# The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India

## TL;DR

This study developed and validated a tool to measure health-seeking behavior for tuberculosis among people living with HIV in India.

## Contribution

The paper introduces a content-valid instrument based on the Modified Andersen’s Behavioral Model of Health Services for TB health-seeking behavior in PLHIV.

## Key findings

- The instrument was validated with 69 items across three domains: knowledge, accessibility, and client satisfaction.
- Content Validity Ratios and Scale Content Validity Indices for all domains were ≥0.62, indicating strong content validity.
- The tool can help assess and improve health-seeking behaviors for tuberculosis among people living with HIV in India.

## Abstract

Determinants of health-seeking behavior among people living with HIV (PLHIV) are important. This study aims to develop and assess the content validity of an instrument that measures health-seeking behavior for tuberculosis among PLHIV in India. An instrument was developed using deductive methods and the Modified Andersen’s Behavioral Model of Health Services (BMHS). We identified three domains using the BMHS. Ten subject experts validated the tool between June 2022 and August 2022. Lawshe’s Content Validity Ratios (CVRs) and Scale Content Validity Indices (CVIs) were computed. The items with CVR and CVI values ≥0.62 were considered for the final tool. The health-seeking behavior among PLHIV, based on the BMHS, identified knowledge regarding TB (domain 1), healthcare accessibility and factors leading to delay in treatment-seeking behavior (domain 2), and client satisfaction regarding diagnostic and treatment-seeking behavior (domain 3). Content Validity Ratios (CVRs) of all the items related to domains 1 and 2 were ≥0.62. The Scale Content Validity Indices (for relevance), i.e., S-CVI (average) and S-CVI (proportional relevance), were ≥0.62 for all domains. The items with CVR and CVI values ≥0.62 in the domains were accepted in the final tool, which contained 69 items.