Development and Validation of a New Questionnaire assessing Knowledge, Attitudes, and Practices on Pre Pregnancy Care Among Women with Chronic Health Conditions

Background The rising prevalence of chronic health conditions has increased the risk of adverse pregnancy outcomes, while awareness of pre pregnancy care (PPC) remains limited. Although PPC can improve maternal and neonatal outcomes, locally validated tools to assess women’s knowledge, attitudes, and practices (KAP) on PPC are scarce. This study aimed to develop and validate a new questionnaire to assess KAP on PPC among women with chronic health conditions in Kelantan. Methods The self-administered questionnaire was developed through extensive literature review and expert consultations. Validation procedures comprised content validation by eight experts, face validation among ten reproductive age women with chronic health conditions, and psychometric evaluation of internal structure among 400 reproductive age women with chronic health conditions attending government-based primary health clinics in Kelantan. Psychometric validation was conducted in two phases. In Phase 1, data from 200 respondents were analyzed using Item Response Theory (IRT) for 42 items binary-response of knowledge domain, and Exploratory Factor Analysis (EFA) for 24 items of five-point Likert scale in attitudes and practices domains. In Phase 2, Confirmatory Factor Analysis (CFA) was performed on another 200 respondents to confirm the factor structures identified for the attitudes and practices domains. Results The development phase produced 74 items across three domains which are knowledge (49 items), attitudes (13 items), and practices (12 items). Following content validation, eight items were revised to improve clarity and eight removed due to low Item-Content Validity Index (I-CVI) or redundancy, resulting in 66 items demonstrating satisfactory face validity indices (Item Face Validity Index (I-FVI) and scale-level face validity index using the averaging method (S-FVI/Ave). IRT analysis indicated acceptable item difficulty and discrimination. EFA supported a one-factor structure for attitudes and a two-factor structure for practices, while CFA confirmed construct validity and satisfactory reliability of Raykov’s rho. The final KAP on PPC Among Women with Chronic Health Conditions (KAP-PPC-CHC) questionnaire comprised of 54 items: knowledge (42 items), attitudes (12 items), and practices (10 items). Conclusions The validated KAP-PPC-CHC questionnaire is a reliable and contextually relevant tool for assessing women’s KAP on PPC, facilitating evidence-based interventions to enhance maternal and neonatal health outcomes.