Development and validation of a national questionnaire assessing knowledge, attitudes, and practices on neglected tropical diseases among italian medical trainees

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BACKGROUND: Neglected Tropical Diseases (NTDs) affect nearly two billion people worldwide, yet preparedness to diagnose and manage them remains limited in high-income countries (HICs), where shifting epidemiology driven by climate changes, migration, mobility, international food and animal trade and global interconnection requires broader clinical competencies. Evidence on NTD-related knowledge among medical trainees in Europe is scarce. This study aimed to develop, validate, and field-test a comprehensive instrument assessing knowledge, attitudes, and practices (KAP) regarding NTDs among Italian medical students, recent graduates, and residents. METHODS: A structured questionnaire was developed using a multi-step approach informed by World Health Organization (WHO) Neglected Tropical Diseases priorities and a targeted literature review. Content validity was assessed through a two-round Delphi process with a multidisciplinary national expert panel (Round 1: n = 36; Round 2: n = 34), followed by external expert evaluation (n = 17). Quantitative content validation included Item- and Scale-Level Content Validity Indices (I-CVI, S-CVI/Ave) and interquartile ranges (IQR) to assess expert consensus. Reliability and psychometric properties were evaluated in a national sample of Italian medical trainees (n = 96), including internal consistency (Cronbach's α; KR-20), test-retest reliability (ICC; Cohen's κ), and item performance analyses. RESULTS: Across Delphi rounds, 91-98% of items reached consensus (IQR ≤ 1), and overall content validity was excellent (S-CVI/Ave 0.96-0.98). Reliability metrics confirmed strong internal consistency (α = 0.863; KR-20 = 0.82) and good temporal stability (ICC = 0.89; κ = 0.72-0.84). Known-groups validity was demonstrated by significantly higher knowledge scores among residents compared with medical students (p = 0.014). CONCLUSIONS: This study provides the first Delphi-validated national instrument assessing NTD-related knowledge among Italian medical trainees. The tool can offer a foundation for evaluating curricula and informing educational reform, supporting the integration of NTD-related competencies in European medical education in response to evolving global health challenges.

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