Psychometric Evaluation of the Knowledge-Attitude-Practice Questionnaire for Health Professionals in Adult Functional Constipation Care (KAP-FC)

Summary

Based on the KAP theory, this study developed and psychometrically evaluated the 28-item KAP-FC questionnaire to assess health professionals’ knowledge, attitudes, and practices regarding the care of adult functional constipation. It demonstrated good reliability (Cronbach's α = 0.914) and validity, providing a tool for nursing quality improvement.

Abstract

Functional constipation is commonly encountered in adult healthcare, yet its clinical assessment is often limited by inconsistent recognition, insufficient nurse training, and the lack of a standardized instrument to assess how healthcare professionals integrate knowledge, attitudes, and practices into routine care. To address this gap, this study developed and psychometrically evaluated the Knowledge-Attitude-Practice Questionnaire for Health Professionals in Adult Functional Constipation Care (KAP-FC). Guided by the Knowledge-Attitude-Practice (KAP) framework, an initial item pool was generated through a literature review, theoretical analysis, and qualitative interviews, followed by two rounds of Delphi consultation with an interdisciplinary expert panel. The revised questionnaire was pre-tested and subsequently administered to 466 nurses from three tertiary hospitals in Nantong using stratified convenience sampling. Item screening was performed using the critical ratio method and item-total correlation analysis, while structural validity, content validity, internal consistency, and test-retest reliability were evaluated. Following item analysis, 28 items were retained, comprising 12 knowledge, 6 attitude, and 10 practice items. Exploratory factor analysis identified six factors that explained 72.344% of the total variance, with factor loadings ranging from 0.511 to 0.894. The overall Cronbach's α was 0.914, with dimension-specific Cronbach's α values ranging from 0.881 to 0.900. The intraclass correlation coefficient for test-retest reliability was 0.936, and the scale-level content validity index (S-CVI) was 0.929. These findings demonstrate that the KAP-FC questionnaire has satisfactory preliminary reliability and validity and may serve as a useful instrument for assessing healthcare professionals' knowledge, attitudes, and practices related to adult functional constipation care.

Introduction

Functional constipation (FC) is a common functional bowel disorder in adults and is classified within disorders of gut-brain interaction¹. It is characterized by difficult, infrequent, or incomplete defecation without an identifiable structural or biochemical cause, and its diagnosis relies mainly on symptom-based clinical criteria rather than a single laboratory or imaging test^2,3. Although FC is frequently encountered in clinical practice, its assessment and management remain inconsistent, particularly in settings where constipation care is handled as part of routine nursing work

Protocol

This study was based on the Knowledge-Attitude-Practice (KAP) framework and used a three-phase process to develop and psychometrically evaluate the Knowledge-Attitude-Practice Questionnaire for Health Professionals in Adult Functional Constipation Care (KAP-FC). The study was approved by the Ethics Committee of Nantong City Hospital (Approval No. NTLYLL2022087), and written informed consent was obtained from all participants before enrollment. Participants were informed that they could withdraw from the study at any time without consequence. All participants were assured that the questionnaire data would be used solely for research purposes and would be kept confident....

Results

Expert consensus and initial questionnaire refinement

Two rounds of Delphi expert consultation were conducted during questionnaire refinement. In the first and second rounds, 17 and 16 consultation questionnaires were distributed, respectively, and 16 valid questionnaires were returned in each round, giving effective response rates of 94.12% and 100.00%. Sixteen experts from six tertiary hospitals in three cities in China participated in the Delphi consultation. The mean age o.......

Discussion

This study developed and psychometrically evaluated the KAP-FC questionnaire for health professionals involved in adult FC care. The main value of the work lies not only in the final 28-item questionnaire but also in the stepwise protocol used to build the instrument. The process combined a literature review, qualitative interviews, a Delphi consultation, pretesting, item analysis, and psychometric evaluation. This sequence helped ensure that the items were first grounded in clinical content and expert experience, and we.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Delphi expert consultation forms	N/A	N/A	Used for two-round expert scoring and iterative revision.
Initial 30-item draft questionnaire	N/A	N/A	Used as the initial instrument for item generation and expert review.
Online questionnaire	N/A	N/A	Used for large-scale data collection.
Paper questionnaire	N/A	N/A	Used for paper-based data collection.
Pretest questionnaire	N/A	N/A	Completed by 30 nurses to assess item clarity.
Revised questionnaire (post-Delphi)	N/A	N/A	Used for pilot testing.
SPSS Statistical Software	IBM Corp., Armonk, NY, USA	Version 23.0	Used for statistical analyses including EFA and reliability testing.