Development and Validation of a Questionnaire to Assess the Knowledge, Attitude, and Practices Regarding Adult Immunization amongst Resident Physicians at an Apex Tertiary Care Center in India

Background:
The coverage of immunization amongst adults in India remains low; a lack of nationally endorsed guidelines and implementation policies is a
contributing factor. There is a paucity of tools available to assess knowledge, attitude, and practices (KAP) regarding adult immunization. Hence,
we attempted to develop a KAP questionnaire to evaluate the existing expertise regarding adult immunization among medicine and infectious
diseases resident doctors in an apex medical institute in India.


Methods:
A two-stage scheme for the development and validation of the questionnaire was followed. The first step involved an exhaustive literature review,
focused group discussion, and in-depth interviews. The prepared draft was reviewed by experts in the field of infectious diseases and adult
immunization across the domains of necessity, relevance, and clarity. ‘Item-level content validity indices’ (I-CVI) and ‘Scale-level content validity
indices’ (S-CVI) were then calculated. Brennan and Prediger's AC (Agreement Coefficient) and Gwet’s AC (Agreement Coefficient) were used to
establish inter-rater agreement on the obtained expert reviews.


Results:
A 57-item KAP questionnaire was developed and was reviewed by a total of 11 experts. The questionnaire had satisfactory I-CVI (>0.6 for all the
items) and S-CVI Ave (>0.9 for each of the domains). The questionnaire had a strong inter-rater agreement as assessed by both Brennan and
Prediger AC (> 0.6, p<1) and Gwet’s AC (>0.8, p<1).


Conclusions:
The developed tool was scientifically validated following a staged process. We propose that this questionnaire can hence be used to evaluate the
knowledge, attitude, and practices regarding adult immunization amongst medical practitioners across medical colleges and hospitals in India. This
may be instrumental in developing programmatic interventions and major policy changes to enhance the practice of adult immunization amongst
healthcare providers.