Razavi Journal of Medicine

Razavi Journal of Medicine

Design and Validation of a Tool to Measure the Knowledge, Attitude, and Performance of Health Workers Regarding Population Growth Policies

Document Type : Original Article

Authors
Najmeh Khodadadi 1, 2
Maryam Paydar 3
Zahra Amiri 4
Mostafa Boskabady 5
1 Department of Health, Safety, and Environment management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran2. Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Environmental Health Engineering, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
4 Department of Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
5 Faculty of Medicine, Mashhad University of Medical Sciences, Khorasan Razavi, Iran
10.30483/rjm.2025.254633.1411
Abstract
Background: The decline in fertility rates, including in Iran, poses demographic challenges like an aging population and a reduced workforce. Iran's fertility rate has fallen below replacement levels. In 2021, legislation was passed to improve fertility and population quality. The law's success depends on the Ministry of Health personnel, as their knowledge and attitudes affect community reproductive behaviors. However, there are no standardized tools to evaluate these factors among Iranian healthcare professionals regarding the new population policies.
 
Objectives: This study aims to create and validate a reliable tool to assess Iranian healthcare workers' knowledge, attitudes, and practices regarding population growth policies.
 
Methods: This instrument development study was conducted in Mashhad during 2022–2023 to design and validate a questionnaire on healthcare providers’ awareness. The initial item pool was derived from the Ministry of Health’s checklist and refined through expert review and consultations with officials from the Health Vice-Chancellor of Mashhad University of Medical Sciences. Overlapping items were removed, and the finalized questions were compiled into the preliminary instrument. Content validity was evaluated using CVR and CVI by 12 experts. Reliability was assessed among 65 healthcare personnel, including physicians, midwives, nurses, and health workers, using Cronbach’s alpha and test–retest methods. Data analysis was performed with SPSS using descriptive and nonparametric statistics.
 
Results: The results showed that 12 items were not suitable in terms of content validity and were removed from the questionnaire, while the other questions remained in the questionnaire with some minor modifications in the writing. The final questionnaire comprised 40 valid items encompassing the domains of knowledge, performance, attitudes towards population growth, and attitudes towards socio-legal and cultural contradictions. Reliability metrics indicated robust internal consistency, with Cronbach's alpha exceeding 0.85 across all domains, and demonstrated satisfactory test-retest reproducibility, with an Intraclass Correlation Coefficient (ICC) of 0.83 or greater.
 
Conclusion: This validated questionnaire is a key tool for assessing health workers' knowledge, attitudes, and practices about population growth policies in Iran. It aids in targeted educational interventions and policy monitoring, supporting demographic goals amid declining fertility trends.
 
Keywords
knowledge
attitudes
performance
population policy

Acknowledgements: Many thanks to Mashhad State Health Center for allowing us to carry out this project.

 

Availability of data and materials: All data generated or analyzed during this study are included in this published article.

 

Conflicts of interests: The authors declare that they have no conflict of interest.

 

Consent for publication: Not applicable.

 

Ethics approval and consent to participate: This study was conducted after receiving ethical approval from Mashhad University of Medical Sciences (IR.MUMS.FHMPM.REC.1401.142). All participants were fully informed of the study's aims and provided written consent prior to their involvement. The research procedures adhered to the ethical standards of the institutional review board and the 1964 Helsinki Declaration.

 

Financial disclosure: Financial support was provided by Mashhad University of Medical Sciences, Mashhad, Iran.

 

Author contributions: NKH and MB contributed to the conception, drafting the manuscript, and language editing of the manuscript. NKH contributed to the conception, data collection, and Drafting of the manuscript. MP and ZA contributed to the conception, data collection, statistical analyses, and interpretation of data. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine
Volume 14, Issue 1
Winter 2026
Pages 33-45