# Development and Preliminary Validation of a Knowledge, Attitude, and Practice Questionnaire Assessing Parental Self-Healthcare for Respiratory Tract Infections in Children With Cerebral Palsy in Malaysia

## TL;DR

This study created and tested a questionnaire to assess how parents of children with cerebral palsy in Malaysia manage respiratory infections at home.

## Contribution

The paper introduces a new, culturally relevant questionnaire for evaluating parental self-healthcare practices related to respiratory infections in children with cerebral palsy in Malaysia.

## Key findings

- The questionnaire showed excellent content validity with all domains scoring S-CVI/Ave ≥ 0.90.
- Internal consistency reliability was good across domains and excellent for the overall scale (α = 0.905).
- Minor revisions were made based on expert feedback, but no items were removed.

## Abstract

Background

Children with cerebral palsy (CP) are vulnerable to recurrent respiratory tract infections (RTIs), contributing to morbidity and repeated hospital admissions. Parents and primary caregivers play a central role in prevention, early recognition, and home management; however, Malaysia‑specific validated tools to assess parental knowledge, attitudes, and practices (KAP) regarding RTIs in CP are limited. Developing and preliminarily validating a KAP questionnaire is essential for assessing parental self-healthcare related to RTIs among children with CP in Malaysia.

Methodology

A methodological study was conducted to develop and preliminarily validate a KAP questionnaire assessing parental self-healthcare related to RTIs among children with CP. Questionnaire items were developed based on a literature review and the KAP framework. Content validity was assessed by a panel of six experts using the Content Validity Index (CVI). Pilot testing was conducted among 33 parents of children with neurodevelopmental disabilities to evaluate item clarity, feasibility, and internal consistency reliability. Reliability analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2016; IBM Corp., Armonk, New York, United States), while CVI calculations were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA, USA).

Results

Item-level content validity indices ranged from 0.67 to 1.00. All domains demonstrated excellent scale-level content validity (S-CVI/Ave ≥ 0.90). Minor wording revisions were made based on expert feedback, with no item removal. Internal consistency reliability was acceptable to good across domains (knowledge α = 0.82; attitude α = 0.739; practice α = 0.795) and excellent for the overall scale (α = 0.905).

Conclusion

The developed questionnaire demonstrated excellent content validity and satisfactory internal consistency reliability, supporting its preliminary psychometric adequacy. Further validation among parents of children with CP is recommended to assess construct validity, test-retest reliability, and broader applicability.