Development and Validation of a Specific Questionnaire for Measuring the Attitude and Behavior of Mask Use in Pandemics with the Dominant Airborne Pattern: the Experience of COVID-19

Abstract

Background and Objectives: Masks play a crucial role in preventing and controlling viral epidemics transmitted predominantly through the air. This study aimed to develop and validate a tool to measure people’s attitudes and behaviors related to mask usage during highly contagious viral epidemics. Methods: In this psychometric study, the initial questionnaire was developed and face validity and content validity were assessed by 17 experts and three lay experts. Reliability was evaluated through internal consistency using Cronbach’s alpha and test-retest reliability using the Intraclass Correlation Coefficient (ICC). Construct validity was measured using exploratory factor analysis (EFA) with the principal component extraction method and Varimax rotation. Results: Based on a review of previous studies, an initial 27-item questionnaire was crafted. During the face validity stage, two items were excluded. Through calculating the Content Validity Ratio (CVR) and the Content Validity Index (CVI), three and one items respectively removed. The average scale level content validity index (S-CVI/Ave) was 0.95. Cronbach's alpha coefficient was found to be 0.76 for attitude and 0.66 for practice sections; the ICC was equal to 0.873. EFA revealed two factors explaining 63.98% of the total variance. Conclusion: This questionnaire demonstrated sound reliability and validity in Persian, providing an effective means to assess attitude and behavior related to mask usage during highly contagious viral epidemics. It stands as a valuable tool for use in Iran and other countries.