Development and validation of questionnaire to assess exposure of children to enteric infections in the rural northwest Ethiopia

In areas where children have multiple environmental exposures to enteric pathogens, identifying the sources of exposure by measuring external and internal exposures to enteric pathogens and complementing by questionnaire and observational checklist to capture behaviors resulting risk of exposure is critical. Accordingly, this study was conducted to design valid and reliable questionnaire to assess behaviors and environmental conditions resulting exposure to enteric pathogens in the rural northwest Ethiopia. We began with a thorough exploration of relevant literature to understand the theoretical framework on the research objectives to identify variables to highlight what the questionnaire is measuring. We then generated items in each domain that can effectively address the study objectives and we refined and organized the items in a suitable format. Then after, we conducted face and content validity by involving experts on the research subject. After pre-testing a pre-final version of the instrument generated in the content validity study, we conducted a pilot study in 150 randomly selected rural households to test the internal consistency reliability. We used content validity ratio (CVR), item-level content validity index (I-CVIs), scale-level content validity index (S-CVI/UA), and modified kappa statistics to measure content validity of items. Moreover, we used agreement and consistency indices (i.e., Cronbach’s alpha) to assess the internal consistency of items. The content validity test result showed that the value of CVR was 0.95, I-CVIs was 0.97, and modified kappa was 0.97 for the whole items, indicating all the items are appropriate. The scale-level content validity index (S-CVI/UA) was 0.95 for the whole items indicating the agreement among judges to each items is higher. The internal consistency reliability test result indicated that Cronbach’s alpha for the pre-final version of the pre-final tool was 0.85, indicating the strong reliability of the tool. The final version of the questionnaire was, therefore, prepared with 8 dimensions and 80 items. In this study, we designed valid and reliable questionnaire to assess behaviors and environmental conditions that result high risk of exposure to enteric infections in rural settings. The questionnaire can be used as a tool in the rural settings of developing countries with some amendments to account local contexts. However, this questionnaire alone does not measure exposure of children to enteric infections. It only complements external and internal exposure assessments.