Development and initial content and face validation of a questionnaire to evaluate pharmacists' attitudes and practices in counselling urinary tract infection patients: A mixed methods study

Background The role of pharmacists in managing urinary tract infections (UTIs) is crucial, yet there is no instrument to assess their attitudes and practices in this area. The study aimed to develop and initially validate a questionnaire to evaluate pharmacists' attitudes and practices concerning patient counselling for UTIs, with the ultimate goal of supporting improvements in pharmacy practice and enhancing the quality of patient care. Methods The questionnaire was developed and initially validated (content and face) through a multi-phase mixed-methods approach consisting of: 1) initial item generation applying a comprehensive literature review, 2) first expert panel discussion, 3) content and cultural validation by pharmacists (focus group discussion), 4) second expert panel discussion, and 5) pretesting by the target population. The necessity, relevance, and clarity were assessed by calculating the Content Validity Ratio (CVR), Item-Level Content Validity Index (I-CVI), and Scale-Level Content Validity Index (S-CVI/Ave). Qualitative data was analyzed using an ethnographic content analysis. Results The initial questionnaire consisted of 33 items, divided into two domains: pharmaceutical practice and attitudes. After phases 2–4, all items were rated with satisfactory CVR and I-CVI values (over 0.99 and 0.83, respectively). The final phase of content validation resulted in the questionnaire final version of 25 items with S-CVI/Ave = 0.98 for relevance and S-CVI/Ave = 1 for clarity. Internal consistency analysis demonstrated high reliability for the attitudes toward antibiotics subscale (Cronbach's α = 0.850) and acceptable reliability for the attitudes toward herbal products subscale (Cronbach's α = 0.735). Conclusions The developed questionnaire is concise, easy to use and has satisfactory content and face validity. The developed questionnaire can be used to assess pharmacists' practices and attitudes in counselling patients with UTI symptoms, contributing to the identification of areas for improvement in pharmacy practice and patient safety.