How to develop and validate a questionnaire to assess knowledge, attitude, and confidence of healthcare workers in Malaysia on wilderness first aid?

Development and Validation of a Wilderness First Aid Questionnaire for Malaysian Healthcare Workers

To develop and validate a questionnaire assessing knowledge, attitude, and confidence of healthcare workers in Malaysia on wilderness first aid, you should follow a systematic mixed-methods sequential exploratory design that includes expert interviews, focus groups, and quantitative assessment using psychometric validation techniques. 1

Conceptual Framework Development

1. Begin with a comprehensive literature review:

   • Review existing wilderness first aid guidelines and assessment tools
   • Identify key domains to be assessed (knowledge, attitude, confidence)
   • Consider Malaysian cultural context and healthcare system specifics

2. Form an expert panel:

   • Include wilderness medicine specialists
   • Include Malaysian healthcare professionals
   • Include psychometricians with expertise in questionnaire development

Content Development Phase

Knowledge Domain

• Develop 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
  • Evacuation decision-making criteria 1
  • Local environmental hazards specific to Malaysian wilderness

Attitude Domain

• Develop items assessing:
  • Perceptions about importance of wilderness first aid training
  • Beliefs about personal responsibility in wilderness emergencies
  • Views on wilderness first aid as part of professional development

Confidence Domain

• Develop items assessing self-efficacy in:
  • Performing specific wilderness first aid skills
  • Making decisions in remote settings with limited resources
  • Adapting standard protocols to wilderness contexts

Validation Methodology

Phase 1: Content and Face Validity

• Submit draft questionnaire to expert panel review
• Conduct cognitive interviews with 8-10 healthcare workers
• Refine items based on feedback 2, 3

Phase 2: Pilot Testing

• Administer refined questionnaire to 30-50 healthcare workers
• Collect feedback on clarity, relevance, and comprehensiveness

Phase 3: Psychometric Validation

• Administer to a larger sample (minimum 100-300 participants) 3

• For Knowledge Domain:

  • Apply Item Response Theory (IRT) to evaluate item difficulty and discrimination parameters 2
  • Ensure items are within acceptable range of difficulty 2

• For Attitude and Confidence Domains:

  • Conduct Exploratory Factor Analysis (EFA) 2, 3
  • Verify sampling adequacy using Kaiser-Meyer-Olkin (KMO) test (target >0.7) 2, 3
  • Perform Bartlett's test of sphericity (should be significant, p<0.001) 2, 3
  • Set factor loading threshold at >0.3 or >0.5 3
  • Extract factors with eigenvalues >1.0 3

• Assess reliability:

  • Calculate Cronbach's alpha (target >0.6 for acceptable reliability) 2, 3
  • Test-retest reliability using intraclass correlation coefficient (target >0.75) 3

Important Considerations and Pitfalls

Cultural Adaptation

• Ensure questionnaire is culturally appropriate for Malaysian context
• Develop in both English and Bahasa Malaysia with proper translation validation
• Consider regional differences within Malaysia (peninsular vs. Borneo)

Practical Application

• Include scenario-based questions to better assess practical application of knowledge 1, 4
• Be aware that knowledge and self-efficacy scores may not correlate strongly with actual skill performance 4
• Consider including skills assessment component alongside questionnaire

Common Pitfalls to Avoid

1. Overlooking the gap between theoretical knowledge and practical skills - research shows that written test scores don't accurately reflect competence in performing practical wilderness first aid skills 4

2. Neglecting regular reassessment - without additional training or refreshers, wilderness first aid knowledge and skills decrease significantly over time 4

3. Failing to address Malaysia-specific wilderness contexts - questionnaire should include items relevant to tropical forest environments 5

4. Not accounting for prior training experiences - 91% of workers in remote areas may have received standard first aid training but still lack wilderness-specific knowledge 5

Implementation Strategy

1. Pilot the questionnaire with diverse healthcare worker populations across Malaysia
2. Refine based on psychometric analysis
3. Establish baseline data on current wilderness first aid preparedness
4. Use findings to develop targeted training programs
5. Plan for periodic reassessment to evaluate knowledge retention and training effectiveness

This structured approach will help develop a valid and reliable tool for assessing wilderness first aid knowledge, attitudes, and confidence among Malaysian healthcare workers, addressing a critical gap in emergency preparedness for remote settings.