Development and validation of a national questionnaire assessing knowledge, attitudes, and practices on neglected tropical diseases among italian medical trainees

Neglected Tropical Diseases (NTDs) affect nearly two billion people worldwide, yet preparedness to diagnose and manage them remains limited in high-income countries (HICs), where shifting epidemiology driven by climate changes, migration, mobility, international food and animal trade and global interconnection requires broader clinical competencies. Evidence on NTD-related knowledge among medical trainees in Europe is scarce. This study aimed to develop, validate, and field-test a comprehensive instrument assessing knowledge, attitudes, and practices (KAP) regarding NTDs among Italian medical students, recent graduates, and residents.

A structured questionnaire was developed using a multi-step approach informed by World Health Organization (WHO) Neglected Tropical Diseases priorities and a targeted literature review. Content validity was assessed through a two-round Delphi process with a multidisciplinary national expert panel (Round 1: n = 36; Round 2: n = 34), followed by external expert evaluation (n = 17). Quantitative content validation included Item- and Scale-Level Content Validity Indices (I-CVI, S-CVI/Ave) and interquartile ranges (IQR) to assess expert consensus. Reliability and psychometric properties were evaluated in a national sample of Italian medical trainees (n = 96), including internal consistency (Cronbach's α; KR-20), test-retest reliability (ICC; Cohen's κ), and item performance analyses.

Across Delphi rounds, 91-98% of items reached consensus (IQR ≤ 1), and overall content validity was excellent (S-CVI/Ave 0.96-0.98). Reliability metrics confirmed strong internal consistency (α = 0.863; KR-20 = 0.82) and good temporal stability (ICC = 0.89; κ = 0.72-0.84). Known-groups validity was demonstrated by significantly higher knowledge scores among residents compared with medical students (p = 0.014).

This study provides the first Delphi-validated national instrument assessing NTD-related knowledge among Italian medical trainees. The tool can offer a foundation for evaluating curricula and informing educational reform, supporting the integration of NTD-related competencies in European medical education in response to evolving global health challenges.