danish Women with a Non-Western Ethnic Minority Background-A Questionnaire Survey

The prevalence of vitamin D deficiency in women with a non-Western ethnic minority background in Nordic countries is high. The aim of this study was to assess vitamin D knowledge, attitudes, and behaviors in women with a non-Western ethic minority background living in Denmark. A validated vitamin D knowledge, attitudes, and behaviors’ questionnaire was translated into Danish, piloted, and distributed via relevant Facebook groups. The responses were analyzed using parametric and non-parametric tests for descriptive and bivariate analyses. In total, 254 women who considered themselves having a non-Western ethnic minority background responded to the questionnaire. The median age (IQR) was 25 (23–33) years old; 32% had a professional bachelor’s, 28% had high school, and 22% had a master’s or higher university education. Participants scored higher on vitamin D general knowledge (scores above 80 on the scale 0–100) compared to vitamin D nutrition knowledge or vitamin D attitudes and behaviors (scores around 60 on the scale 0–100). In conclusion, the vitamin D knowledge among study participants—i.e., young well-educated non-Western ethnic minority women in Denmark—was pretty good. The further examination of vitamin D knowledge, attitudes, and behaviors should explore specifics related to nationality and religion and focus on less-educated non-Western ethnic minority women in Denmark and other Nordic countries.

Reliability and validity of a General Nutrition Knowledge Questionnaire for adults in a Romanian population

Background

Nutritional knowledge assessment is an important component in nutrition research, and a prerequisite for the implementation of many policies and programs aimed at improving eating behavior. In order to generate objective results, validated tools for a given population must be employed. The aim of this study was to determine the validity and reliability of a nutrition knowledge questionnaire for Romanian adults.

Methods

Kleimann’s version of a General Nutrition Knowledge Questionnaire, was translated and adapted to Romanian language, culture, and cuisine. The final format was developed in several steps and used four components: internal and external reliability were assessed in a general population sample (n1 = 412), respectively in a subgroup (n2 = 46) from Component 1; Component 3 assessed construct validity (n3 = 96) using the “known-groups” method; Component 4 (convergent validity, n4 = 508) tested the association between socio-demographic characteristics and nutrition knowledge.

Results

The overall internal reliability was 0.878 and the external reliability was >0.880 in all sections, and overall. Specialists had higher scores than nonspecialists, with a very large effect size. In the general population, females scored higher than males, and middle-aged and older adults scored higher than young adults. Higher scores were associated with higher levels of education. The characteristics of individuals prone to giving wrong answers were: males (beta = 0.170), high school or less (beta = 0.167), and no training in nutrition (beta = 0.154).

Conclusions

The Romanian version of the General Nutrition Knowledge Questionnaire is a reliable and valid tool for measuring nutrition knowledge in adults.

Knowledge, Attitude and Practice Related to Vitamin D and Its Relationship with Vitamin D Status among Malay Female Office Workers

This study assessed knowledge, attitude and practice (KAP) related to vitamin D and its relationship with vitamin D status among Malay female office workers. A total of 147 women aged between 20 and 55 years were recruited from a university in Kuala Lumpur. They answered questionnaires related to KAP on vitamin D, sun exposure, dietary vitamin D intake and physical activity. Serum 25-hydroxyvitamin D (25OHD) was analysed using an enzyme-linked immunoassay. Nearly half (45%) of the subjects had good knowledge but moderate attitude (76%) and practice (84%) towards sunlight exposure and dietary vitamin D intake. Median serum 25OHD was 34.1 nmol/L with the majority (91%) had vitamin D insufficiency (25OHD < 50 nmol/L). Knowledge was weakly associated with attitude (r = 0.29, p < 0.001) but no association was found between knowledge and practice (r = 0.08, p = 0.355) nor attitude and practice (r = -0.001, p = 0.994). Serum 25OHD was positively associated with sunlight exposure (r = 0.22, p = 0.008) and dietary vitamin D intake (r = 0.37, p < 0.001). It can be implied that this group is at increased risk of low bone health status, which highlights the needs of public health campaigns to improve their vitamin D status.

A Comparative Study of Nutritional Status, Knowledge Attitude and Practices (KAP) and Dietary Intake between International and Chinese Students in Nanjing, China

University students tend to have poor dietary practices, which ultimately affect their nutritional status. International students are becoming more prevalent in China. The current study aimed to compare the nutritional status, knowledge attitude and practices (KAP) and dietary intake between international and Chinese students in China. A comparative study was conducted in undergraduate students of Nanjing Medical University aged 17–31 years including 308 international and 393 Chinese students. Data was collected by self-administered questionnaire. Body composition was detected by bioelectrical impedance analysis (BIA). Student t-test and chi square test were used for comparison. Linear regressions were used for association of nutritional status with determinants. The prevalence of overweight and obesity in international student was higher than Chinese students. International male and female students were having significantly (p < 0.05) high BMI and percent body fats than Chinese male and female students. Nutritional KAP scores of Chinese students was significantly (p < 0.05) higher than international students. As for diet consumption, daily milk consumption was high in international students while daily egg and weekly fish and meat consumption were found more in Chinese students. Fast foods and carbonated drinks weekly consumption was significantly (p < 0.001) high in international students. After adjusted for age, gender, education, sleeping duration and physical exercise, the inverse association of nutritional KAP with BMI remained significant. Our data indicate that international students had more percent body fats, less nutritional KAP scores and unhealthy dietary habits than Chinese students. Proper nutrition education and guidance for improving good habits and nutritional status is suggested for international students.

Associations Between Maternal Nutrition Knowledge, Attitude, and Practice and 25-Hydroxyvitamin D Levels and Rickets in Children in Xinjiang Province, People's Republic of China

We explored the association between maternal nutrition knowledge, attitude, and practice (KAP) and 25-hydroxyvitamin D (25(OH)D) values in children with rickets in Xinjiang, People's Republic of China. We recruited 514 mothers with children (<2 years) from pediatric outpatient departments. We determined general status of families, maternal nutrition KAP, and 25(OH)D values in 212 children with rickets, with doctors using "Prevention and Treatment Program for Infant and Young Children Rickets" and "Application Guideline for Vitamin D and Bone Health in Adult Chinese (2014 Standard Edition)" to identify. We then assessed the associations between nutrition KAP and 25(OH)D values. The 25(OH)D values were positively correlated with maternal nutrition KAP scores. Factors influencing rickets included per-capita monthly dietary expenditure and spousal education level. Factors associated with nutrition practice included maternal education level, gestational vitamin D level, and nutrition knowledge. Augmented maternal nutrition KAP may improve 25(OH)D levels in children with rickets to a normal range.