Introduction

Tuberculosis (TB) is an infectious-contagious disease caused by Mycobacterium tuberculosis. According to the World Health Organization (WHO), in 2022, it was estimated that 10.6 million people got TB in 2021, and 1.6 million people died due to it (1). In labor health terms, all over the world, 9,299 cases of TB in healthcare workers were reported (1).

In Colombia, in 2022, 17,460 cases of TB were reported, with an incidence rate of 31 cases per 100,000 people; 84.9% corresponded to cases of pulmonary TB, and 15.1% cases were extrapulmonary TB. Equally, it was reported 12% of coinfected cases with TB and human immunodeficiency virus (HIV), and in total, 213 cases of drug-resistant TB were presented (2).

This disease is considered a risk factor that can affect the well-being of healthcare workers. Different investigations have demonstrated that the probability of contagion is two or three times higher in this population group than in the general population (3,4). Also, it has been related to low levels of knowledge about TB, with deficient control measures at the administrative level and personal protection that increases the risk of transmission between people and healthcare personnel (5-8). In this sense, evaluating objectively the knowledge, attitudes, and practices (KAP) about TB of the healthcare workers, allows the identification of strengths and weaknesses to develop effective and efficient strategies that increase self-care and care for everyone else (7,8).

The measurement instruments are tools that allow quantifying constructs. To achieve this objective, they must undergo validation processes that guarantee the confirmability and validity of the collected data (9). The WHO has developed a methodology guide to orient the development of valid and reliable instruments that allow the evaluation of KAP based on promotion, communication, and social mobilization activities (10).

Scientific literature evidenced different instruments that measure KAP in continents like Asia and Africa, where the translation and adaptation processes were unviable because epidemiologic, normative, and cultural contexts differed from the Colombian contexts (11,12). Conversely, no valid or reliable instruments have evaluated KAP on TB among healthcare workers in Colombia.

For this reason, the objective of this investigation was to design and validate an evaluating instrument of KAP on TB healthcare workers in Colombia.

Methodology

Study design

Content, face, and construct validation study of the instrument knowledge, attitudes, and practices about TB for healthcare workers (KAP-TB in workers) (13-15)(Figure 1).

Sample

Content validity

Five experts participated for the content validity indices, following the recommendations of Tristan-Lopez (16) to be able to use a modified Lawshe index for each of the items.

Face validation

For the face validity study, 32 healthcare workers were enrolled, the minimum sample number recommended by Perneger et al. (17), which allows to know if there is confusion about any item and if healthcare professionals have suggestions for possible improvements to the items. Likewise, having this validation allows us to have an approximate idea of the distribution of the response to each item, which can be informative to determine if there is enough variation in the response.

Construct validation

Regarding the validation of the construct, because 44 items and three dimensions are expected, that is, there are 15 items per factor, the criteria given by Mundfrom (18) are considered. In this case, it is guaranteed that with at least 100 healthcare workers, we have an excellent level to obtain correlations between items and good performance of the factor analysis. Furthermore, according to the criteria given in Comrey (19), with at least 132 healthcare workers, we will have a ratio of 3 workers to 1 item, guaranteeing a good level of adequacy of the factor analysis. Therefore, with 140 healthcare workers, a good construct validity performance was obtained.

Inclusion and exclusion criteria

Content validation

The experts enrolled in the content validation were required to have at least five years of academic or professional experience related to TB in the Colombian context, experience in instrument validation psychometric processes in the healthcare sector and agree to participate. Those experts who sent their evaluation outside the established times were excluded.

Face validation

The inclusion criteria in the face validation phase were workers from a healthcare institution, technicians or professionals in the healthcare industry, a minimum of one year’s experience in TB-related issues, having internet access, and a computer or smartphone. Workers with a history of TB and students studying healthcare sciences were excluded.

Construct validation

Finally, the workers included in the construct validation had to be healthcare personnel with employment contract, have access to the internet and a mobile device or computer, and sign the informed consent. Workers with a history of TB and healthcare science students were excluded.

Data collection

Data collection was carried out in phases. Content validity was assessed through a panel of five experts. The judges evaluated the sufficiency, clarity, and relevance (20-22) through a scale from one to four (1. Does not meet the criteria, 2. Low level, 3. Moderate level, and 4. High level) (23).

In the face validation, the understandability of the KAP- TB in healthcare workers was assessed. The instrument was evaluated through the Google Forms platform, where the participants were asked directly whether each item was understandable; it was applied to 32 healthcare workers.

Finally, construct validation was carried out using the latest version of the KAP-TB instrument in healthcare workers through a Google form between November and December 2020; it was applied to 140 healthcare workers.

Type of analysis

Content validity

For content validity, the validity agreement between the judges was calculated and measured with the Lawshe Content Validity Index by item (CVR’) and Global (CVI). The following formulas were used (16,24):

● Formula for content validity modified for each item:

Where:

ne = Number of experts who have agreement on the category per item.

n = Total number of experts

The adjusted validity index was used as an acceptance criterion for item validity:

The criterion “Correction of the minimum value of the CVR” used to accept each item was CVR’> 0.583. Each item must be 58% acceptable, regardless of the number of evaluators (16).

Face validation

On the other hand, in face validation, a descriptive and qualitative analysis of the questions was carried out to identify percentages of clarity. In those items where the user expressed concerns, adjustments were made to the writing and grammar of the question.

Construct validation

Finally, construct validation was carried out with 140 healthcare workers. An exploratory factor analysis was carried out for this validation using the Kaiser- Meyer-Olkin measure of sampling adequacy (>0.60).

Additionally, Bartlett’s test of sphericity was applied to identify that the correlation between the items of the instrument is significant (p<0.001) (25,26). In the same way, Cronbach’s Alpha was calculated to quantify the instrument’s reliability level. The information was entered and refined in Excel version 2019 and processed in SPSS version 25.0.

Ethical considerations

Regarding ethical considerations, in this research, the national and international provisions related to research ethics, outlined in Resolution 8430 of 1993 of the Ministry of Health (27), were respected. In addition, this research had ethics approval 013-19 from the Faculty of Nursing of the Universidad Nacional de Colombia. The participants in each phase voluntarily signed the informed consent in which they agreed to participate.

Results

• Literature review

A total of 14 articles were selected. The instrument’s development was identified to measure validated and reliable KAP in most countries with a high incidence of TB in Asia and Africa (23.10%) (6,8,28–32)(Table 1).

Three evaluating dimensions of the instrument were recognized: knowledge, attitudes, practices, and the items that conformed to each dimension. The following components were identified in the knowledge dimension: the etiology, transmission, control measures, treatment, and diagnosis of TB in the transversal studies revised (6,8,32,33). The attitudes were more heterogenic; not all the instruments evaluated them (5,33–35); however, the perceptions against TB as a labor disease, control measures, feelings, and stigma were the most frequent aspects. The practice dimension was also not considered in all the revised articles (8,29,32). Still, the items related to the development of controlled activities and prevention, the use of personal protection, and the contact investigation of people affected with TB were highlighted.

• Instrument design

Three principal dimensions (knowledge, attitudes, and practices) and an initial version of 44 items were established. Subsequently, the knowledge scale was defined as correct and incorrect. For attitude and practice, a Likert scale was used: never, rarely, frequently, almost always, and always.

Table 1. Literature review on KAP measurement instruments, 2020.

● Content validation

The content validation was realized through a panel of five experts in TB disease who have experience in psychometric processes of instrument validation for health measurement. The 44 items obtained a CVR’, sufficiency greater than 0.58. The global index of sufficiency was 0.97. The consensus was reached in two rounds.

The clarity evaluation process indicated that 43 items obtained a CVR superior of 0.58. The only item underneath the limit was question 17, “Is extrapulmonary tuberculosis diagnosed with tissue samples?” (CVR’ 0.40). The global index in terms of clarity was 0.95.

In the case of relevance, all the items reached the index of Lawshe’s Adjusted Validity, achieving a Global Content Validation Index, which was 0.96 (Table 2).

Table 2. Evaluation of the adequacy, clarity, and relevance of the Tuberculosis Knowledge, Attitudes, and Practices Instrument for health care workers.

● Face validity

A pilot test was conducted with 32 healthcare workers to evaluate how understandable the instrument items were (Table 3). The understandability of the instrument ítems reached 84%. Seven questions received observations and were subjected to a revision of clarity, content, and grammar by the investigators. Six questions were adjusted, and question 31 was deleted from the attitudes dimension, achieving a second version of 43 items.

Table 3.Sociodemographic characteristics of healthcare workers pilot test, 2020.

● Construct validity

Exploratory factorial analysis

An exploratory factorial analysis was conducted with 140 healthcare workers to validate the construct. The knowledge items were grouped into three factors, the attitudes, and practices in one factor each. The pertinence of the factorial analysis was evaluated with Kaiser-Meyer-Olkin sampling adequacy, which was 0.741, and Bartlett’s sphericity test demonstrated that the matrix items are significantly correlated (p < 0.001). Finally, the intern consistency was evaluated, and a Cronbach’s Alpha of 0.72 was obtained.

The factors selection with the criteria of the eigenvalues greater than two, was fulfilled three factors with an explained variance of 44.70%. Each of the factors was presented as follow: F1 – knowledge (23.50%), F2 –attitudes (11.50%), and F3 – practices (9.70%).

In the evaluation of factorial weights or loadings of each instrument item, the second factor of knowledge is the one that contributes more weight to the construct (two with high positive correlations and one with high negative correlation). In the third factor of practices, the highest weights were observed in items 28, 29, 30 y 3 (high positive correlations) (Table 4).

Table 4. Exploratory factor analysis. Matrix of factor loadings of the rotated factors.

Items 26, 27, and 32 were not part of the attitudes factor. However, they are not excluded from the final version of the instrument cause of the consensus and expertise of the authors; they are considered relevant to this dimension evaluation.

Finally, the KAPTB-HW instrument, which has 3 dimensions and 43 questions, is validated.

Discussion

The KAP-TB instrument for healthcare workers has undergone successful validation of its content, comprehensibility, and construct through a systematic, statistical, and reliable process. The validation of questionnaires within the healthcare field is a crucial process, ensuring the reliability and validity of data collection; our study provides a robust instrument for assessing the knowledge, attitudes, and practices related to TB among healthcare workers.

It is important to note that studies on the three dimensions among healthcare workers in Latin America are very scarce or even unexisting, despite the region being home to countries with a high and medium burden of disease. Most relevant research in these areas is conducted in African and Asian countries: this disparity underscores a gap in Latin American research and reveals the region’s scarcity and low quality of research processes.

Additionally, some studies measure the KAP regarding TB in healthcare workers using instruments lacking demonstrated validation or reliability (38,39), or with validation limited to face (40). This scenario introduces information bias, as data collected through unvalidated instruments risks producing unreliable yet statistically significant information. Hence, the validation of measurement instruments becomes highly relevant, supporting methodological rigor and the generation of reliable results (41).

Next, the validation processes in this research will be compared to those of similar investigations. Irani et al. (32) developed a KAP questionnaire on TB for healthcare workers in Iran, primarily relying on available scientific literature. Unlike this study, content validity was solely assessed qualitatively with a panel of experts. Similarly, Noe et al. (7) employed a KAP instrument on TB for healthcare workers in Mozambique. This instrument was evaluated through a pilot test involving 32 healthcare workers. Conversely, Van Rensburg et al. (5) noted that their pilot study in South Africa enhanced reliability and achieved both face and content validity, as it facilitated clarification of certain dimensions and adjustments to the measurement.

Pradipta et al. (42) developed a KAP instrument tailored for healthcare workers in Indonesia. Their questionnaire was based on recommendations from the WHO KAP survey guide, the national tuberculosis guidelines of Indonesia, and expert consensus. Their methodology is similar to ours, as we also reviewed and incorporated the WHO guide during the instrument development. Additionally, Resolution 227 of 2020 from the Ministry of Health and Social Protection was a foundational reference, and input from field professionals was sought to ensure thoroughness and relevance.

However, there are points of agreement and discrepancies regarding the design of KAP instruments on tuberculosis for healthcare workers. In terms of knowledge, the most relevant aspects to assess are the cause of tuberculosis, modes of transmission, symptoms, signs, diagnosis, and treatment; these elements are included in the instrument used in this study (42,43).

Conversely, various authors have approached the dimension of attitudes differently. An Y. et al. (43) assessed perceptions about the disease within this construct, whereas Pradipta et al. (42) interpreted attitudes in terms of the workers’ risks, beliefs, and capacities. In contrast, we defined attitudes as encompassing beliefs, feelings, thoughts, and values towards the disease. Finally, the definition of practices did not present difficulties because, in all the studies, it is related to the activity carried out by the healthcare worker or their duties.

In terms of construct validation, research has been conducted in African countries with a high incidence of tuberculosis to identify KAP regarding childhood TB among different healthcare workers. For example, in Cambodia, the KAP of 330 healthcare workers were evaluated using an instrument that covered three dimensions: knowledge, attitudes, and practices. The evaluation of each dimension achieved a Cronbach’s Alpha of 0.856, 0.653, and 0.676, respectively

(43).

In Indonesia, a KAP instrument tailored for healthcare workers, particularly pharmacy personnel, was developed and validated. The questionnaire comprised 40 items distributed across three dimensions. Face, content, and construct validity were achieved through a pilot test involving 200 healthcare workers. The instrument demonstrated moderate reliability with Cronbach’s Alpha coefficients of 0.63 for knowledge, 0.69 for attitudes, and 0.79 for practices (42).

The Cronbach’s Alpha achieved by our instrument was 0.72, which is considered acceptable. This result indicates a moderate correlation between the items. However, it is important to highlight that acceptability criterion can vary depending on the context of its application, the type of scale used, and the population studied.

Additionally, it is important to mention that instruments have also been designed and validated for patients with TB. Muñoz-Sánchez et al. (12) developed a KAP instrument for people with TB in Colombia. After evaluation by experts and the target population, the instrument proved to be sensitive, reliable, and valid, underscoring its usefulness in measuring health education and its impact on this population. This study is particularly relevant because it represents the first attempt to validate an instrument with this purpose in the country. Scatena et al. (44) validated an instrument in Brazil to evaluate the structure of primary healthcare units in the treatment of TB. They concluded that such tools are useful for determining the feasibility of their application and their potential use in primary care units for tuberculosis treatment.

Given the points mentioned previously, it is recognized how important it is to conduct studies to develop and validate KAP instruments for TB among healthcare workers. These studies are crucial in both public and occupational health domains.

Limitations

We recognize some limitations in the development of the instrument. The attitudes dimension had fewer questions and received a lower rating than the other dimensions. Moreover, it underwent substantial modifications based on feedback from experts and healthcare workers regarding its comprehensibility. These limitations stem from both inherent and external factors related to the instrument, including the selected sample and the wording of the questions.

Furthermore, the COVID-19 pandemic contributed to delays in the data collection process, which is acknowledged as an additional limitation in this study.

Conclusion

It is important to mention that a group of highly skilled thematic and methodological experts validated the results of this study. Additionally, a pilot group of healthcare workers, specialists in TB, adjusted the comprehensibility and grammar. Finally, construct evaluation demonstrated the presence of three robust dimensions with strongly related items.

This process evidences an organized, systematic, and statistically rigorous approach, yielding a validated, reliable, and updated instrument tailored to the Colombian context.

Assessing the KAP of healthcare workers identifies the need for continuous health education within this population, thus strengthening the processes of constant improvement in tuberculosis programs.

It is recommended that the validation processes of this instrument continue to enhance the attitude dimension, ensuring a valid, reliable, and helpful tool for the Colombian context and its target population.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Funding

This research derives from the degree work entitled “Design and Validation of an Instrument for the Evaluation of Knowledge, Attitudes, and Practices on Tuberculosis in Healthcare Workers” developed within the research project “Effectiveness of an educational strategy on Tuberculosis with the use of ICT tools in a Specialized Hospital Medical Unit in the city of Bogotá” with code 45982, financed by the Ministry of Science, Technology, and Innovation. Contract 444 of 2020.

Ethical responsibilities

Protection of people: This study is considered risk-free due to its nature. It was approved by the Institutional Ethics Committee.

Confidentiality of data: The authors declare they have followed their work center’s protocols on the publication of patient data.

Right to privacy and informed consent: The authors have obtained the informed consent of patients and/or subjects mentioned in the article. This document is in the possession of the corresponding author referred to in the article.

References

1. World Health Organization. Global Tuberculosis Report 2022. [Internet]. Geneva:WHO;2022. Available from: https://www.who.int/publications/i/item/9789240061729

2. Ministerio de Salud y Protección Social. Informe de evento Tuberculosis año 2022. Programa Nacional de Prevención y Control de la Tuberculosis [Internet]. Bogotá:Minsalud;2022. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/comportamiento-tuberculosis-2020.pdf

3. Mendoza-Ticona A. Tuberculosis como enfermedad ocupacional. Rev Peru Med Exp Salud Pública. [Internet]. 2012;29(2):232-36. Available from: https://www.scielosp.org/pdf/rpmesp/2012.v29n2/232-236/es

4. Muñoz-Sanchez AI. Control de la exposición ocupacional a tuberculosis en instituciones de salud. Med Segur Trab [Internet]. 2016;62(244):188-98. Available from: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0465-546X2016000300003

5. van Rensburg AJ, Engelbrecht M, Kigozi G, van Rensburg-DPhil D. Tuberculosis prevention knowledge, attitudes, and practices of primary health care nurses: Nurses’ TB prevention knowledge, attitudes and practices. Int J Nurs Pract [Internet]. 2018;24(6):e12681. doi: https://doi.org/10.1111/ijn.12681

6. Cruz-Martínez ÓA, Flórez-Suancha ÉL, Muñoz-Sánchez AI. Conocimientos sobre tuberculosis en trabajadores de la salud en una localidad de Bogotá D. C. Av En Enferm [Internet]. 2011;29(1):143-51. Available from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0121-45002011000100014&lng=pt&nrm=iso&tlng=es

7. Noé A, Ribeiro RM, Anselmo R, Maixenchs M, Sitole L, Munguambe K, et al. Knowledge, attitudes and practices regarding tuberculosis care among health workers in Southern Mozambique. BMC Pulm Med [Internet]. 2017;17(1):2. doi: https://doi.org/10.1186/s12890-016-0344-8

8. Carvajal-Barona R, Varela-Arévalo MT, Hoyos PA, Angulo-Valencia ES, Duarte-Alarcón C. Conocimientos, actitudes y prácticas frente a la tuberculosis en trabajadores del sector salud en municipios prioritarios de la Costa Pacífica colombiana. Rev Cienc Salud [Internet]. 2014;12(3):339-52. doi: https://doi.org/10.12804/revsalud12.03.2014.04

9. Alaminos A, Castejón Costa JL. Elaboración, análisis e interpretación de encuestas, cuestionarios y escalas de opinión [Internet]. Alicante:Universidad de Alicante;2006. Available from: http://rua.ua.es/dspace/handle/10045/20331

10. World Health Organization (WHO). Advocacy, communication and social mobilization for TB control: a guide to developing knowledge, attitude and practice Surveys [Internet]. Geneva:WHO;2008. Available from: https://www.who.int/publications/i/item/9789241596176

11. Antolinez-Figueroa C, Bello-Velásquez MC, Romero-Bernal LF, Muñoz-Sánchez AI. Instrumentos y herramientas de evaluación sobre conocimientos de tuberculosis. Enf Global [Internet]. 2017;16(4):499-531. doi: https://doi.org/10.6018/eglobal.16.4.262831

12. Muñoz-Sánchez AI, Rubiano-Mesa YL, Saavedra-Cantor CJ. Measuring instrument: knowledge, attitudes and practices of people with pulmonary tuberculosis. Rev Latino-Am Enfermagem [Internet]. 2019;27:e3086. doi: https://doi.org/10.1590/1518-8345.2608.3086

13. Castejón-Costa JL, Gilar R, González-Gómez MC, Miñano-Pérez P. Psicología de la educación. 1 Ed [Internet]. Canada:Club Universitario;2010. Available from: https://dokumen.pub/psicologia-de-la-educacion-1nbsped-8499482376-9788499482378.html

14. Polit D, Hungler B. Diseños de investigación para estudios cuantitativos. Sexta edición. México: McGraw Hill;2000.

15. Cruz-Martínez OA. Validación de instrumento para identificar el nivel de vulnerabilidad de los trabajadores de la salud a la tuberculosis en instituciones de salud. (IVTS TB001). [Tesis de Maestría]. Bogotá (Colombia): Universidad Nacional de Colombia [Internet]. 2016. Available from: https://repositorio.unal.edu.co/handle/unal/55364

16. Tristán-López A. Modificación al modelo de Lawshe para el dictamen cuantitativo de la validez de contenido de un instrumento objetivo. Avances en Medición [Internet]. 2008;6:37-48. Available from: https://www.humanas.unal.edu.co/lab_psicometria/application/files/9716/0463/3548/VOL_6._Articulo4_Indice_de_validez_de_contenido_37-48.pdf

17. Perneger TV, Courvoisier DS, Hudelson PM, Gayet-Ageron A. Sample size for pre-tests of questionnaires. Qual Life Res [Internet]. 2015;24:147-151. doi: https://doi.org/10.1007/s11136-014-0752-2

18. Mundfrom DJ, Shaw DG, Ke TL. Minimum Sample Size Recommendations for Conducting Factor Analyses. Int J Test [Internet]. 2005;5(2):159-68. doi: https://doi.org/10.1207/s15327574ijt0502_4

19. Comrey AL, Lee HB. A First Course in Factor Analysis. 2 Ed [Internet]. New York:Psychology Press;2013. doi: https://doi.org/10.4324/9781315827506

20. López-Franco MD, Parra-Anguita L, Comino-Sanz IM, Pancorbo-Hidalgo PL. Development and Psychometric Properties of the Pressure Injury Prevention Knowledge Questionnaire in Spanish Nurses. Int J Environ Res Public Health [Internet]. 2020;17(9):3063. doi: https://dx.doi.org/10.3390/ijerph17093063

21. Zhang W, Zeng L, Li J, Deng X, Jin M, Chen Z, et al. Construction and reliability and validity tests of the dietary self-management ability scale for kidney transplant recipients. Ann Palliat Med [Internet]. 2020;9(2):352-8. doi: https://dx.doi.org/10.21037/apm.2020.03.07

22. Dois A, Bravo P, Mora I, Soto G. Estudio de familia en Atención Primaria: construcción y validación de una herramienta para la valoración familiar. Rev Med Chil. [Internet]. 2019;147(5):589-601. doi: http://dx.doi.org/10.4067/S0034-98872019000500589

23. Escobar-Pérez J, Cuervo-Martínez Á. Validez de contenido y juicio de expertos: una aproximación a su utilización. Avances en Medición [Internet]. 2008;6(1):27-36. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=2981181

24. Lawshe CH. A quantitative approach to content validity. Pers Psychol [Internet]. 1975;28(4):563-75. doi: https://doi.org/10.1111/j.1744-6570.1975.tb01393.x

25. López-Aguado M, Gutiérrez-Provecho L. Cómo realizar e interpretar un análisis factorial exploratorio utilizando SPSS. Rev Innov Recer Educ [Internet]. 2019;12(2):1-14. Available from: http://revistes.ub.edu/index.php/REIRE/article/view/reire2019.12.227057

26. Lloret-Segura S, Ferreres-Traver A, Hernández-Baeza A, Tomás-Marco I. El análisis factorial exploratorio de los ítems: una guía práctica, revisada y actualizada. An Psicol [Internet]. 2014;30(3):1151-69. doi: https://dx.doi.org/10.6018/analesps.30.3.199361

27. Colombia, Ministerio de Salud y Protección Social. Resolución 8430 de 1993. Normas científicas, técnicas y administrativas para la investigación en salud. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.PDF

28. Trajman A, Wakoff-Pereira MF, Ramos-Silva J, Cordeiro-Santos M, Militão-de Albuquerque MF, Hill PC, et al. Knowledge, attitudes and practices on tuberculosis transmission and prevention among auxiliary healthcare professionals in three Brazilian high-burden cities: a cross-sectional survey. BMC Health Serv Res [Internet]. 2019;19(1):532. doi: http://dx.doi.org/10.1186/s12913-019-4231-x

29. da Silva-Gaspar LM, Braga C, Militäo-de Albuquerque GD, Nascimento-Silva MP, Maruza M, Ramos-Montarroyos U, et al. Conhecimento, atitudes e práticas de agentes comunitários de saúde sobre tuberculose pulmonar em uma capital do Nordeste do Brasil. Ciênc Saúde Coletiva [Internet]. 2019;24(10):3815-24. doi: https://doi.org/10.1590/1413-812320182410.01722018

30. Romani-Romani FR, Roque-Henríquez J, Catacora-López F, Hilasaca-Yngas G. Conocimientos, percepciones y prácticas de personal de salud en la detección de sintomáticos respiratorios en una región de muy alto riesgo de trasmisión de tuberculosis en el Perú. An Fac Med [Internet]. 2016;77(2):123. doi: http://dx.doi.org/10.15381/anales.v77i2.11816

31. Bhebhe LT, Van Rooyen C, Steinberg WJ. Attitudes, knowledge and practices of healthcare workers regarding occupational exposure of pulmonary tuberculosis. Afr J Prim Health Care Fam Med [Internet]. 2014;6(1):1-6. doi: http://dx.doi.org/10.4102/phcfm.v6i1.597

32. Irani AD, Shahraki AH, Ghaderi E, Nasehi M, Mostafavi E. Lack of optimum practice among health care workers regarding tuberculosis in Iran: A knowledge, attitude, and practice study. Am J Infect Control [Internet]. 2015;43(5):e7-12. doi: http://dx.doi.org/10.1016/j.ajic.2015.01.020

33. Alotaibi B, Yassin Y, Mushi A, Maashi F, Thomas A, Mohamed G, et al. Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj. PloS One [Internet]. 2019;14(1):e0210913. doi: http://dx.doi.org/10.1371/journal.pone.0210913

34. Ramathebane MM, Makatjane TJ, Thetsane RM, Mokhethi M. Assessment of tuberculosis knowledge among Lesotho village health workers and utilisation of their tuberculosis services by the communities they serve. Afr J Prim Health Care Fam Med [Internet]. 2019;11(1):e1-7. doi: http://dx.doi.org/10.4102/phcfm.v11i1.1944

35. Alene KA, Adane AA, Yifiru S, Bitew BD, Adane A, Koye DN. Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study. BMJ Open [Internet]. 2019;9(2):e022948. doi: http://dx.doi.org/10.1136/bmjopen-2018-022948

36. Ou Y, Luo Z, Mou J, Ming H, Wang X, Yan S, et al. Knowledge and determinants regarding tuberculosis among medical students in Hunan, China: a cross-sectional study. BMC Public Health [Internet]. 2018;18(1):730. doi: http://dx.doi.org/10.1186/s12889-018-5636-x

37. Montagna MT, Napoli C, Tafuri S, Agodi A, Auxilia F, Casini B, et al. Knowledge about tuberculosis among undergraduate health care students in 15 Italian universities: a cross-sectional study. BMC Public Health [Internet]. 2014;14(1):970. doi: http://dx.doi.org/10.1186/1471-2458-14-970

38. Podewils LJ, Long EF, Fuller TJ, Mwakazanga D, Kapungu K, Tembo M, et al. Zambia Assessment of Tuberculosis (TB) and HIV in the Mines (ZATHIM): implications for programs and policies. BMC Public Health [Internet]. 2022;22(1):791. doi: https://doi.org/10.1186/s12889-022-13053-8

39. Montes-Tello SA, Moreno-Turriago MS, Tello-Cajiao ME, Serrano-Tejada LM, Rodas-Morales ÁJ, García-Goez JF. Conocimientos, prácticas y actitudes del manejo programático de la tuberculosis en estudiantes de medicina de Colombia. Enf Global [Internet]. 2023;22(3):454-78. doi: https://doi.org/10.6018/eglobal.554191

40. Joshi B, Font H, Wobudeya E, Nanfuka M, Kobusingye A, Mwanga-Amumpaire J, et al. Knowledge, attitudes and practices on childhood TB among healthcare workers. Int J Tuberc Lung Dis [Internet]. 2022;26(3):243-51. doi: https://doi.org/10.5588/ijtld.21.0317

41. de Souza AC, Costa-Alexandre MC, Guirardello EB. Psychometric properties in instruments evaluation of reliability and validity. Epidemiol Serv Saúde [Internet]. 2017;26(3):649-59. doi: https://doi.org/10.5123/S1679-49742017000300022

42. Pradipta IS, Khairunnisa K, Bahar MA, Kausar MN, Fitriana E, Ruslami R, et al. Knowledge, attitude and practice of community pharmacy personnel in tuberculosis patient detection: a multicentre cross-sectional study in a high-burden tuberculosis setting. BMJ Open [Internet]. 2022;12(7):e060078. doi: http://dx.doi.org/10.1136/bmjopen-2021-060078

43. An Y, Teo AKJ, Huot CY, Tieng S, Khun KE, Pheng SH, et al. Knowledge, attitude, and practices regarding childhood tuberculosis detection and management among healthcare providers in Cambodia: a cross-sectional study. BMC Infect Dis [Internet]. 2022;22:317. doi: https://doi.org/10.1186/s12879-022-07245-1

44. Scatena LM, Domingues-Wysocki A, Beraldo AA, Tavares-Magnabosco G, Firmino-Brunello ME, Netto AR, et al. Validity and reliability of a health care service evaluation instrument for tuberculosis. Rev Saúde Pública [Internet]. 2015;49:7. doi: http://dx.doi.org/10.1590/S0034-8910.2015049005548

Notas de autor

hnurregop@unal.edu.co

Información adicional

How to reference.: Urrego-Parra HN, Muñoz-Sánchez AI, Ibáñez-Pinilla M, Muñoz- Castaño YL. Validation of an instrument to assess knowledge, attitudes, and practices on tuberculosis among health care workers in Colombia. MedUNAB [Internet]. 2023;26(3):417-431. doi: https://doi.org/10.29375/01237047.4505

Author Contributions: HNUP. Conceptualization, research, data curation, writing original draft. AIMS. Conceptualization, validation, supervision, writing, reviewing, and editing. MIP. Methodology, software, formal analysis. YLMC. Writing, reviewing, and editing.

Enlace alternativo

https://revistas.unab.edu.co/index.php/medunab/article/view/4505 (html)

https://revistas.unab.edu.co/index.php/medunab/article/view/4505/4013 (pdf)

https://revistas.unab.edu.co/index.php/medunab/article/view/4505/4014 (pdf)

https://revistas.unab.edu.co/index.php/medunab/article/view/4505/4035 (xml)