Development and validation of a Knowledge, Attitudes and Practices (KAP) questionnaire for healthcare professionals on environmental sustainability in healthcare in Southern Africa

Global environmental degradation is increasingly driving poor health outcomes worldwide. Healthcare systems and services are often not environmentally sustainable and compound the problem, while healthcare professionals are also recognised as key leaders in advancing sustainable healthcare. To adopt this leadership position, healthcare professionals' knowledge, attitudes, and practices regarding environmental sustainability in healthcare must be established. This article reports the development and validation of a new instrument for this purpose that corresponds to the specificities of the Southern African context. Questionnaire development followed a seven-stage process. Information was obtained from a 2021 study titled 'South African Healthcare Professionals' Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study' to develop the instrument. Information was also sourced from the literature regarding environmental sustainability and healthcare to generate the first questionnaire with 29 items. The following stages included two rounds of expert input, separated by a pilot study with the target population to receive feedback regarding the instrument's structure, relevance, and length. Content validity was determined through statistical analysis. Feedback was received from nine experts in stage two and 13 pilot-study participants in stage four and incorporated to improve the questionnaire. In stage six, the questionnaire was rated by seven experts. The content validity index of the questionnaire was calculated at two different stages, after which the indices were compared. Following a final edit, the questionnaire has 24 questionnaire items. The closing analysis calculated the scale content validity index average (S-CVI/Ave) of 0,922; this indicates that the final questionnaire has excellent content validity. A questionnaire that assesses the knowledge, attitudes and practices of healthcare professionals regarding environmental sustainability in Southern Africa has been developed and validated. This questionnaire can now be used for further studies in Southern Africa.