A sequential, exploratory, mixed-methods approach for development and validation of a context-specific knowledge, attitude and practice questionnaire on micronutrients for literate mothers of school-age children

ObjectiveTo develop and validate a context-specific comprehensive knowledge, attitude and practice (KAP) questionnaire for literate mothers on factors affecting micronutrient status of 6-10-year-old children.DesignSequential exploratory mixed-methods study using focus group discussions (FGD) and psychometric validation.SettingSeven randomly selected villages with >500 households with three to five family members each, in Ghatkesar sub-district, Medchal district, Telangana state, India.ParticipantsLiterate mothers from middle-income households with at least one child (6-10 years) for FGD (n 44), for testing the internal consistency (n 80) and for test-retest reliability (n 30).ResultsThe themes for FGD were diet diversity, micronutrients, cooking and eating practices, national programmes and sunlight exposure. Knowledge among caregivers about sources of micronutrients, deficiency symptoms, cooking/eating practices was low, while attitude towards diet diversity and sunlight was good. Non-availability of fruits and vegetables was a barrier to diet diversity. About 72 % of the questions from the item pool were based on FGD. After content validity, 125 items were selected for the questionnaire which, upon psychometric validation, was reduced to an eighty-eight-item questionnaire with difficulty index of 010-091, discrimination index of 009-068, Cronbach's alpha of 078 (reliability of knowledge and attitude) and 050 (practice). A Bland-Altman plot showed good agreement between test and retest scores.ConclusionsThe questionnaire developed and validated using a sequential exploratory mixed-methods approach can be used for assessing KAP on micronutrients and factors affecting consumption of diverse diets in rural Indian households.