A sequential, exploratory, mixed-methods approach for development and validation of a context-specific knowledge,...

To develop and validate a context-specific comprehensive knowledge, attitude and practice (KAP) questionnaire for literate mothers on factors affecting micronutrient status of 6-10-year-old children.

Sequential exploratory mixed-methods study using focus group discussions (FGD) and psychometric validation.

Seven randomly selected villages with >500 households with three to five family members each, in Ghatkesar sub-district, Medchal district, Telangana state, India.ParticipantsLiterate mothers from middle-income households with at least one child (6-10 years) for FGD (n 44), for testing the internal consistency (n 80) and for test-retest reliability (n 30).

The themes for FGD were diet diversity, micronutrients, cooking and eating practices, national programmes and sunlight exposure. Knowledge among caregivers about sources of micronutrients, deficiency symptoms, cooking/eating practices was low, while attitude towards diet diversity and sunlight was good. Non-availability of fruits and vegetables was a barrier to diet diversity. About 72 % of the questions from the item pool were based on FGD. After content validity, 125 items were selected for the questionnaire which, upon psychometric validation, was reduced to an eighty-eight-item questionnaire with difficulty index of 0·10-0·91, discrimination index of 0·09-0·68, Cronbach's α of 0·78 (reliability of knowledge and attitude) and 0·50 (practice). A Bland-Altman plot showed good agreement between test and retest scores.

The questionnaire developed and validated using a sequential exploratory mixed-methods approach can be used for assessing KAP on micronutrients and factors affecting consumption of diverse diets in rural Indian households.