Development and validation of the knowledge, attitudes, and practices (KAP) questionnaire on pediatric pain management for physicians and nurses

BACKGROUND: Effective pediatric pain management is often hindered by gaps in medical staff's knowledge, attitudes, and practices. Few reliable instruments comprehensively measure these domains. This study aimed to develop and preliminarily validate a Knowledge, Attitudes, and Practices (KAP) Questionnaire on pediatric pain management for physicians and nurses. METHODS: A preliminary pool of items was generated from a literature review and refined through two rounds of Delphi consultations with 19 multidisciplinary experts. A pilot test with 20 physicians and nurses was conducted to ensure clarity. In June 2024, a convenience sample of 603 physicians and nurses from a specialized children's hospital in Chongqing, China, completed the questionnaire for psychometric validation. RESULTS: The final questionnaire comprised 32 items across three dimensions (knowledge: 13; attitudes: 10; practices: 9), a self-report tool using a five-point Likert scale. Items showed good discrimination (CR: 12.29-19.78) and acceptable item-total correlations (r = 0.49-0.72). Content validity indices were high (I-CVI: 0.86-1.00; S-CVI/Ave: 0.996). The overall Cronbach's α was 0.96, with values for the three dimensions ranging from 0.92 to 0.98. Exploratory factor analysis extracted three factors explaining 70.56% of the variance (KMO = 0.95; Bartlett's χ² = 12,459.51, p < 0.001), supporting construct validity, and confirmatory factor analysis supported the three-factor structure (CFI = 0.90, TLI = 0.90, RMSEA = 0.10, SRMR = 0.06). Convergent validity was supported by average variance extracted values ranging from 0.56 to 0.84. Discriminant validity was established as the square root of the AVE for each factor (knowledge: 0.79; attitudes: 0.92; practices: 0.75) exceeded its inter-factor correlations. CONCLUSIONS: The pediatric pain management KAP questionnaire demonstrated adequate psychometric properties in this initial validation. It provides a practical tool to assess physicians' and nurses' knowledge, attitudes, and practices, supporting the identification of gaps and guiding targeted training and quality improvement initiatives to enhance pediatric pain care.