Development and validation of a questionnaire assessing knowledge, attitude, and practice of snake envenomation among health care providers (KAPSE-HCPQ) in sub-Saharan African countries

Abstract

Background A tropical disease that is often overlooked yet poses a significant risk to public health is envenomation caused by snakebite. This study aimed to develop a validated questionnaire to evaluate healthcare providers' knowledge, attitudes, and practices regarding snakebite envenomation (KAPSE-HCPQ).

Methods A cross-sectional survey among healthcare providers in 11 Sub-Saharan African countries was conducted from 3 November 2023 to 25 February 2024, using convenience and snowball sampling methods. Data collection included electronic surveys and face-to-face interviews. Internal consistency using Cronbach's alpha was measured to determine sub-domain scales' reliability. We assessed the instrument's validity using multiple approaches, including face, content, convergent, and divergent validity, and evaluated its structural validity through exploratory and confirmatory factor analyses.

Results A total of 634 healthcare providers were included in the study. The median age of participants was 31 years (interquartile range [IQR]: 11), with 61.0% being male, 47.9% holding a bachelor's degree, and the median years of professional experience were 5 years (IQR: 8). The Kaiser–Meyer–Olkin was 0.869, indicating a robust sample for factor analysis. Bartlett's test of Sphericity was statistically significant (p <0.001), confirming the suitability of the data for factor analysis. Three factors were extracted, collectively explaining 41% of the total variance. Knowledge items retained had loadings between 0.410 and 0.821, while attitude items ranged from 0.421 to 0.736. Practice items had loadings between 0.588 and 0.666. Confirmatory factor analysis results indicated good fit measures (RMSEA <0.08, GFI, NFI, CFI, TLI >0.9, and SRMR<0.08), with all domain correlations remaining below 0.05, confirming divergent validity. Cronbach's alpha values for knowledge, attitude, and practice domains were above 0.7, demonstrating acceptable internal consistency.

Conclusions The developed questionnaire has good reliability, validity, and good psychometric properties to be used as a tool for assessing knowledge, attitude, and practice of snake envenomation among healthcare providers.