Development and validation of a knowledge, attitude, and practice questionnaire for management of metabolic complications after solid organ transplantation among medical staff

Metabolic diseases are common complications after solid organ transplantation (SOT) and significantly affect recipients’ quality of life and long-term survival. To our knowledge, no validated questionnaire specifically evaluates medical staff’s knowledge, attitude and practice (KAP) regarding post-transplant management of metabolic complications. This study aimed to develop and examine the validity and reliability of a questionnaire on KAP regarding management of metabolic complications after SOT among medical staff. This study was conducted in two phases from November 2024 to April 2025. In phase I, the initial item pool was developed within the KAP framework, based on a literature review and research team discussions. A two-round Delphi method with 15 experts was employed to revise the initial questionnaire. In phase II, the questionnaire was distributed to medical staff in the field of SOT from China. Following data collection, item analysis was conducted using the critical ratio method, correlation analysis, and Cronbach’s α. The validity and reliability of the questionnaire were then evaluated by assessing its content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and internal consistency reliability. After two rounds of Delphi consultation, the questionnaire contained 26 knowledge, 12 attitude, and 12 practice items. A total of 277 questionnaires were included in the analysis. Item analysis led to the removal of six items that failed to meet the t value ( P > 0.05) or correlation coefficient thresholds ( r < 0.3). The overall content validity index for the remaining items was 0.939. Subsequent EFA resulted in the removal of one knowledge item with factor loading below 0.4, resulting in a stable three-factor structure with a cumulative variance contribution of 61.459%. The final CFA model exhibited an acceptable fit to the data (χ 2 /df = 2.106, RMSEA = 0.063, CFI = 0.916, TLI = 0.909, SRMR = 0.044). Excellent reliability was confirmed by a high Cronbach's α for the overall questionnaire and three dimensions (> 0.900), and further supported by split-half reliability (Spearman–Brown coefficient = 0.976; α = 0.917 and 0.909 for the halves). This study indicates that the developed 43-item questionnaire can serve as a valid and reliable instrument for assessing the KAP status of medical staff in the management of metabolic complications after SOT, thereby guiding the development of targeted training and clinical management strategies.