Crimean-Congo Hemorrhagic Fever Disease Awareness Scale: Scale Development, Validity, and Reliability Study

Crimean-Congo Hemorrhagic Fever (CCHF) is a life-threatening, tick-borne, viral disease with substantial public health importance, particularly in endemic regions. Because no licensed vaccine or specific antiviral treatment is currently available, improving public awareness remains a key strategy for preventing transmission and promoting early diagnosis. However, no standardized instrument has been available to comprehensively assess CCHF awareness among adults.

This study aimed to develop and psychometrically evaluate the Crimean-Congo Hemorrhagic Fever Disease Awareness Scale (CCHF-DAS) for use among adults.

This cross-sectional methodological study was conducted between March and June 2025 among 293 adults recruited from 2 family health centers in Türkiye. An initial 29-item scale was developed following a comprehensive literature review and expert evaluation using the Davis technique. A pilot study involving 45 individuals assessed item clarity and comprehensibility. Construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). EFA was performed to determine the underlying factor structure of the scale, and CFA was subsequently conducted to evaluate the fit of the proposed factor structure. Reliability was evaluated using Cronbach α, split-half reliability, composite reliability, average variance extracted (AVE), McDonald ω, and item-total correlations. The Harman single-factor test was performed to assess common method variance.

Content validity indices indicated excellent expert agreement for all items (Item Content Validity Index=1.00). EFA resulted in a unidimensional 25-item structure explaining 35.66% of the total variance. The Kaiser-Meyer-Olkin value was 0.912, and the Bartlett test was significant (χ²₄=3385.4; P<.001), supporting sample adequacy. CFA demonstrated acceptable model fit (χ²_4.15/df=4.15, root mean square error of approximation=0.075; standardized root mean square residual=0.072; goodness-of-fit index=0.95; adjusted goodness-of-fit index=0.94; comparative fit index=0.97). The scale demonstrated excellent internal consistency (Cronbach α=0.916; McDonald ω=0.931; composite reliability=0.931), although the AVE (0.356) was below the recommended threshold. Split-half reliability coefficients (Spearman-Brown=0.899; Guttman=0.898) further supported reliability. The Harman single-factor test indicated that common method bias was unlikely to be substantial.

The CCHF-DAS is the first validated instrument specifically designed to assess adult awareness of CCHF. The scale demonstrated satisfactory construct validity and excellent reliability, supporting its use in epidemiological research, public health surveillance, and evaluation of educational interventions. Further validation in larger, culturally diverse populations and independent samples is recommended.