# Dual psychometric evaluation of measures assessing attitudes toward prenatal alcohol exposure and fetal alcohol spectrum disorder

## TL;DR

This study evaluates two tools to measure healthcare workers' attitudes about alcohol use during pregnancy and fetal alcohol spectrum disorder.

## Contribution

The study provides a dual psychometric evaluation of two attitude measures related to prenatal alcohol exposure and FASD.

## Key findings

- Both measures showed multifactor structures with good model fit and convergent validity.
- Total scales were reliable, but some subfactors had poor internal consistency.
- Ceiling effects and item-level issues suggest the need for revisions to improve the measures.

## Abstract

Uninformed attitudes toward prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorder (FASD) remain barriers in the assessment and diagnosis of affected individuals. While there is a growing need to evaluate the attitudes of professionals who work closely with pregnant individuals and those living with FASD, it is currently unknown whether existing psychometric tools, quantifying such attitudes, are reliable. The psychometric properties of two measures were therefore investigated: the “Alcohol and Pregnancy Measure” (capturing attitudes toward PAE) and the “Knowledge and Attitudes Regarding FASD Measure” (capturing attitudes toward FASD).

A total of 1797 healthcare workers, recruited largely from the National Health Service in Scotland, completed both psychometric measures as part of a nationwide survey of attitudes. Participants also completed novel measurements of their knowledge of FASD and their attitudes toward the health advice for pregnant women regarding alcohol use during pregnancy.

Support for the psychometric validity of the two measures was partially observed. Both measures were found to have multifactor structures, instead of the hypothesised one‐factor solutions. Such multifactor structures demonstrated goodness‐of‐fit in confirmatory factor analyses. Moreover, both measures showed convergent validity with both knowledge of FASD and attitudes toward current health advice regarding PAE. Both the measures' sensitivity to ceiling effects and poor subfactor internal consistencies, however, remain a concern.

Results indicate that both measures, when used at the total‐scale level, can acceptably assess attitudes toward PAE and FASD. Revisions are required at the item‐level to further improve subfactor internal consistency and minimize ceiling effect likelihood.

Uninformed attitudes toward prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD) hinder assessment and diagnosis. The reliability of two attitude measures—the Alcohol and Pregnancy Measure and the Knowledge and Attitudes Regarding FASD Measure—was assessed using data from 1797 healthcare workers. Both measures showed multifactor structures with good model fit and convergent validity with FASD knowledge and attitudes toward prenatal alcohol use guidance. While total scales were reliable, several subfactors demonstrated poor internal consistency.