Development and psychometric evaluation of the knowledge, attitudes, and practices toward complementary and alternative medicine in stroke.

Abstract

Background: Stroke is a major public health concern and leading cause of long-term disability. Complementary and alternative medicine (CAM) is increasingly used in stroke management, yet public knowledge, attitudes, and practices (KAP) regarding its use remain poorly understood. Misconceptions or lack of awareness may lead to unsafe practices and delays in seeking medical care.

Objective: The study aimed to develop the Knowledge, Attitude and Practice toward Complementary and Alternative Medicine use in Stroke Management (KAP-CAM-Stroke) questionnaire and conduct an initial psychometric evaluation.

Methods: This multi-phase instrument-development study comprised Phase I, which included item generation, content validation using a two-round Delphi technique, face validity, and pilot testing, and Phase II, which used a cross-sectional survey to conduct an initial psychometric evaluation in 136 members of the Malaysian public. IRT was applied to the knowledge domain, whereas EFA was used for the attitude and practice domains.

Results: The final questionnaire comprised 58 items across four sections: sociodemographic (16 items), knowledge (10 items), attitude (10 items), and practice (22 items). Content validity was supported by S-CVI/Ave values of at least 0.90 after Delphi Round 2. IRT identified variable item performance in the knowledge domain, including an unstable extreme discrimination estimate for item K4. EFA identified a four-factor attitude structure explaining 63.84% of the variance (Cronbach's alpha = 0.655) and a six-factor practice structure explaining 74.94% (Cronbach's alpha = 0.860). These findings provide preliminary evidence of content and structural validity; internal consistency met the prespecified threshold for the knowledge and practice domains but not for the attitude domain.

Conclusion: The KAP-CAM-Stroke questionnaire provides preliminary psychometric evidence for assessing public knowledge, attitudes, and practices regarding CAM use in stroke management. Further evaluation in larger and more diverse samples, including test-retest reliability and confirmatory factor analysis, is required before the instrument can be considered fully validated.