Multicentre Delphi consensus-based development and validation of the Tele-ESSI-KAP scale: Assessing epilepsy
Marami Das1, Rajni Sharma2, Sulena Sulena3
1Department of Neurology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Introduction:
Teachers are critical in supporting students with epilepsy; however, validated instruments to assess their knowledge, attitudes, and practices (KAP) are limited. This study aimed to develop and psychometrically validate the Tele-School Health-Led Epilepsy Smart Schools in India (ESSI) KAP Scale (Tele-ESSI-KAP Scale), an instrument designed to assess epilepsy-related competencies among school teachers and staff.
Methods:
A multicentre, descriptive, cross-sectional Delphi study was conducted across three tertiary care centres in India. The initial 102-item pool was derived through literature review, expert consultation, and focus group discussions. Following iterative Delphi rounds, items with ≥80 % expert consensus were retained. The final instrument was translated into Hindi, Punjabi, Marathi, and Assamese using forward-backwards translation, followed by cognitive debriefing and pilot testing. Construct validity was assessed using an exploratory factor analysis, and reliability was evaluated using Cronbach's alpha, intraclass correlation coefficients (ICCs), and Bland-Altman analysis.
Results:
A total of 760 school teachers participated. The final 33-item scale comprised four domains: Knowledge (10 items), Attitude (9 items), Practice (10 items), and Rescue Medicine (4 items), explaining 59.84 % of total variance. Content validity was excellent (S-CVI = 0.92). Internal consistency was high across all language versions (Cronbach's α = 0.78-0.99), and test-retest reliability demonstrated strong temporal stability (ICC = 0.71-0.99). Bland-Altman analyses showed minimal systematic bias between test and retest administrations. Cross-language correlations (r = 0.264-0.995, p < 0.001) indicated strong conceptual equivalence across translations.
Conclusions:
The Tele-ESSI-KAP Scale is a theory-informed, psychometrically rigorous, and culturally adaptable instrument for assessing teacher competencies in school-based epilepsy management, including emergency seizure response. It establishes a standardised framework to reduce variability in preparedness, guide targeted training, and support equitable epilepsy care within educational settings.
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