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Development and validation of a skin health knowledge; attitudes; and behaviors questionnaire for the general population: a cross-sectional study
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DOI：10.3389/fpubh.2026.1856843.png)
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Abstract
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BackgroundExisting skin health assessments predominantly focus on single topics or diseases; making it difficult to cover the complete “Knowledge–Self-efficacy–Attitudes–Behaviors (KSAB)” continuum.ObjectiveTo develop and validate a skin health knowledge; attitudes; and behaviors questionnaire for the general population.MethodsA cross-sectional online survey was conducted among the general population between October and November 2025. The questionnaire was developed based on a conceptual structure incorporating four dimensions: knowledge; self-efficacy; attitudes; and behaviors. Content validity was assessed by 13 experts; and the Item-level Content Validity Index (ICVI) and modified Kappa (K*) were calculated. Construct validity was examined using confirmatory factor analysis (CFA). Item-level evaluation was performed using item response theory (IRT); including the two-parameter logistic (2PL) model for dichotomous items and the graded response model (GRM) for ordered items.ResultsA total of 865 individuals were enrolled (men: women = 1.24:1). Content validity was good (ICVI = 0.846–1.000; K* = 0.845–1.000). The five-factor model from CFA showed a good fit (CFI = 0.969; TLI = 0.960; RMSEA = 0.070; SRMR = 0.095). IRT analysis indicated that K1–K5 had acceptable discrimination (a = 0.59–2.40) and difficulty parameters ranging from −3.63 to −1.33. However; items K6; K7 and S1 were excluded due to insufficient threshold coverage. The proportion of women reporting frequent sunscreen use was higher than that of men. Self-efficacy levels showed a decreasing trend with age. Furthermore; individuals in service/manual labor occupations exhibited lower proportions on certain items.ConclusionThis study developed and validated a KSAB questionnaire on skin health knowledge; attitudes; and behaviors; showing good validity and item-level performance. The findings support targeted health promotion for men; older adults; and service/manual workers.
Keywords:
confirmatory factor analysis
cross-sectional survey
item response theory
content validity index
Knowledge–Self-Efficacy–Attitudes–Behaviors
skin health questionnaire
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