Development and psychometric validation of a KAP questionnaire on fluoride exposure and fluorosis in parents and/or caregivers

Abstract Background Excessive exposure to fluoride remains a public health concern in several regions of the world due to its association with dental and skeletal fluorosis. Parents and caregivers play a critical role in children’s exposure to fluoride. Currently, there are few validated instruments to assess their knowledge, attitudes, and practices (KAP) regarding fluoride exposure and fluorosis. Therefore, the objective of this study was to develop and evaluate the psychometric properties of a questionnaire designed to measure knowledge, attitudes, and practices related to fluoride exposure and fluorosis in parents and/or caregivers. Methods A cross-sectional study was conducted among 340 parents and caregivers of children attending public schools in the department of Huila, Colombia. The questionnaire items were developed based on a literature review and were evaluated by a panel of five experts to determine content validity using the Content Validity Index (CVI). Subsequently, a pilot test was conducted to assess the comprehensibility and acceptability of the items. The psychometric properties of the items were analyzed, including mean item scores, discrimination, and ceiling and floor effects. Construct validity was assessed using exploratory factor analysis based on polychoric correlations, minimum residual extraction, parallel analysis, and oblimin rotation. Internal consistency was assessed separately for each retained factor using Cronbach’s alpha and McDonald’s omega. All participants signed the informed consent form. Results The initial questionnaire consisted of 31 items distributed across three domains: knowledge, attitudes, and practices. Content validity indices demonstrated that the items possessed adequate relevance, clarity, coherence, and representativeness. Exploratory factor analysis supported a three-factor solution after item refinement, resulting in a final 17-item instrument. Parallel analysis supported the retention of three factors, with eigenvalues of 6.03, 2.69, and 1.28, which together accounted for 58.8% of the variance. Cronbach’s alpha coefficients for the three retained factors were 0.86 (95% CI, 0.84 to 0.88), 0.77 (95% CI, 0.73 to 0.81), and 0.68 (95% CI, 0.62 to 0.74), respectively; corresponding McDonald’s omega coefficients were 0.87, 0.80, and 0.70. Conclusions The questionnaire demonstrated evidence of content validity, construct validity, and internal consistency for assessing fluoride-related knowledge, attitudes, and practices among parents and caregivers. The final instrument comprised 17 items across three empirically derived factors. Further studies should confirm the factor structure in independent populations and evaluate test–retest reliability and responsiveness before the questionnaire is used as an outcome measure in educational or preventive interventions.