To Örebro University

BACKGROUND: Wound cleansing is a fundamental component of chronic wound management; yet, high-quality evidence to guide practice is limited. Understanding nurses' knowledge, attitudes, and practices (KAP) is essential, but no instrument with published evidence of acceptable measurement properties exists.

OBJECTIVE: To develop a KAP questionnaire on wound cleansing for community nurses and evaluate its measurement properties.

METHODS: A multi-phase study was conducted, including literature/consensus item generation; a two-round international Delphi process; pilot cognitive interviews; and field testing in Canada. Knowledge was assessed for item and construct validity; attitude for internal consistency (Cronbach's α); and all KAP items for stability using test-retest reliability.

RESULTS: 26 experts supported content relevance; feedback led to targeted revisions. Field testing involved 130 nurses (83.1 % homecare; >80 % with ≥5 years of wound care experience). Several knowledge items were too easy (≥.90); none negatively discriminated. Exploratory principal components analysis of attitudes yielded three components (63 % of variance); internal consistency ranged from α = 0.41 to α = 0.76. In the subsample (n = 30), knowledge κ values ranged from slight/fair to substantial; some items showed ceiling effects (uniform responses, κ undefined). Attitude and practice item-level intraclass correlation coefficients varied (.07-.95), with several ≥.75 and others <.60. Known-groups comparison supported higher knowledge among formally educated nurses.

CONCLUSION: Evidence supports content validity and a clarified attitudes structure; internal consistency and stability were acceptable for some elements but below the threshold for others. Future refinement and confirmatory testing are warranted.