Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire

Baharudin Abdullah; Ramaprabah Kandiah; Nik Fariza Husna Nik Hassan; Ahmad Filza Ismail; Zahiruddin Wan Mohammad; De Yun Wang

doi:10.1016/j.waojou.2020.100482

Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire

World Allergy Organ J. 2020 Nov 18;13(12):100482. doi: 10.1016/j.waojou.2020.100482. eCollection 2020 Dec.

Authors

Baharudin Abdullah¹, Ramaprabah Kandiah¹, Nik Fariza Husna Nik Hassan¹, Ahmad Filza Ismail², Zahiruddin Wan Mohammad², De Yun Wang³

Affiliations

¹ Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
² Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
³ Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.

Abstract

Background: Primary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose.

Methods: The development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items.

Results: The final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance.

Conclusions: The newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.

Keywords: 2-PL IRT, Two-parameter logistic item response theory; ARIA, Allergic Rhinitis and its Impact on Asthma; Allergic rhinitis guidelines; Attitude; CVI, Content Validity Index; EAR, Allergic rhinitis; EFA, exploratory factor analysis; FVI, Face Validity Index; GINA, Global Initiative for Asthma; IgE, immunoglobulin; KMO, Kaiser-Meyer-Olkin test; ORL, Otorhinolaryngologist; PCPs, Primary care practitioners; Perception; Practice; Primary care practitioners; S-CVI/Ave, Scale-level CVI of averaging calculation method.