Initial psychometric evaluation of an Ebola preparedness knowledge, attitudes and self-reported practices instrument among undergraduate nursing students in Egypt: a methodological cross-sectional study

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Background: Ebola outbreaks require nursing graduates who can recognize risk, apply infection prevention and control (IPC), communicate accurately and provide ethical care. Knowledge, attitudes and practices (KAP) surveys are often used without adequate evidence that their scores are interpretable or resistant to patterned responding. Aim: To evaluate and refine an Ebola preparedness KAP instrument for undergraduate nursing students in Egypt. Methods: This methodological cross-sectional study analyzed 250 usable online questionnaires from a convenience sample. The 49-item instrument comprised 20 Knowledge, 14 Attitude and 15 self-reported Practice items. Analyses included item performance, bootstrap confidence intervals for Cronbach's alpha, principal component and parallel analyses, categorical-correlation sensitivity analyses, response-pattern audits and HC3-robust regression. Results: A10 remained negatively correlated with the Attitude total after verified reverse scoring ( r = −0.337) and was removed. Alpha estimates were very high for Knowledge (0.969), refined Attitude (0.983) and Practice (0.980). Mean percentage scores were 58.6%, 68.9% and 74.4%. Invariant raw-response patterns occurred in 28.4%, 40.4% and 55.2%, and sensitivity analysis suggested two Practice components. In the primary regression (R 2 = 0.379), Attitude was the stronger correlate of Practice (beta = 0.539, p < .001); Knowledge was weaker (beta = 0.192, p = .002) and attenuated in sensitivity analysis. Conclusion: The refined 48-item instrument may support low-stakes formative assessment. Very high alpha estimates, extensive invariant responding and instability in Practice dimensionality limit interpretation. Independent multicenter validation, test-retest assessment and comparison with observed performance are required; the instrument should not be used for high-stakes decisions or competency certification.

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