# Development, content validation and piloting of a questionnaire on how midwives in Germany provide advice on early childhood allergy prevention in a health literacy responsive way

## TL;DR

This study developed and tested a questionnaire to understand how midwives in Germany support parents in preventing childhood allergies while considering health literacy.

## Contribution

The study introduces a validated questionnaire to assess midwives' practices in allergy prevention advice with a health literacy focus.

## Key findings

- The questionnaire was found to be understandable, feasible, and relevant for midwives.
- Suggestions for improvement included clarifying midwifery-specific terms and ensuring a 'no answer' option for all questions.
- A multifaceted, personal approach is recommended to recruit midwives for future research.

## Abstract

Preventive behaviors in the first three years of life may reduce the onset of allergic conditions. Midwives support families closely during this time and hence could play a key role in strengthening parental health literacy regarding early childhood allergy prevention. The aim of this study was to develop, content-validate and pilot a questionnaire to improve the currently low level of evidence on practices, barriers and facilitators of providing advice on early childhood allergy prevention in a health literacy responsive way by midwives in Germany.

We developed a 64-item online questionnaire informed by the findings of a previous qualitative study. Subsequently, the content of the questionnaire was tested in cognitive interviews with midwives and public health experts. The focus was on: overall impression, comprehensibility, response options, relevance, completeness, and ideas for improvement. Then, two versions were piloted in two German federal states on acceptability and to learn more about recruiting midwives for research.

Data from the cognitive interviews (n=8) and the piloting (n=59) indicated that the questionnaire is understandable, feasible and relevant for the target group. Suggestions for improvement focused mainly on midwifery specific terms. The ‘no answer’ option was considered important for all questions. Response options appeared appropriate and scales were mostly fully used.

Following minor adaptions, the questionnaire can now be applied on a larger scale, as a nationwide survey in Germany addressing all midwives. In order to reach midwives to participate in research, a multifaceted but personal approach seems advisable.