Development, validity, and reliability of harm perception and attitudes questionnaire for smokers of roll-your-own and factory-made cigarettes: A pilot study in Southern Thailand

Background: Understanding roll-your-own (RYO) and factory-made (FM) cigarette smokers’ perceptions of harm and their attitudes toward smoking is essential for identifying the barriers they face in effective smoking cessation counseling. However, there are few tools available for measuring these perceptions and attitudes among smokers of RYO and FM cigarettes. Objective: This study aimed to develop and subsequently test the validity and reliability of a questionnaire designed to measure harm perception and attitudes among smokers of RYO and FM cigarettes in Thailand. Materials and methods: The questionnaire was developed based on data from focus groups with eight adult RYO and FM cigarette smokers and in-depth interviews with four medical professionals with experience in caring for smokers. The content validity of the questionnaire was measured by three experts. The Cronbach’s alpha coefficient was used to measure the internal consistency and reliability of the questionnaire. Data from 30 adult RYO and FM cigarette smokers were considered for the test-retest of reliability, measured using the intraclass correlation coefficient. Results: The harm perception and attitudes questionnaire for RYO and FM cigarette smokers demonstrated good content validity. The item content validity index of 21 out of 29 items was higher than 0.79, and the scale content validity index was 0.9. Additionally, Cronbach’s alpha coefficient of 0.719 and the intraclass correlation coefficient of 0.975 (p<0.001) indicated the good reliability of the tool. Conclusion: This study presented a validated questionnaire to assess harm perception and attitudes among smokers of RYO and FM cigarettes. The development and validation process ensured the tool’s reliability and effectiveness in elucidating smoking behavior and facilitating targeted cessation interventions.