Development and validation of a knowledge, attitudes and practices (KAP) questionnaire for healthcare professionals on environmental sustainability in healthcare in Southern Africa
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Development and validation of a knowledge, attitudes and practices (KAP) questionnaire for healthcare professionals on environmental sustainability in healthcare in Southern Africa
Lister, Helga Elke; Mostert, Karien; Botha, Tanita; Field, Emma; Knock, Danté; Mubi, Natasha; Odendaal, Stefani; Rohde, Megan; Maric, Filip
Date:
2024-10
Abstract:
BACKGROUND: The triple planetary crisis of climate change, environmental pollution, and biodiversity loss is increasingly driving poor health outcomes
worldwide. Healthcare systems and services are often not environmentally sustainable and compound the problem, while healthcare professionals are also recognised as key leaders in advancing sustainable healthcare. To adopt this leadership position, healthcare professionals’ knowledge, attitudes, and practices
regarding environmental sustainability in healthcare must be established. This article reports the development and validation of a new instrument for this purpose that corresponds to the specificities of the Southern African context.
METHODS: Questionnaire development followed a seven-stage process. Information was obtained from a 2021 study titled ‘South African Healthcare Professionals’ Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed Methods Study’ to develop the instrument. Information was also sourced from the literature regarding environmental sustainability and healthcare to generate the first questionnaire with 29 items. The following stages included two rounds of expert input, separated by a
pilot study with the target population to receive feedback regarding
the instrument’s structure, relevance, and length. Content validity was
determined through statistical analysis.
RESULTS: Feedback was received from nine experts in stage two and 13 pilot study participants in stage four and incorporated to improve the
questionnaire. In stage six, the questionnaire was rated by seven
experts. The content validity index of the questionnaire was calculated
at two different stages, after which the indices were compared.
Following a final edit, the questionnaire has 24 questionnaire items.
The closing analysis calculated the scale content validity index average
(S-CVI/Ave) of 0,922; this indicates that the final questionnaire has
excellent content validity.
CONCLUSION: A questionnaire that assesses the knowledge, attitudes and practices of healthcare professionals regarding environmental sustainability in
Southern Africa has been developed and validated. This questionnaire
can now be used for further studies in Southern Africa.
Description:
DATA AVAILABILITY STATEMENT: Figshare: First Round Expert Feedback, Ratings and Question Feedback, 10.6084/m9.figshare.21220283.v2.
This project contains the following raw underlying data:
• First round expert feedback, ratings and question feedback (this dataset contains the ratings given by 9 experts
for every questionnaire item as well as feedback on how each questionnaire item can be improved.)33
Figshare: First Round Expert Feedback: General Feedback, 10.6084/m9.figshare.21220697.v2.
This project contains the following raw underlying data:
• First round expert feedback: General feedback (this dataset contains general information provided by the
experts about the layout, time taken to complete the questionnaire and additional feedback about the
questionnaire.)34
Figshare: First Round I-CVI and Average S-CVI, 10.6084/m9.figshare.21224900.v2.
This project contains the following raw underlying data:
• First round I-CVI and average S-CVI (this document shows the item content validity index (I-CVI), as well as
the average scale content validity index (S-CVI) calculated after the first round of expert feedback.)35
Figshare: Pilot Study Participant Feedback, 10.6084/m9.figshare.21224918.v2.
This project contains the following raw underlying data:
• Pilot study participant feedback (this dataset provides feedback from the pilot-study participants regarding
language, clarity of questions, length of the questionnaire and user-friendliness.)36
Figshare: Final Round Expert Feedback and Ratings, 10.6084/m9.figshare.21224954.v2.
This project contains the following raw underlying data:
• Final round expert feedback and ratings (this dataset provides the final ratings given by the experts for the
improved questionnaire items as well as additional feedback on how the questionnaire can be improved
further.)37
Figshare: Final Round Average I-CVI and S-CVI Calculation, 10.6084/m9.figshare.21224975.v2.
This project contains the following raw underlying data:
• Final round average I-CVI and S-CVI calculation (the item content validity index (I-CVI) of the questionnaire
items included in the final questionnaire as well as the average scale content validity index (S-CVI/Ave) of the
final questionnaire.)38
Data is available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0).
Extended data
Final questionnaire on the knowledge, attitudes and practices of healthcare professionals on environmental sustainability
in Southern Africa, 10.6084/m9.figshare.21224993.v2
Page 14 of 24
F1000Research 2025, 13:1308 Last updated: 27 MAR 2025
This project contains the following raw underlying data:
• Final questionnaire on the knowledge, attitudes and practices of healthcare professionals on environmental
sustainability in Southern Africa (the final questionnaire of 24 questionnaire items with excellent content
validity.)39
Data is available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0).
