Development and Validation of a Questionnaire to Explore Tuberculosis Knowledge in Foreign-Born Subjects From High Tuberculosis Incidence Countries

Background: Italy is a low tuberculosis (TB) incidence country, and TB cases cluster especially among foreign-born subjects from high TB incidence countries. Several determinants of health contribute to active TB development in this population and TB control strategies should address all. TB knowledge represents only one of these determinants, and all alone does not increase person’s empowerment. However, TB knowledge could represent a contribution to TB control, when integrated into a framework of actions. To our knowledge, there are no validated questionnaires exploring TB knowledge among foreign-born subjects from high TB incidence countries who are living in a low TB incidence setting. Materials/Methods: the questionnaire’s item pool was compiled from literature reviews. The questionnaire collected demographic data, social determinants’ data and TB knowledge information. Questionnaire had to be performed face-to-face and answers were open-ended or multiple choice. Content validity was assessed by content validity index (CVI) and Delphi technique. Linguistic and cultural barriers were assessed undergoing a health literacy review and performing a focus group and two pilot tests. Reliability was assessed calculating Cronbach’s alpha coefficient. We computed the Kaiser-Meyer-Olkin test (KMO test) and the sphericity Bartlett’s test in order to perform principal component analysis (PCA). PCA was performed to assess validity. We enrolled and interviewed 96 adult foreign-born subjects from high TB incidence countries from November 2019 to December 2019 in four different facilities (a school, a refugee centre, an infectious diseases unit and an immigrant-health ambulatory) in Ferrara, Italy. Descritpive statistics was used to summarize dempgraphic data. Results: Seven TB experts evaluated the questionnaire with two Delphi technique rounds. Nineteen (50%) out of 38 items presented CVI <80% and were deleted. The focus group was conducted with four foreign-born subjects and two items were deleted and one item added. Eleven subjects underwent the first pilot test and 40 subjects the second one: no items were deleted. Cronbach’s alpha coefficient was 0.70 for TB knowledge items (four items). KMO test value was 0.68 and the sphericity Bartlett’s test was < 0.001. The questionnaire presented one factor (eigenvalue=1.99) [Figure1]. Table 1 and 2 show demographic data and social determinants of health of the population interviewed. Conclusions: We developed and validated a questionnaire as a reliable and valid tool for measuring TB knowledge among foreign-born subjects from high incidence TB countries, who are living in a low TB incidence setting. We hope this questionnaire could contribute to TB control.