Development, validity, and reliability of Challenges and Attitudes to Practice Primary Eye Care (CAPEC) questionnaire among Malaysian private sector optometrists

Background: Primary Eye Care (PEC) is vital in preventing visual impairment, yet private sector optometrists in Malaysia face barriers that hinder its implementation. This study aimed to develop and validate the Challenges and Attitudes to Practice Primary Eye Care (CAPEC) questionnaire to assess the barriers and attitudes of optometrists in the Malaysian private sector toward implementing primary eye care (PEC) services. Methods:The CAPEC questionnaire was developed based on qualitative insights and thematic analysis from initial interviews with optometrists. The instrument underwent rigorous content validation by experts using the Content Validity Index (CVI) and exploratory factor analysis (EFA) for construct validity. A pilot study tested reliability and readability, and the finalized questionnaire was distributed to a sample of private sector optometrists. Results: The validated CAPEC questionnaire consists of 34 items within four domains addressing challenges (working environment, support and recognition, self-sufficiency, and customer influence) and two domains on attitudes (motivation and sense of responsibility). Results from the pilot study confirmed the questionnaire’s reliability, with high internal consistency (Cronbach’s alpha scores above 0.7 for all domains). Conclusion: The CAPEC questionnaire is a valid and reliable tool for assessing challenges and attitudes in PEC practice among optometrists. Its use may support further research and efforts to enhance PEC implementation in private optometry settings in Malaysia.