What is the framework for developing and validating a questionnaire to assess knowledge, attitude, and confidence of healthcare workers in Malaysia regarding wilderness first aid?

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

A comprehensive research framework for developing and validating a questionnaire to evaluate knowledge, attitude, and confidence on wilderness first aid among healthcare workers in Malaysia should follow a mixed-methods sequential exploratory design, including expert interviews, focus groups, and quantitative assessment using a validated questionnaire. 1

Literature Review and Research Gap

Current State of Wilderness First Aid Research

• International Consensus on First Aid Science (2015) provides evidence that first aid training improves patient outcomes, with trained providers demonstrating reduced mortality rates (9.8% vs 15.6%) compared to untrained individuals 2
• Despite the importance of wilderness first aid training, there is a significant lack of research evaluating care provided by healthcare responders in wilderness settings 1
• Current research lacks diversity, with most studies focusing on male, White participants from North America and Western Europe 1
• Evidence shows that without additional training or regular use of course content, wilderness first aid knowledge, self-efficacy, and skill proficiency decrease over time 3

Research Gap

• Limited research on wilderness first aid knowledge, attitudes, and confidence specifically among healthcare workers in Malaysia
• Lack of validated assessment tools for measuring wilderness first aid competency in Malaysian healthcare contexts
• Need for culturally appropriate and validated instruments to assess wilderness first aid preparedness in low and middle-income countries 1
• Knowledge and self-efficacy beliefs are not highly correlated with actual skill performance in wilderness first aid, highlighting the need for comprehensive assessment tools 3

Problem Statement

Healthcare workers in Malaysia may lack adequate knowledge, positive attitudes, and confidence in providing wilderness first aid despite its importance in reducing mortality and improving patient outcomes in remote settings. The absence of a validated assessment tool specific to the Malaysian context hampers efforts to identify gaps in wilderness first aid preparedness and develop targeted training interventions.

Significance of Research

• Will establish baseline data on the current level of wilderness first aid preparedness among Malaysian healthcare workers
• Will identify specific knowledge gaps and training needs for wilderness first aid in Malaysia
• Will provide a validated tool for evaluating the effectiveness of wilderness first aid training programs
• Will contribute to the development of culturally appropriate wilderness first aid education in Malaysia
• Will address the American Heart Association's call for greater diversity in first aid research and understanding the unique needs of underrepresented populations 1

Research Questions

1. What is the current level of knowledge, attitude, and confidence regarding wilderness first aid among healthcare workers in Malaysia?
2. What are the key components that should be included in a valid and reliable questionnaire to assess wilderness first aid competency in the Malaysian context?
3. What factors influence wilderness first aid knowledge, attitudes, and confidence among Malaysian healthcare workers?
4. How do demographic variables (age, gender, professional background, years of experience) correlate with wilderness first aid competency?
5. What is the reliability and validity of the developed wilderness first aid assessment tool in the Malaysian healthcare context?

Research Objectives

General Objective

To develop and validate a questionnaire to assess knowledge, attitudes, and confidence regarding wilderness first aid among healthcare workers in Malaysia.

Specific Objectives

1. To identify key components of wilderness first aid knowledge, attitudes, and confidence relevant to Malaysian healthcare workers through literature review and expert consultation
2. To develop a preliminary questionnaire based on identified components
3. To establish content and face validity of the questionnaire through expert review and cognitive interviews
4. To determine the construct validity of the questionnaire using exploratory factor analysis
5. To assess the reliability of the questionnaire through internal consistency and test-retest reliability
6. To evaluate the relationship between demographic factors and wilderness first aid knowledge, attitudes, and confidence

Methodology

Phase 1: Questionnaire Development

1. Literature Review

   • Comprehensive review of existing wilderness first aid guidelines, training programs, and assessment tools
   • Review of questionnaire development methodologies in healthcare settings

2. Qualitative Exploration

   • In-depth interviews with wilderness medicine experts (8-10 participants)
   • Focus group discussions with healthcare workers (3-4 groups, 6-8 participants each)
   • Thematic analysis to identify key domains and items

3. Item Generation and Questionnaire Construction

   • Development of items for knowledge, attitude, and confidence domains
   • Knowledge domain should include items on recognition and management of heat-related illnesses, traumatic injuries in remote settings, wound care, and evacuation decision-making 1
   • Use of scenario-based questions to assess practical application of knowledge
   • Initial item pool should be 30-50% larger than anticipated final questionnaire

4. Content Validity Assessment

   • Expert panel review (8-10 experts in wilderness medicine, emergency medicine, and questionnaire development)
   • Content Validity Index (CVI) calculation for each item and the overall questionnaire
   • Retention of items with CVI ≥ 0.78

5. Face Validity Assessment

   • Cognitive interviews with 10-15 healthcare workers
   • Assessment of clarity, relevance, and comprehensiveness
   • Refinement based on feedback

Phase 2: Questionnaire Validation

1. Pilot Testing

   • Administration to 30-50 healthcare workers
   • Assessment of administration time, completion rate, and preliminary reliability
   • Further refinement of questionnaire

2. Main Validation Study

   • Sample size: Minimum 300 healthcare workers (based on recommendation of 5-10 participants per item)
   • Sampling: Stratified random sampling from various healthcare facilities across Malaysia
   • Data collection: Self-administered questionnaire (online or paper-based)

3. Psychometric Analysis

   • For Knowledge Domain:

     • Item Response Theory (IRT) to evaluate item difficulty and response patterns 4
     • Item discrimination analysis
     • Kuder-Richardson Formula 20 (KR-20) for reliability

   • For Attitude and Confidence Domains:

     • Exploratory Factor Analysis (EFA) to identify underlying factor structure 5, 4
     • Kaiser-Meyer-Olkin (KMO) test and Bartlett's test of sphericity to verify sampling adequacy 5
     • Cronbach's alpha for internal consistency (target > 0.7)
     • Test-retest reliability with intraclass correlation coefficient (target > 0.75) 5

4. Confirmatory Factor Analysis

   • Verification of the factor structure identified in EFA
   • Assessment of model fit using standard indices (CFI, TLI, RMSEA, SRMR)

Phase 3: Final Questionnaire Development and Testing

1. Questionnaire Finalization

   • Selection of final items based on psychometric properties
   • Development of scoring system and interpretation guidelines

2. Known-Groups Validity

   • Comparison of scores between groups with different levels of wilderness first aid training
   • Assessment of the questionnaire's ability to discriminate between groups

3. Criterion Validity

   • Correlation with existing measures (if available)
   • Correlation with actual performance in simulated wilderness first aid scenarios

Ethical Considerations

• Ethical approval from relevant institutional review boards
• Informed consent from all participants
• Confidentiality and anonymity of responses
• Data protection measures

Anticipated Challenges and Limitations

• Potential sampling bias due to voluntary participation
• Self-reported nature of the questionnaire
• Challenges in assessing actual wilderness first aid skills through a questionnaire format
• Need to balance comprehensiveness with practical administration time
• Potential regional variations within Malaysia that may affect generalizability

By following this comprehensive framework, the study will develop a valid and reliable tool for assessing wilderness first aid knowledge, attitudes, and confidence among Malaysian healthcare workers, addressing an important gap in the literature and contributing to improved wilderness first aid training and practice.