Development and Validation of the OH-KAP Survey for use with Pastoral and Other Rural Communities in Africa

Background Evaluating One Health at community-level requires robust, valid measures of what communities know, believe, and do about health risks shared by people, animals, and the environment. We developed and validated a One Health Knowledge, Attitudes and Practices (OH-KAP) instrument tailored to (agro)-pastoralist and mixed-farming systems covering key One Health topics including zoonoses, antimicrobial resistance, and food safety. Methods An initial pool of 155 items was derived from the literature and refined through expert content validation to 126-items. Subsequently, the questionnaire was translated into Somali and field-tested with 300 adults in Middle Shabelle, Somalia. Psychometric analysis of knowledge and attitudes items was undertaken using classical test theory, exploratory factor analysis, and bifactor item response theory (2-parameter logistic models for binary knowledge items; graded response models for Likert-scale attitudes items). Practice items were analysed using exploratory graph analysis and community detection. Results The final instrument included 27 knowledge, 19 attitude and 29 practice items. The knowledge sub-scale loaded onto a general One Health factor with 4 domain-specific subfactors: zoonotic transmission and environmental risks; animal bites and safe food handling; AMR; and direct contact and food contamination risks (reliability: α = 0.94; model fit: CFI = 0.96, RMSEA 0.08). The attitudes sub-domain loaded onto a general One Health factor with 5 domain-specific subfactors: hand hygiene; animal husbandry; zoonotic outbreaks; AMR; and antimicrobial use (AMU) (α = 0.93; CFI = 0.99, RMSEA 0.05). Practices clustered into four stable domains: animal management and AMU; direct contact and exposure control; responsible husbandry, food safety and stewardship; and hand hygiene and disease reporting (bootstrap stability > 65%). Conclusions The OH-KAP is a concise, field-ready tool for quantifying integrated One Health knowledge, attitudes and practices. It supports baseline assessments and monitoring associated with awareness-creation and behaviour-change programming. Future work should extend coverage to additional One Health priorities and assess invariance across settings and languages.