Development and reliability testing of an orthopaedic nurses' knowledge, attitudes, and practices (KAP) questionnaire on perioperative nutrition management for older adults with hip fractures

Abstract

Background

In China, orthopaedic nurses serve as the primary providers of perioperative nutritional management for older adults with hip fractures. Their knowledge, attitudes, and practices regarding nutritional management directly impact protocol implementation, therapeutic efficacy, and patient rehabilitation outcomes. Although enhancing these competencies is crucial, no validated assessment tool currently exists for this specific context.

Objective

To develop and validate a questionnaire assessing orthopaedic nurses' knowledge, attitudes, and beliefs regarding perioperative nutritional management for older adults with hip fractures.

Methods

The preliminary questionnaire was developed based on the Knowledge-Attitude-Practice (KAP) theory framework, incorporating literature analysis, a two-round Delphi expert consultation, and a pilot survey. Using convenience sampling, we recruited 387 orthopaedic nurses from 11 tertiary-level public hospitals (Grade B or above) in Jiangsu Province between October and December 2024. The questionnaire underwent rigorous item analysis, reliability assessment and validity testing.

Results

The final questionnaire comprised 39 items across three dimensions, demonstrating excellent reliability (Cronbach's α = 0.977) and validity (item-level CVI = .800–1.000; scale-level CVI = .923). Exploratory factor analysis supported the theoretical Knowledge-Attitude-Practice framework, extracting three factors with loadings of .591–.855 that collectively explained 72.396 % of variance. Confirmatory factor analysis further validated the structure, showing acceptable model fit indices and questionnaire stability.

Conclusion

The Orthopaedic Nurses' Knowledge, Attitudes and Practices (KAP) on Perioperative Nutritional Management for Older Adults with Hip Fractures Questionnaire demonstrates robust psychometric properties, establishing its validity and reliability as an assessment tool for evaluating nursing competencies in this clinical domain.