The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India
Abstract
:1. Introduction
2. Materials and Methods
- Step 1: Identification of the domains for the construct and item generation by a thorough deductive literature review
- Step 2: Categorization of items into dimensions based on the Modified Andersen’s Behavioral Model of Health Services (BMHS)
- Step 3: Judgment of the scale by expert validation
- Step 4: Quantification of Content Validity Ratios and Indices
- Step 4a: Quantifying content validity using Lawshe’s score or Content Validity Ratio
- Step 4b: Proportional agreement on items and the scale quantification using the Content Validity Indices (CVIs) according to Waltz and Brussel
3. Results
3.1. Design of the Instrument to Measure Health-Seeking Behavior for Tuberculosis among PLHIV
- Knowledge of the symptoms and transmission of TB.
- Health care accessibility, barriers, and factors related to delays in seeking treatment for tuberculosis among people living with HIV (PLHIV).
- Client satisfaction regarding diagnostic and treatment-seeking behavior for TB among PLHIV.
3.2. Determination of the Content Validity Ratios and Content Validity Indices of the Items in the Scale
3.3. Finalizing the TB Health-Seeking Behavior Scale for PLHIV
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Tuberculosis (TB). Available online: https://www.who.int/news-room/fact-sheets/detail/tuberculosis (accessed on 9 May 2024).
- Annual Reports: Central TB Division. Available online: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4160&lid=2807 (accessed on 9 May 2024).
- Chakaya, J.; Petersen, E.; Nantanda, R.; Mungai, B.N.; Migliori, G.B.; Amanullah, F.; Lungu, P.; Ntoumi, F.; Kumarasamy, N.; Maeurer, M.; et al. The WHO Global Tuberculosis 2021 Report—Not so Good News and Turning the Tide Back to End TB. Int. J. Infect. Dis. 2022, 124, S26–S29. [Google Scholar] [CrossRef] [PubMed]
- Kraef, C.; Bentzon, A.; Panteleev, A.; Skrahina, A.; Bolokadze, N.; Tetradov, S.; Podlasin, R.; Karpov, I.; Borodulina, E.; Denisova, E.; et al. Delayed Diagnosis of Tuberculosis in Persons Living with HIV in Eastern Europe: Associated Factors and Effect on Mortality—A Multicentre Prospective Cohort Study. BMC Infect. Dis. 2021, 21, 1038. [Google Scholar] [CrossRef]
- Lederle, M.; Tempes, J.; Bitzer, E.M. Application of Andersen’s Behavioural Model of Health Services Use: A Scoping Review with a Focus on Qualitative Health Services Research. BMJ Open 2021, 11, e045018. [Google Scholar] [CrossRef]
- Seeling, S.; Mavhunga, F.; Thomas, A.; Adelberger, B.; Ulrichs, T. Barriers to Access to Antiretroviral Treatment for HIV-Positive Tuberculosis Patients in Windhoek, Namibia. Int. J. Mycobacteriol. 2014, 3, 268–275. [Google Scholar] [CrossRef]
- Schacht, C.D.; Mutaquiha, C.; Faria, F.; Castro, G.; Manaca, N.; Manhiça, I.; Cowan, J. Barriers to Access and Adherence to Tuberculosis Services, as Perceived by Patients: A Qualitative Study in Mozambique. PLoS ONE 2019, 14, e0219470. [Google Scholar] [CrossRef] [PubMed]
- Samal, J. Health Seeking Behaviour among Tuberculosis Patients in India: A Systematic Review. J. Clin. Diagn. Res. 2016, 10, LE01–LE06. [Google Scholar] [CrossRef] [PubMed]
- Zamanzadeh, V.; Ghahramanian, A.; Rassouli, M.; Abbaszadeh, A.; Alavi-Majd, H.; Nikanfar, A.-R. Design and Implementation Content Validity Study: Development of an Instrument for Measuring Patient-Centered Communication. J. Caring Sci. 2015, 4, 165–178. [Google Scholar] [CrossRef] [PubMed]
- Taherdoost, H. Validity and Reliability of the Research Instrument; How to Test the Validation of a Questionnaire/Survey in a Research. Int. J. Acad. Res. Manag. 2016, 5. [Google Scholar] [CrossRef]
- Yusoff, M.S.B. ABC of Content Validation and Content Validity Index Calculation. EIMJ 2019, 11, 49–54. [Google Scholar] [CrossRef]
- Zweben, A.; Piepmeier, M.E.; Fucito, L.; O’Malley, S.S. The Clinical Utility of the Medication Adherence Questionnaire (MAQ) in an Alcohol Pharmacotherapy Trial. J. Subst. Abuse Treat. 2017, 77, 72–78. [Google Scholar] [CrossRef] [PubMed]
- Jeyaseelan, L.; Kumar, S.; Mohanraj, R.; Rebekah, G.; Rao, D.; Manhart, L.E. Assessing HIV/AIDS Stigma in South India: Validation and Abridgement of the Berger HIV Stigma Scale. AIDS Behav. 2013, 17, 434–443. [Google Scholar] [CrossRef] [PubMed]
- Tolera, H.; Gebre-Egziabher, T.; Kloos, H. Using Andersen’s Behavioral Model of Health Care Utilization in a Decentralized Program to Examine the Use of Antenatal Care in Rural Western Ethiopia. PLoS ONE 2020, 15, e0228282. [Google Scholar] [CrossRef] [PubMed]
- Hirshfield, S.; Downing, M.J.; Horvath, K.J.; Swartz, J.A.; Chiasson, M.A. Adapting Andersen’s Behavioral Model of Health Service Use to Examine Risk Factors for Hypertension among U.S. MSM. Am. J. Mens. Health 2018, 12, 788–797. [Google Scholar] [CrossRef] [PubMed]
- Seidu, A.-A. Using Anderson’s Model of Health Service Utilization to Assess the Use of HIV Testing Services by Sexually Active Men in Ghana. Front. Public Health 2020, 8, 512. [Google Scholar] [CrossRef] [PubMed]
- Pampalia, N.; Waluyo, A.; Yona, S. Knowledge, Stigma and Health-Seeking Behavior of Patients Co-Infected with HIV and Tuberculosis in Jakarta. Enfermería Clínica 2021, 31, S291–S295. [Google Scholar] [CrossRef]
- Onyango, P.A.; Ter Goon, D.; Rala, N.M.D. Knowledge, Attitudes and Health-Seeking Behaviour among Patients with Tuberculosis: A Cross-Sectional Study. Open Public Health J. 2020, 13, 739. [Google Scholar] [CrossRef]
- Burapat, C.; Kittikraisak, W.; Cain, K.P.; Tasaneeyapan, T.; Nateniyom, S.; Akksilp, S.; Mankatittham, W.; Sirinak, C.; Sattayawuthipong, W.; Varma, J.K. Health-Seeking Behavior among HIV-Infected Patients Treated for TB in Thailand. Southeast Asian J. Trop. Med. Public Health 2009, 40, 1335–1346. [Google Scholar] [PubMed]
- Buregyeya, E.; Kulane, A.; Colebunders, R.; Wajja, A.; Kiguli, J.; Mayanja, H.; Musoke, P.; Pariyo, G.; Mitchell, E.M.H. Tuberculosis Knowledge, Attitudes and Health-Seeking Behaviour in Rural Uganda. Int. J. Tuberc. Lung Dis. 2011, 15, 938–942. [Google Scholar] [CrossRef] [PubMed]
- Khan, A.; Shaikh, B.T.; Baig, M.A. Knowledge, Awareness, and Health-Seeking Behaviour Regarding Tuberculosis in a Rural District of Khyber Pakhtunkhwa, Pakistan. BioMed Res. Int. 2020, 2020, 1850541. [Google Scholar] [CrossRef]
- Annan, A.; Singh, A.; Dogbe, J.; Asante, D.; Owusu-Dabo, E. Health-Seeking Behaviour of Tuberculosis Patients and Related Factors in the Central Region of Ghana. J. Sci. Technol. 2014, 33, 27. [Google Scholar] [CrossRef]
Health Literacy Domain | Healthcare Seeking Domain | Predisposing Factors Domain | Enabling Factors Domain |
---|---|---|---|
Knowledge of symptoms and transmission of tuberculosis disease | Medication adherence domain: using Morisky’s medication adherence questionnaire (already validated in India) [12] | Socio-demographic characteristics of PLHIV attending a district antiretroviral (ART) center | Perceived stigma (Berger’s HIV Stigma Scale: already validated in India) [13] |
Client satisfaction with healthcare services for the diagnosis and treatment of tuberculosis | Healthcare accessibility and factors related to delays in treatment-seeking behavior for tuberculosis | ||
24 items | 26 items | 10 items | 31 items |
Domains | Items | Experts (n) who Deemed the Items as Essential | Lawsche’s Score for CVR | Interpretation |
---|---|---|---|---|
Domain 1: Knowledge of symptoms and transmission of TB among PLHIV | 24 | 24 | 1.0 for all items | All items accepted for the final scale |
Domain 2: Healthcare accessibility and factors related to delays in treatment seeking for TB among PLHIV | 31 | 27 | 1.0 for 27 items | All items accepted for the final scale |
0.9 for 4 items | Accepted with modifications and included in the final scale | |||
Domain 3: Client satisfaction regarding diagnostic and treatment-seeking behavior for TB among PLHIV | 26 | 14 | 1.0 for 14 items | All items accepted for the final scale |
≤0.62 for 12 items * | Rejected and not included in the final scale |
Domains | Number of Items | I-CVI ≥ 0.62 | S-CVI (Average) | S-CVI (Proportional Relevance) | S-CVI (Universal Agreement) | Interpretation |
---|---|---|---|---|---|---|
Domain 1: Knowledge of symptoms and transmission of TB among PLHIV | 24 | 24 | 0.991 | 0.991 | 0.92 | All items accepted for the final scale |
Domain 2: Healthcare accessibility and factors related to delays in treatment seeking for TB among PLHIV | 31 | 31 | 0.987 | 0.987 | 0.87 | All items accepted for the final scale |
Domain 3: Client satisfaction regarding diagnostic and treatment-seeking behavior among PLHIV | 26 | 26 | 0.917 | 0.846 | 0.038 | Only 12 items were not accepted as these items affected the Universal Agreement |
Domains | Items | CVR | I-CVI | S-CVI (Average) | S-CVI (Proportional Relevance) | S-CVI (Universal Agreement) | Interpretation |
---|---|---|---|---|---|---|---|
Domain 1 Knowledge of symptoms and transmission of tuberculosis | 1 | 1 | 1 | 0.991 | 0.991 | 0.916 | Excellent; can be included in the final tool |
2 | 1 | 1 | |||||
3 | 1 | 0.9 | |||||
4 | 1 | 1 | |||||
5 | 1 | 1 | |||||
6 | 1 | 1 | |||||
7 | 1 | 1 | |||||
8 | 1 | 1 | |||||
9 | 1 | 1 | |||||
10 | 1 | 0.9 | |||||
11 | 1 | 1 | |||||
12 | 1 | 1 | |||||
13 | 1 | 1 | |||||
14 | 1 | 1 | |||||
15 | 1 | 1 | |||||
16 | 1 | 1 | |||||
17 | 1 | 1 | |||||
18 | 1 | 1 | |||||
19 | 1 | 1 | |||||
20 | 1 | 1 | |||||
21 | 1 | 1 | |||||
22 | 1 | 1 | |||||
23 | 1 | 1 | |||||
24 | 1 | 1 | |||||
Domain 2 Healthcare accessibility and factors related to delays in treatment seeking for tuberculosis among PLHIV | 1 | 1 | 1 | 0.987 | 0.987 | 0.87 | Excellent; can be included in the final tool |
2 | 1 | 1 | |||||
3 | 1 | 1 | |||||
4 | 1 | 1 | |||||
5 | 1 | 1 | |||||
6 | 1 | 1 | |||||
7 | 1 | 1 | |||||
8 | 1 | 1 | |||||
9 | 1 | 1 | |||||
10 | 1 | 1 | |||||
11 | 1 | 1 | |||||
12 | 1 | 1 | |||||
13 | 1 | 1 | |||||
14 | 1 | 1 | |||||
15 | 0.8 | 1 | |||||
16 | 1 | 1 | |||||
17 | 1 | 1 | |||||
18 | 0.8 | 1 | |||||
19 | 1 | 0.9 | |||||
20 | 1 | 0.9 | |||||
21 | 1 | 0.9 | |||||
22 | 1 | 1 | |||||
23 | 1 | 1 | |||||
24 | 1 | 0.9 | |||||
25 | 1 | 1 | |||||
26 | 1 | 1 | |||||
27 | 1 | 1 | |||||
28 | 1 | 1 | |||||
29 | 1 | 1 | |||||
30 | 1 | 1 | |||||
31 | 1 | 1 | |||||
Domain 3 Client satisfaction regarding diagnostic and treatment-seeking behavior among PLHIV | 1 | 1 | 1 | 0.917 | 0.846 | 0.038 | Excellent; can be included in the final tool |
2 | 1 | 0.9 | |||||
3 | 1 | 0.9 | |||||
4 | 1 | 0.9 | |||||
5 | 1 | 0.9 | |||||
6 | 1 | 0.9 | |||||
7 | 1 | 0.9 | |||||
8 | 1 | 0.9 | |||||
9 | 1 | 0.9 | |||||
10 | 1 | 0.9 | |||||
11 | 1 | 0.9 | |||||
12 | 0.4 | 0.8 | Poor; not included in the final tool | ||||
13 | 0.2 | 0.8 | |||||
14 | 0.2 | 0.8 | |||||
15 | 1 | 0.8 | Excellent; can be included in the final tool | ||||
16 | 0.4 | 0.8 | Poor; not included in the final tool | ||||
17 | 0.2 | 0.8 | |||||
18 | 0.2 | 0.8 | |||||
19 | 1 | 0.8 | Excellent; can be included in the final tool | ||||
20 | 0.6 | 0.8 | Poor; not included in the final tool | ||||
21 | 0.4 | 0.8 | |||||
22 | 0.6 | 0.8 | |||||
23 | 1 | 0.8 | Excellent; can be included in the final tool | ||||
24 | 0 | 0.8 | Poor; not included in the final tool | ||||
25 | 0 | 0.8 | |||||
26 | 0 | 0.8 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Jacob, A.M.; Jacob, J.; Peersman, W.; Shetty, A.K. The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India. Trop. Med. Infect. Dis. 2024, 9, 181. https://doi.org/10.3390/tropicalmed9080181
Jacob AM, Jacob J, Peersman W, Shetty AK. The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India. Tropical Medicine and Infectious Disease. 2024; 9(8):181. https://doi.org/10.3390/tropicalmed9080181
Chicago/Turabian StyleJacob, Ankeeta Menona, Jeni Jacob, Wim Peersman, and Avinash K. Shetty. 2024. "The Content Validity of an Instrument That Measures Health-Seeking Behavior for Tuberculosis among People Living with HIV in India" Tropical Medicine and Infectious Disease 9, no. 8: 181. https://doi.org/10.3390/tropicalmed9080181