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Development and validation of a skin health knowledge, attitudes, and behaviors questionnaire for the general
Xinquan Wang1,2, Liping Jin1, Yuanzhi Wang1
1Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, Hainan, China.
Background:
Existing skin health assessments predominantly focus on single topics or diseases, making it difficult to cover the complete "Knowledge-Self-efficacy-Attitudes-Behaviors (KSAB)" continuum.
Objective:
To develop and validate a skin health knowledge, attitudes, and behaviors questionnaire for the general population.
Methods:
A cross-sectional online survey was conducted among the general population between October and November 2025. The questionnaire was developed based on a conceptual structure incorporating four dimensions: knowledge, self-efficacy, attitudes, and behaviors. Content validity was assessed by 13 experts, and the Item-level Content Validity Index (ICVI) and modified Kappa (K*) were calculated. Construct validity was examined using confirmatory factor analysis (CFA). Item-level evaluation was performed using item response theory (IRT), including the two-parameter logistic (2PL) model for dichotomous items and the graded response model (GRM) for ordered items.
Results:
A total of 865 individuals were enrolled (men: women = 1.24:1). Content validity was good (ICVI = 0.846-1.000, K* = 0.845-1.000). The five-factor model from CFA showed a good fit (CFI = 0.969, TLI = 0.960, RMSEA = 0.070, SRMR = 0.095). IRT analysis indicated that K1-K5 had acceptable discrimination (a = 0.59-2.40) and difficulty parameters ranging from -3.63 to -1.33. However, items K6, K7 and S1 were excluded due to insufficient threshold coverage. The proportion of women reporting frequent sunscreen use was higher than that of men. Self-efficacy levels showed a decreasing trend with age. Furthermore, individuals in service/manual labor occupations exhibited lower proportions on certain items.
Conclusion:
This study developed and validated a KSAB questionnaire on skin health knowledge, attitudes, and behaviors, showing good validity and item-level performance. The findings support targeted health promotion for men, older adults, and service/manual workers.
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