Design and validation of Brucellosis prevention questionnaire focused on animal vaccination

doi:10.21203/rs.3.rs-26120/v1

Background Animal breeders' inadequate awareness about the transmission of brucellosis and their improper knowledge about prevention of brucellosis are among important barriers to vaccinate animals against brucellosis. The aim of this study is design, implementation and evaluation of a theory-driven and vaccination-focused training program for brucellosis prevention.

Methods In this exploratory psychometric study, a brucellosis prevention questionnaire (BPQ) was developed. Face-to-face interviews were conducted to develop the initial items of BPQ. The findings from interviews were merged with those of literature review. Face, content and construct validity of BPQ were assessed by participation of animal breeders, veterinarians and health educationists. Impact Score (IS), Content Validity Ratio (CVR) and Content Validity Index (CVI) of the items were calculated. Construct validity of BPQ was evaluated through factor analyses. Cronbach’s alpha, Intra-class correlation coefficient (ICC), composite reliability and standard error of measurement (SEM) were measured to assess the reliability of the findings by BPQ.

Results BPQ was finalized by 53 items. Its validity was confirmed by CVI, CVR, and IS of 0.90, 0.74 and 4.30, respectively. The items were loaded into three constructs of awareness, attitude and practice. The predictive power of the awareness, attitude and practice was 43.43%, 15.81% and 15.78%, respectively. The fitness of the proposed model among those constructs was confirmed by RMSEA < 0.08, Normed Chi2 < 5, CFI > .90, TLI > .90.

Conclusion The brucellosis prevention questionnaire has acceptable psychometric properties. Applying BPQ, veterinarians and educational planners can identify factors influencing animal breeders' preventive behavior.

Health Policy

Infectious Diseases

Health Economics & Outcomes Research

Prevention

Questionnaire

Brucellosis

Vaccination

Validity and Reliability

Brucellosis is a highly contagious and zoonotic bacterial disease [1]. Half of the countries with the highest rate of human brucellosis are located in the Middle East [2]. For this reason, brucellosis is known as the Mediterranean fever [3]. Iran, as one of the biggest countries in the Middle East, has the second highest brucellosis prevalence in the world [4].Complications of the brucellosis, increase disability-adjusted life years (DALY) among patients and result in substantial economic losses to dairy farmers [5]. Animal vaccination significantly decreases the rate of brucellosis infection in people. It is recommended by World Health Organization (WHO) that priority should be given to animal vaccination in order to eradicate the disease [6].

Among many barriers to vaccination, there are some pivotal obstacles on the farmers' side. .Those farmer-side barriers may be farmers' inadequate awareness about the transmission of brucellosis or their improper knowledge about prevention of the disease [7]. Animal vaccination against brucellosis is not satisfactory in Iran [7]. Animal breeders’ training is one of the most effective ways to overcome the barriers to brucellosis vaccinations [8].Considering the remarkable role of theories and models in designing, implementation and evaluation of the educational programs, planning for a theory-driven and vaccination-focused training program for animal breeders can be very helpful [9, 10].To the best of our knowledge, until the time of this study, no theory-driven intervention with a focus on animal vaccination has been conducted to prevent brucellosis; hence, we decided to design, implement and evaluate a theory-driven and vaccination-focused training program for brucellosis prevention.

The research tool Brucellosis Prevention Questionnaire (BPQ) in this study is a self-administered questionnaire to assess animal breeders' awareness, attitude and practice regarding prevention of brucellosis. In this article, as a part of our bigger study, the design and validation process of BPQ thorough an exploratory psychometric study is described. Psychometric properties of BPQ are presented too. Applying BPQ, as a valid and reliable questionnaire, veterinarians and educational planners can identify factors influencing animal breeders' preventive behavior.

This exploratory psychometric study was conducted in 2018 in Beiragh, in the suburb of Tabriz metropolitan city. The Ethics Review board at Tarbiat Modares University approved conducting the study.

Developing the Initial Questionnaire

Initial items of BPQ were achieved through a thorough literature review and interviews with all stakeholders. Databases, including MEDLINE, PubMed, EMBASE, ERIC, Cochrane Library and CINAHL were searched to find any published study about brucellosis prevention or animal vaccination. A combination of keywords of "preven*", "brucell*" and "vaccinat*" were used to search in English and Persian. Approximately 110 related papers, published between 2008 and 2019, were found. Reviewing those papers and contacting the corresponding authors, nine Persian and three English questionnaires were obtained.

Interviews were conducted to identify the factors influencing animal breeders' prevention behavior. The conceptual framework for conducting the interviews was the concepts from the first four phases of PRECEDE model [10]. Purposive sampling was employed to recruit participants [11] and directed content analysis was used to analyze the content of the interviews [12].

Six Animal breeders, four health educationists, four veterinarians and three experts from a vaccine providing institute in the region, who were volunteer, participated in 30 to 45 minute long, face-to- face interviews. Interviews were took place at participants' desired time and place. They were told that their information will be kept confidential and will be used by an anonymous way.

The items from literature review were combined with the findings from interviews. Identical and duplicate questions were removed and some questions were edited. Finally, after three sessions of group discussion, the first draft of the research questionnaire was confirmed. Anchor response of the items were discussed and finalized by research team members too.

Assessment of face and content validity of the questionnaire

Face validity was examined in both qualitative and quantitative ways. For qualitative assessment, based on the feedback from animal breeders and health educationists, any ambiguity in the meaning, wording and scaling of the items, errors in grammar and errors in items allocation, were identified and resolved. For quantitative assessment, impact score (IS) of each item was calculated.

Fifteen animal breeders and seven health educationists participated to assess the face validity of BPQ. Those animal breeders were different from the ones, who participated later in assessing the construct validity of BPQ and those in the cross-sectional part of the study. In this phase, BPQ was emailed to twenty veterinarians and health educationists to evaluate the impact score and content validity of the questionnaire (Response rate= 0.85%). To evaluate the face validity of the items, the appropriateness of each item was rated by an expert, using a five-point Likert scale. Impact score of each item was calculated by the formula of:

Impact Score = Frequency (%) × Importance [13, 14].

Content validity of the questionnaire was examined in both qualitative and quantitative ways, too. For quantitative assessment of content validity, Content Validity Index (CVI) and the Content Validity Ratio (CVR) were calculated. To do so, BPQ was submitted to twenty experts. Response rate was 95 percent. Concerning the precision of the data, two questionnaires were set aside. CVI and CVR were calculated based on three and four part Likert scales, respectively. CVR was calculated by the formula of (Ne – N/2)/ (N/2) [14]. In this formula, N is the total number of panelists and Ne is the number of panelists who rated the item to be “essential”. Based on the Lawshe table, items with CVR below 0.46 were removed [15, 16].

CVI of the items was calculated by the formula of

CVI=the number of specialists who assigned scores 3 and 4 to the items/N

Relevance of each item was rated by a 4-point Likert scale. Items with the CVI less than was 0.79 were removed [15,17].

Assessment of construct validity of the questionnaire

Construct validity of the questionnaire was evaluated by both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) [18]. Four hundred and fifty animal breeders, who were randomly selected, participated at this phase.

Exploratory Factor analysis (EFA)

EFA was done on 42 binary items and 17 Likert-scale items, which were intended to explain animal breeders' prevention behavior.

Principal component analysis and oblimin rotation method were used to determine the number of optimal factors. Loadings with significance lower than 0.05 were excluded from the analysis [19]. If an item was loaded into different factors, that item was related to the factor in which it had the largest factor loading. The extracted factors were named by team members.

Confirmatory Factor analysis (CFA)

For the items with binary response anchors, the generalized confirmatory factor analysis [20] and WLSMV statistical estimation method were used [20]. The software of M-Plus- version 7.4 was applied to test and evaluate the intended conceptual model.

The fitness of the proposed model was assessed by fit indices including the ratio of Chi-square to degrees of freedom (X²/DF), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). The values of at least 0.90 for CFI and TLI, and below 0.08 for RMSEA represented a good fitness [21, 22]. After excluding non-significant items, the final conceptual model was introduced.

Assessment of reliability of the questionnaire

Cronbach’s alpha coefficient and composite reliability (CR) were calculated for testing the internal consistency of the questionnaire. Stability of the results was examined by calculating the Interclass Correlation Coefficient (ICC) [23,24]. To do so, forty two volunteer animal breeders were asked to complete the research questionnaires twice (by a two-week interval) [24]. For analysis of the absolute reliability of the results, standard error of measurement (SEM) was calculated.

The IBM SPSS statistics 24 was used to perform data cleaning and calculating reliability indices. P values lower than 0.05 were considered significant.

After completing the validation process, some items were removed. The final research questionnaire included 10 questions about participants' baseline characteristics and 67 content-specific questions.

Participants' baseline characteristics

The mean age of the participants was 51.68±16.40 years. Participants' baseline characteristics, divided by each phase of the study are presented in Table 1.

Table 1. Baseline characteristics of livestock breeders divided by each phase of the study (n=432)

Variables

Total (n=432)

Exploratory Factor analysis

data (n=212)

Confirmatory Factor analysis data(n=220)

P-value

*

Age

Sex

Male

Female

Animal type

Cow

Sheep & Goat

Job

Private

Government worker

Farmer

Unemployed

Education level

Illiterate

Elementary

High school

Graduate diploma

Income

Less than household expenses

Equal to household expenses

Prior brucellosis prevention

No

Yes

Previous history of brucellosis

No

Yes

Number of family members

51.68±16.40

432(100%)

0(0%)

53 (12.3%)

379 (87.7%)

16 (3.7%)

12 (2.8%)

329 (76.1%)

75 (17.4%)

191 (44.2)

14 (42.6)

48 (11.1)

9 (2.1)

382 (88.4%)

50 (11.6%)

412 (95.4%)

20 (4.6%)

256 (59.3%)

176 (40.7%)

6.5 ( 5 – 8)

51.43±16.78

212(100%)

0(0%)

25 (11.8%)

187 (88.2%)

6 (2.8%)

6 (2.8)

162 (76.4%)

38 (18.0%)

92 (43.4%)

93 (43.9%)

23 (10.8%)

4 (1.9%)

189 (89.2%)

23 (10.8%)

202 (95.3%)

10 (4.7%)

127 (59.9%)

85 (40.1%)

6.5 ( 5 – 8)

51.92±16.05

220(100%)

0(0%)

28 (12.7%)

192 (87.3%)

10 (4.5%)

6 (2.7%)

167 (75.9%)

37 (16.9%)

99 (45.0%)

91 (41.4%)

25 (11.4%)

5 (2.3%)

193 (87.7%)

27 (12.3%)

210 (95.5%)

10 (4.5%)

129 (58.6%)

91 (41.4%)

6.5 ( 5 – 8)

0.76

0.77

0.91

0.95

0.64

0.93

0.79

0.96

*The relationship between the two nodes of exploratory and confirmatory factor analysis

Face Validity

With participation of 15 animal breeders, all items of BPQ became clear and understandable. The impact score (IS) of items were in a range between 3.6 and 4.8. IS of all items are shown in Table 2.

Table 2. The measures of face and content validity of the items of brucellosis prevention questionnaire (BPQ)

Construct or sub-construct

Item

Content Validity Ratio

Content Validity Index

Impact Score

AD=direct awareness score

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

Can brucellosis be transmitted from an animal to a human?

Can brucellosis be transmitted from a sheep or a goat to a human?

Can brucellosis be transmitted from a cow to a human?

Is brucellosis transmitted from a person to another person?

Can brucellosis be transmitted from skin contact with an infected animal?

Can brucellosis be transmitted from Breathing into infected animals’ stalls?

Can brucellosis be transmitted from touching the aborted fetus and placenta of an infected animal?

Can wearing gloves prevent getting brucellosis when you contact uterine secretions of dead animals?

Does the brucellosis spread in the environment by animal’s urine?

If an abortion happens in your trap, will you burn the aborted fetus?

Does the brucellosis spread in the environment by animals’ fetus and placenta?

Does the brucellosis spread in the environment by wool?

Does the killing of infected animals prevents the development of brucellosis

Do you disinfect the place of abortion when an abortion happens?

Do you let your dog’s eat the aborted fetus?

Do you bury the aborted fetus?

Is brucellosis a preventable disease?

Should the area be disinfected after an abortion was occurred?

0.88

0.64

0.76

0.76

0.88

0.64

1

0.64

0.88

0.64

0.76

0.64

0.52

0.76

0.52

0.52

0.88

0.76

1

0.98

0.96

0.86

1

0.84

0.94

0.80

0.90

1

0.94

0.98

0.94

1

0.80

0.86

0.80

0.80

4.8

4.8

4.7

4.4

4.2

4.7

4.7

4

3.8

4.1

4.2

4.3

3.8

4.7

4.2

3.8

4.7

4.2

ID=indirect awareness score

1

2

3

4

5

6

7

8

9

10

Can brucellosis be transmitted through consumption of infected milk and dairy products?

Can brucellosis be transmitted from semi-cooked meat?

Can brucellosis be transmitted through breathing into animals’ stalls?

Can washing milking dishes prevent getting brucellosis?

Can boiling milk prevent getting brucellosis?

Can keeping cheese in salty water for 2 months before consumption prevent getting brucellosis?

Does using a mask when cleaning the stable prevent the transmission of Brucella disease?

Does the brucellosis spread in the environment by milks of infected livestock?

Does the brucellosis spread in the environment by meat of infected livestock?

Do you ask a veterinarian to help for an animal’s abortion?

0.64

0.76

0.88

0.52

0.76

0.76

0.64

0.88

0.64

0.52

0.90

0.88

0.92

0.80

0.80

0.86

0.90

0.92

0.94

0.98

4

4.2

4.1

3.7

3.6

4.2

3.8

4.7

4.6

4.1

V=vaccine oriented behavior score

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Can vaccination of livestock prevent the Malta fever among human?

Can brucellosis be prevented by vaccination of livestock?

Is the cost of vaccinating animals high for you?

Do you have access to livestock vaccination services?

Does the veterinary organization offer timely vaccination services for your animals?

Does the veterinarians encourage you to vaccinate your livestock?

Does the health personnel encourage you to vaccinate your livestock?

Does family members encourage you to vaccinate your livestock?

In which season should brucellosis vaccine be injected?

How often should the brucellosis vaccine be repeated?

Because the veterinarian does not pay full compensation for the slaughtered animals caused by brucellosis, I would love to prevent the disease by vaccine?

At what age should livestock be vaccinated against brucellosis?

After vaccination against brucellosis,

After brucellosis vaccination,

0.52

0.76

0.88

0.88

0.64

0.64

0.76

0.64

0.88

0.64

0.52

1

0.88

0.52

0.92

0.80

0.90

0.82

0.96

0.98

0.94

1

0.84

0.96

0.82

0.98

0.80

0.82

4.7

4.2

4.3

4.7

4

4.2

4.4

4.1

4.7

4.8

4.2

4.8

4.2

4

A=attitude score

1

2

3

4

5

6

7

8

9

There will be no abortion, if the animals are vaccinated.

Livestock breeders should ask a veterinarian to examine their livestock.

I will not get brucellosis, if I touch Vaccinated animals’ milk, urine, placenta and fetus.

As vaccination is time-consuming, I prefer getting brucellosis instead of vaccinating my animals.

Animal vaccination is a very difficult process.

If I get brucellosis, I will be unable to work for a long time.

If I do not vaccinate the animals, my family and I will get brucellosis.

If I vaccinate my livestock, people will not get brucellosis with consumption of my dairy products.

I may still be in danger of getting brucellosis, even if I do preventative behaviors.

0.76

0.88

0.76

0.88

0.52

0.76

0.88

0.76

0.88

0.84

0.98

0.94

0.92

0.96

1

0.82

0.86

0.98

4.1

3.9

4.6

4.8

4.2

3.2

4.7

4.8

4.2

P=practice score

1

2

3

4

5

6

7

8

I keep records and documents of medical history and vaccination of my livestock in a proper place.

I have experienced abortion among my livestock.

I always keep an eye on the cold chain about vaccines being injected into my cattle.

I vaccinate my livestock at the proper and recommended time.

Every year, I vaccinate my livestock against brucellosis.

My livestock are in contact with other non-vaccinated livestock.

When I buy a new livestock, I am curious to know about their vaccination history.

When I buy a new livestock, I ask a vet to examine my animal.

1

0.52

0.64

0.88

0.76

0.64

0.88

0.76

0.94

0.84

0.96

0.98

0.88

0.82

0.80

0.80

4.8

4.2

4.8

4.7

4.1

3.8

4.2

4

Mean

0.74

0.90

4.3

Content validity

The ranges for CVI and CVR of items were 0.80–1.00 and 0.52–1.00, respectively. CVI and CVR of the items are presented in Table 2.

Construct Validity

From all 450 completed questionnaires, 18 incomplete questionnaires were excluded. EFA was done based on 212 completed questionnaires. CFA was done based on the data from 220 completed questionnaires.

Exploratory factor analysis

Generalized exploratory factor analysis (GEFA) was done. Based on the findings from principal component analysis and oblimin rotation method, Likert-type items were loaded into two factors. The factors were named attitude (9 items) and practice (8 items). Binary-type items were loaded into one factor, including three sub-scales. The subscales were named Awareness about the direct ways (AD) with16 items; Awareness about the indirect ways (Aid) with 9 items and Awareness about the role of vaccine (AV) with 12 items. Changes in animal breeders' prevention behavior were predicted by the changes in their awareness, attitude and practice scores. The predictive power of the awareness, attitude and practice scales was 43.43%, 15.81% and 15.78% respectively. Loadings of the extracted factors are presented on Table 3.

Table 3. The results of measurement model divided by the each construct of the brucellosis prevention questionnaire (BPQ)

scale	χ2	χ2/df	P	CFI	TLI	RMSEA (95% CI)	Eigenvalue	%variance	Cumulative % variance
Direct Awareness(AD)	270.20	2.00	<0.001	.940	.932	.069 (.057 ; .081)	9.41	15.89	15.89
Indirect Awareness(ID)	42.36	1.21	0.183	.990	.987	.031 (.001 ; .061)	4.93	14.81	30.69
Vaccine-oriented behavior	235.87	3.06	<0.001	.976	.953	.079 (.064 ; .093)	5.65	12.73	43.42
Attitude	44.40	1.64	0.019	.991	.988	.055 (.023 ; .083)	5.26	15.81	59.22
Practice	91.6	4.58	<0.001	.972	.961	.079 (.053 ; .106)	4.67	15.78	75.00

χ2, chi-square; χ2/df, normed chi-square; CFI, comparative Fit Index; TLI, Tucker and Levis Index; RMSEA, root mean square error of approximation

Confirmatory factor analysis

Confirmatory factor analysis for the 17 Likert-type items and 37 binary items was done.

All the relationship between constructs and items were significant (All P<0.05) except for ad6 in AD construct .The results indicated a good fit for the model. Routing diagrams for generalized validation model for all structures are shown in a single model. The model and the loadings of the extracted factors are presented on Figure 1.

Insert Figure 1

Reliability

The measures of reliability, divided by each scale of the research questionnaire are presented in Table 4.

Table 4. The measures of reliability, divided by each scale of the Brucellosis Prevention Questionnaire (BPQ)

Construct or sub=construct

Intra-class Correlation Coefficient

ICC (95% CI)

Cronbach’s Alpha

(α)

standard error of measurement

(SEM)

Composite Reliability

(CR)

Awareness in all

Direct awareness

Indirect awareness

Vaccine-oriented

Attitude

Practice

0.958(0.920-0.978)

0.957(0.919-0.977)

0.947(0.900-0.972)

0.885(0.783-0.939)

0.896(0.803-0.945)

0.927(0.863-0.962)

0.865

0.863

0.831

0.718

0.833

0.825

5.448

7.591

10.446

11.330

8.231

10.477

0.974

0.951

0.908

0.895

0.912

0.896

Prediction of Brucellosis prevention behavior by BPQ

In all, according to the findings from this study, livestock breeders' prevention behavior can be predicted by the formula of:

Behavior=)0.591*AD(-)0.077 *ID(+)0.79*V(+)0.411*A(+)0.417*P(

(AD=direct awareness score; ID=indirect awareness score; V=vaccine oriented behavior score; A=attitude score and P=practice score)

The Brucellosis Prevention Questionnaire (BPQ) is the first theory-based questionnaire, which is designed and validated for Brucellosis prevention. The impact of education on brucellosis prevention among animal breeders is studied in some studies [8, 25–29]; however, the effectiveness of education in those studies is evaluated by researcher-made questionnaires and the psychometric properties of research questionnaires in those studies are not reported.

BPQ has acceptable psychometric properties. All items of BPQ were loaded into three different constructs. They were named awareness, attitude and practice. In all 75% percent of changes in animal breeders' brucellosis prevention behavior was predicted by variations in their awareness, attitude and practice scores. The predication power of each construct was 43.43%, 15.81% and, 15.78%, respectively.

In this study, attitude was the most predictive construct of animal breeders' prevention behavior. This finding confirms the role of education in brucellosis prevention. Indeed, the findings of this study shows that increasing awareness, attitude and practice of animal breeders can change their behavior and can reduce the prevalence of brucellosis. Similar indicates that awareness about transmission methods of brucellosis increases the rate of preventive behaviors and human infection [25]. The crucial role of attitude in changing health behaviors is highlighted in some other studies [8, 25, 30, 31]. For instance, animal breeders' attitude and practice scores were significantly improved after a PRECEDE-based educational intervention in a quasi-experimental study[29].Psychometric properties of the research tool in this study are not fully investigated. Only Cronbach's Alpha is reported for predictive constructs of awareness=( 0.83), attitude( 0.8) and practice( 0.9) [29]. The items in BPQ were internally consistent, too. In our study, Cronbach's Alpha for awareness, attitude, and practice was 0.865, 0.833 and 0.825, respectively, indicating acceptable internal consistency of the items [32].

The final conceptual model in this study had proper fitness indices (χ2 = 2248.06; χ2/df = 1.64; RMSEA = 0.054; CFI = 0.940 and TLI = 0.932. As fitness of structural equation modellings are confirmed when RMSEA < 0.08 and CFI and TLI are above 0.9 [21], the fitness indices of the final conceptual model are considered acceptable.

CVI and CVR of the items of BPQ were in ranges of 0.80–1.00 and 0.52–1.00, respectively. These numbers confirm that BPQ is able to assess what is intended to assess [15–17]

Items of the final BPQ had impact scores above 1.5. Impact scores of the items ranged between 3.6 and 4.8. These findings represented good face validity of BPQ [23].

Reliability of the research findings was confirmed by ICC, CR and SEM of constructs, being at least 0.885, 0.895 and 5.448 respectively. All these numbers represent acceptable internal consistency and stability of the findings by BPQ [13, 33].

In all, other health educationists and researchers can identify factors influencing animal breeders' preventive behavior by employing BPQ, as a valid and reliable questionnaire.

BPQ is the first theory-driven questionnaire in the field of brucellosis prevention and focuses on real problems, barriers and facilitators of animal breeders' prevention behavior. It was designed and validated for a theory-driven and vaccination-focused training program.

In this study, method triangulation was employed to generate the items of the research questionnaire. The items were produced by literature review, the main researcher's field notes and face-to- face interviews with different stakeholders (animal breeders, health educationists, veterinarians and experts from vaccine and serum production institute).

BPQ, which was designed and validated in this study, can be employed by all health educationists to plan for necessary educational interventions.

Additional file 1. BPQ Questionnaire

BPQ: Brucellosis Prevention Questionnaire; CFI: Comparative Fit Index; CVI: Content Validity Index; CVR: Content Validity Ratio; ICC: Intra-class Correlation Coefficient; RMSEA: Root Mean Square Error of Approximation; SRMSEA: Standardized Root Mean Square

Acknowledgements

We would like to express our gratitude to all animal breeders, health educationists, veterinarians and experts, who participated in this study, for dedication of their invaluable time and experiences.

Authors’ contributions

FB conceived and the study; collected and analyzed the data; interpreted the findings; wrote the first draft of the manuscript; read and critically revised the first draft and confirmed the final version of the manuscript.

FGh conceived and the study; analyzed the data; interpreted the findings; contributed to the validation study of the research questionnaire; read and critically revised the first draft and confirmed the final version of the manuscript.

SGh analyzed the data; interpreted the findings; contributed to the validation study of the research questionnaire; read and critically revised the first draft and confirmed the final version of the manuscript.

RZ collected and analyzed the data; interpreted the findings; contributed to the validation study of the research questionnaire; read and critically revised the first draft and confirmed the final version of the manuscript.

Funding

This study is a part of a Ph.D. dissertation of FB at Tarbiat Modares University.

Availability of data and materials

All data and materials will be available on reasonable request from the corresponding author.

Ethical considerations

Conducting this research was approved by the Ethics Committee of Tarbiat Modares university (The ethics code number=IR.MODARES.REC.1397.001). All participants provided written informed consent and they were assured that their responses will be remained confidential.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Authors’ details

F.B, Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. [email protected]

F.Gh, Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. [email protected]

S.Gh, Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. [email protected]

R.Z, Department of Health Sciences, Unit for Public Health Sciences, Mid Sweden University, Sundsvall- Sweden. [email protected]

Jameson JL. Harrison's principles of internal medicine. 20th ed. McGraw-Hill Education; 2018.
Nematollahi S, Ayubi E, Karami M, Khazaei S, Shojaeian M, Zamani R, et al. Epidemiological characteristics of human brucellosis in Hamadan Province during 2009–2015: results from the National Notifiable Diseases Surveillance System. Int J Infect Dis. 2017;61:56–61.
Mirnejad R, Jazi FM, Mostafaei S, Sedighi M. Epidemiology of brucellosis in Iran: A comprehensive systematic review and meta-analysis study. Microb Pathog. 2017;109:239–47.
Moosazadeh M, Nikaeen R, Abedi G, Kheradmand M, Safiri S. Epidemiological and Clinical Features of People with Malta Fever in Iran: A Systematic Review and Meta-Analysis. Osong Public Health Res Perspect. 2016;7:157–67.
Musallam II, Abo-Shehada MN, Holt HR, Guitian FJ, Hegazy YM, et al. Systematic review of brucellosis in the Middle East: disease frequency in ruminants and humans and risk factors for human infection. Epidemiol Infect. 2016;144:1–15.
Hashemi Tabar G, Jafari A. Preventive and Control Programs for Brucellosis in Human and Animals. J Zoonoses. 2014;1:9–30.
Esmaeili HH, Esmaeili HH, Amiri K. The effects of brucellosis vaccination in domestic animal on human brucellosis in IRAN. Razi J Med Sci. 2013;20:80–6.
Kansiime C, Atuyambe LM, Asiimwe BB, Mugisha A, Mugisha S, Guma V, et al. Community perceptions on integrating animal vaccination and health education by veterinary and public health workers in the prevention of brucellosis among pastoral communities of south western Uganda. PLoS One. 2015;10:e0132206.
Ghaffarifar S, Ghofranipour F, Ahmadi F, Khoshbaten M. Why Educators Should Apply Theories and Models of Health Education and Health Promotion to Teach Communication Skills to Nursing and Medical Students. Nurs midwifery Stud. 2015;4:e29774.
Naestoft J, Hvidberg EF, Sjö O. Saturable metabolic pathways for ethotoin in man. Clin Exp Pharmacol Physiol. 1976;3:453–9.
McKenzie JF, Wood ML, Kotecki JE, Clark JKBR. Establishing content validity: Using qualitative and quantitative steps. Am J Health Behav. 1999;23:311–8.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277–88.
Ghanbari-Homayi S, Dencker A, Fardiazar Z, Jafarabadi MA, Mohammad-Alizadeh-Charandabi S, Meedya S, et al. Validation of the Iranian version of the childbirth experience questionnaire 2.0. BMC Pregnancy Childbirth. 2019;19:465.
Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar A-R. Design and Implementation Content Validity Study: Development of an instrument for measuring Patient-Centered Communication. J caring Sci. 2015;4:165–78.
Khajeh FK, Pezeshki MZ, Ghaffarifar S, Faridaalaee G. Development of the Persian hypertension self-management questionnaire. Int Cardiovasc Res J. 2019;13:17–22.
CH.Lawshe LAWSHE, CH CHLawshe. LAWSHE CH. A quantitative approach to content validity. Pers Psychol. 1975;28:563–75.
Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30:459–67.
Sitzia J. How valid and reliable are patient satisfaction data? An analysis of 195 studies. Int J Qual Health C. 1999;11:319–28.
Hadia NU, Abdullah N, Sentosa I. An Easy Approach to Exploratory Factor Analysis: Marketing Perspective. J Educ Soc Res. 2016;6:215–23.
Muthen LK, Muthén BO. Mplus User's Guide. user guide. 8th ed. Los Angeles: Muthén & Muthén; 2017.
Tinsley HEA, Brown SD. Handbook of Applied Multivariate Statistics and Mathematical Modeling. Academic press; 2000.
Bentler PM, Bonett DG. Significance tests and goodness of fit in the analysis of covariance structures. Psychol Bull. 1980;88:588–606.
Seyf AA. Measurement, test and educational evaluation (Persian). Tehran: Dowran Pub; 2016.
Boulet JR, Murray D, Kras J, Woodhouse J, McAllister J, Ziv A. Reliability and Validity of a Simulation-based Acute Care Skills Assessment for Medical Students and Residents. Anesthesiology. 2003;99:1270–80.
Lindahl E, Sattorov N, Boqvist S, Magnusson U. A study of knowledge, attitudes and practices relating to brucellosis among small-scale dairy farmers in an urban and peri-urban area of Tajikistan. PLoS One. 2015;10:e0117318.
Jelastopulu E, Bikas C, Petropoulos C, Leotsinidis M. Incidence of human brucellosis in a rural area in Western Greece after the implementation of a vaccination programme against animal brucellosis. BMC Public Health. 2008;8:241.
Karimy M. M A. The effect of an educational program based on health belief model on the empowerment of rural women in prevention of brucellosis. J Arak Uni Med Sci. 2012;14:85–94.
Ramezankhani A, Jahani H, Hatami H, Sharifzadeh G, Hosseini S. Determine the effect of intervention on the adoption of preventive behaviours of the brucellosis was based on the health belief model. J North Khorasan Univ Med Sci. 2016;8:33–45.
Oruogi MA, Bayt Asghari A, Charkazi A, Jvaheri J. Survey on effect of health education intervention on reduction of brucellosis incidence in rural areas of Khomein based on PRECED framework. J Health. 2012;3:50–8.
Khani Jeihooni A, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A. RETRACTED. The effect of an educational program based on health belief model and social cognitive theory in prevention of osteoporosis in women. J Health Psychol. 2017;22:NP1–11.
Glanz K, Rimer BK, Viswanath K. Health Behaviour and Health Education. 4th ed. John Wiley & Sons; 2008.
Thorsen SV, Bjorner JB. Reliability of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38 Suppl:3:25–32.
Barati M, Taheri-Kharameh Z, Farghadani Z, Rásky É. Validity and reliability evaluation of the persian version of the heart failure-specific health literacy scale. Int J Community Based Nurs Midwifery. 2019;7:222–30.

questionnaire.docx

Design and validation of Brucellosis prevention questionnaire focused on animal vaccination

Status:

Journal Publication

Version 1

Abstract

Figures

Introduction

Materials And Methods

Results

Discussion

Strengths Of The Study

Implications:

Abbreviations

Declarations

References

Supplementary Files

Status:

Journal Publication

Version 1