Development and validation of an Arabic questionnaire to assess the knowledge of neonatal danger signs (AQ-KNDS) and its possible determinants among Arab population.

Background: The neonatal period is the most dangerous time during which the newborn challenges the highest risk of death. This study aimed to develop a validated questionnaire to assess the knowledge of the population about neonatal danger signs (NDS) in Arab-speaking communities.

Methods: A cross-sectional survey was conducted; participants were recruited from the population visiting El-Raml Pediatric Hospital and El-Shatby Hospital in Alexandria in 2023.The study used Item Response Theory (IRT) techniques to evaluate the validity of the Arabic questionnaire. Various IRT models (1PL, 2PL, 3PLS) were employed to improve the scale's accuracy. To assess how the item response model fits the data, we used the M2 index and other fit indices (Comparative Fit Index (CFI), Tucker-Lewis index (TLI), Akaike Information Criterion (AIC), and Bayesian Information Criterion (BIC)). Additionally, item fit indices including Pearson's χ2 and Root Mean Square Error of Approximation (RMSEA) were measured to determine how well each item fits the final model. Reliability was assessed using Cronbach's alpha and test-retest reliability. Additionally, we utilized a logistic regression model to identify the predictors of knowledge of the NDS.

Results: A total of 283 participants were included, their mean age was 32.3 ± 8.62 years, 96.5% were female, 94.7% were currently married, 27.6% had a university or higher education, and 83.7% were of urban residence. The final questionnaire consists of 16 items. The best model was retained where its M2 statistics were comparatively low indicating that there was no significant difference between the model and the data (M2 = 84 with 88 degrees of freedom and a P = 0.688) with the following fit measures RMSEA = 0.001, AIC = 2650.04, BIC = 2825.7, and TLI and CFI were 1.0. Full information factor analysis indicated that the total proportion of variance extracted by the model was 63.7%. Multiple logistic regression indicated that the explanatory variables for the level of knowledge toward danger signs were female sex (AOR = 5.54, 95% CI:1.25-31.0, P = 0.034), age (AOR = 1.04. 95%CI:1.01-1.08, P = 0.025), and working outside the medical field (AOR = 3.26, 95%CI: 1.14-9.73, P = 0.034).

Conclusions: The developed questionnaire is valid and reliable in informing public health policymakers about community awareness regarding NDS and implementing interventions to improve neonatal health and reduce newborn morbidity and mortality rates.