Knowledge, attitudes, and practices (KAP) of nurses towards wound cleansing: design and evaluation of measurement properties of a questionnaire
Bibliographic record
Abstract
Wound cleansing is a fundamental component of chronic wound management; yet, high-quality evidence to guide practice is limited. Understanding nurses’ knowledge, attitudes, and practices (KAP) is essential, but no instrument with published evidence of acceptable measurement properties exists. To develop a KAP questionnaire on wound cleansing for community nurses and evaluate its measurement properties. A multi-phase study was conducted, including literature/consensus item generation; a two-round international Delphi process; pilot cognitive interviews; and field testing in Canada. Knowledge was assessed for item and construct validity; attitude for internal consistency (Cronbach’s α); and all KAP items for stability using test-retest reliability. 26 experts supported content relevance; feedback led to targeted revisions. Field testing involved 130 nurses (83.1% homecare; > 80% with ≥ 5 years of wound care experience). Several knowledge items were too easy (≥ 0.90); none negatively discriminated. Exploratory principal components analysis of attitudes yielded three components (63% of variance); internal consistency ranged from α = 0.41 to α = 0.76. In the subsample (n = 30), knowledge κ values ranged from slight/fair to substantial; some items ceiling effects (uniform responses, κ undefined). Attitude and practice item-level intraclass correlation coefficients varied (0.07 – 0.95), with several ≥ 0.75 and others < 0.60. Known-groups comparison supported higher knowledge among formally educated nurses. Evidence supports content validity and a clarified attitudes structure; internal consistency and stability were acceptable for some elements but below the threshold for others. Future refinement and confirmatory testing are warranted. • Wound cleansing is critical yet under-researched; recommendations rely heavily on expert consensus, contributing to clinical uncertainty and practice variation. • A KAP questionnaire on wound cleansing was developed and its measurement properties evaluated (Delphi, cognitive interviews, field testing) in line with COSMIN methodology. • Evidence supported content validity and a three-component attitude structure; internal consistency was acceptable for one component (α = 0.76) and low for another (α = 0.41). • Known-groups analysis showed higher knowledge among nurses with formal education; item-level stability was mixed (several ICC ≥ 0.75; others < 0.60; ceiling effects on some knowledge items). • Findings identify targets for refinement (over-easy/weakly discriminating items; ambiguous wording) and underscore the need for empirical studies on effective irrigation pressures in chronic wounds; the instrument shows promise for education and quality improvement pending further testing.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".