Developing and Validating a Questionnaire on Wilderness First Aid Knowledge, Attitude, and Confidence Among Malaysian Healthcare Workers
To develop and validate a questionnaire assessing wilderness first aid knowledge, attitude, and confidence among Malaysian healthcare workers, you should follow a structured methodological approach that includes content development, validation processes, and psychometric testing.
Step-by-Step Development Process
1. Initial Questionnaire Development
- Literature Review: Begin by conducting a comprehensive literature review on wilderness first aid practices, existing assessment tools, and Malaysian healthcare context
- Expert Panel Formation: Assemble a panel of experts in emergency medicine, wilderness medicine, and questionnaire development
- Content Domain Identification: Define the specific domains to be measured:
- Knowledge domain: factual understanding of wilderness first aid principles
- Attitude domain: beliefs and perceptions about wilderness first aid
- Confidence domain: self-efficacy in performing wilderness first aid skills
2. Item Generation and Content Validity
- Item Pool Creation: Develop a comprehensive pool of items for each domain
- Content Validity Assessment: Have your expert panel review the items for:
- Relevance to wilderness first aid
- Appropriateness for Malaysian healthcare context
- Clarity and comprehensibility
- Comprehensiveness of content coverage
- Content Validity Index (CVI): Calculate item-level and scale-level CVIs to quantify expert agreement 1
3. Face Validity and Pilot Testing
- Face Validity Assessment: Test the preliminary questionnaire with a small group (10-15) of healthcare workers to evaluate:
- Clarity of instructions
- Comprehensibility of items
- Time required for completion
- Format and presentation
- Cognitive Interviews: Conduct interviews to understand how respondents interpret questions
- Revision: Refine the questionnaire based on feedback
4. Psychometric Validation
- Sample Size Determination: Recruit 5-10 participants per item for adequate statistical power 1, 2
- Data Collection: Administer the questionnaire to the target population
- Item Analysis for Knowledge Domain: Apply Item Response Theory (IRT) to evaluate:
- Item difficulty
- Item discrimination
- Response patterns 1
- Factor Analysis for Attitude and Confidence Domains:
- Conduct Exploratory Factor Analysis (EFA) to identify underlying factor structure
- Verify sampling adequacy using Kaiser-Meyer-Olkin (KMO) test (aim for >0.7) 2, 3
- Perform Bartlett's test of sphericity (should be significant, p<0.001)
- Extract factors with eigenvalues >1.0
- Retain items with factor loadings >0.3 1, 2
5. Reliability Assessment
- Internal Consistency: Calculate Cronbach's alpha for each domain (aim for >0.7)
- Test-Retest Reliability: Administer the questionnaire twice to a subset of participants (2-4 weeks apart)
- Calculate Intraclass Correlation Coefficient (ICC): Aim for >0.75 for good reliability 3
Specific Content Recommendations for Each Domain
Knowledge Domain Items
Based on evidence from wilderness first aid guidelines 4, include items assessing knowledge of:
- Recognition and management of heat-related illnesses
- Management of traumatic injuries in remote settings
- Wound care and infection prevention in wilderness settings
- Management of environmental emergencies (hypothermia, altitude sickness)
- Improvisation of medical equipment in resource-limited settings
- Evacuation decision-making criteria
Attitude Domain Items
Include items assessing:
- Perceived importance of wilderness first aid training
- Beliefs about the effectiveness of wilderness first aid interventions
- Perceptions about the role of healthcare workers in wilderness settings
- Willingness to provide care in remote environments
- Attitudes toward improvisation in resource-limited settings
Confidence Domain Items
Include items assessing self-efficacy in:
- Performing wilderness first aid skills without standard equipment
- Making clinical decisions in remote settings
- Improvising medical equipment
- Managing patients until evacuation
- Teaching wilderness first aid skills to others
Potential Pitfalls and How to Avoid Them
- Cultural Context: Ensure questionnaire is culturally appropriate for Malaysian healthcare workers by involving local experts in development
- Translation Issues: If developing in English, follow proper translation and back-translation procedures for Malay version
- Response Bias: Include both positively and negatively worded items to minimize acquiescence bias
- Ceiling Effects: Include items of varying difficulty to differentiate between respondents with high knowledge/confidence
- Practical Application: Include scenario-based questions to assess application of knowledge rather than mere recall
Implementation Considerations
- Format: Consider both paper-based and electronic formats for wider accessibility
- Length: Keep questionnaire concise (under 50 items total) to minimize respondent fatigue
- Scoring System: Develop a clear scoring system for each domain
- Interpretation Guide: Create guidelines for interpreting scores and identifying areas for improvement
Conclusion
The development of this questionnaire will fill an important gap in wilderness medicine education and assessment in Malaysia. Evidence shows that first aid training improves patient outcomes, with trained providers demonstrating reduced mortality rates compared to untrained individuals (9.8% vs. 15.6%) 4. However, research specifically in wilderness first aid education remains limited 4, highlighting the importance of your work in developing validated assessment tools.
By following this structured approach to questionnaire development and validation, you will create a robust instrument that can effectively assess knowledge, attitude, and confidence in wilderness first aid among Malaysian healthcare workers, ultimately contributing to improved emergency care in remote settings.