Development and validation of “Knowledge on screening and identification of mental illness (KSIM) questionnaire” among primary care nurses in India

BACKGROUND: As stated in the World Health Organization's Mental Health Report 2022, 13%, or almost a billion people, had a mental health issue, and 82% of these people resided in low- and middle-income countries with limited access to mental health treatments. Successful integration of mental health services into primary healthcare depends on primary healthcare providers receiving the proper training and information required to provide basic mental health care in the community. Primary care nurses generally lack the confidence and skills to handle mental health issues while being in an excellent position to screen, identify, refer, and follow-up on a person with mental illness (PMI). The study aimed to develop and validate the KSIM questionnaire to assess the knowledge of primary care nurses in screening, identifying, referral, and follow-up persons with mental health issues in the community. MATERIALS AND METHODS: The study was conducted based on a sequential exploratory design in two phases: the development and the validation phases. An extensive literature search was done, and the themes derived from the two focus group discussion (FGD) and three direct interviews, and the inputs from the mental health experts were used to design the KSIM questionnaire. A panel of 17 experts validated the KSIM questionnaire through item-level content validity index (I-CVI) and scale-level CVI (S-CVI) for content validation, and the reliability test was done using the intraclass correlation coefficient ICC test–retest method. RESULTS: The draft version-1 of the KSIM questionnaire showed high content validity of individual items (I-CVI range: 0.82–1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The KSIM questionnaire consists of 30 multiple choice questions and 10 case vignettes. The KSIM questionnaire has a very good test–retest reliability using the single measure two-way mixed absolute agreement ICC value 0.97 with 95% CI. CONCLUSIONS: Using an iterative approach, the development and validation of the KSIM questionnaire demonstrated high I-CVI and S-CVI with good ICC test-retest reliability to assess the knowledge of primary care nurses on screening and identification, referral and follow-up of a PMI in the community. Primary care nurses' knowledge on how to screen for and identify people with mental health issues in the primary care setting can be evaluated with the help of the KSIM questionnaire, and providing need-based training may help to reduce the time taken for people with mental illness to receive professional help.