Development and Validation of An Instrument for Assessing Obstetric Nurses’s Knowledge, Attitude and Practice (KAP) on Prevention of Maternal-To-Child Transmission of Hepatitis B

Development and Validation of An Instrument for Assessing Obstetric Nurses’s Knowledge, Attitude and Practice (KAP) on Prevention of Maternal-To-Child Transmission of Hepatitis B | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development and Validation of An Instrument for Assessing Obstetric Nurses’s Knowledge, Attitude and Practice (KAP) on Prevention of Maternal-To-Child Transmission of Hepatitis B SITI HAJAR MUDA, MALINI MAT NAPES, MOHD SALAMI IBRAHIM This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8974224/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Prevention of mother-to-child transmission (PMTCT) of hepatitis B remains a critical public health issue and a central component of Malaysia’s Triple Elimination Initiative. Obstetric nurses play a pivotal role in implementing PMTCT strategies; however, the absence of psychometrically validated instruments limits the accurate assessment of their knowledge, attitudes and practices (KAP). Objective To develop KAP instrument for PMTCT of hepatitis B among obstetric nurses (SureHepB) and to assess its validity and reliability. Methods A cross-sectional validation study was conducted using a two-phase approach in a tertiary hospital setting. Phase 1 involved questionnaire development, content validation by a multidisciplinary expert panel, and face validation among obstetric nurses. Phase 2 comprised psychometric evaluation using two independent samples for exploratory factor analysis (EFA; n = 207) and confirmatory factor analysis (CFA; n = 203). Results Content validity indices indicated high relevance among expert (S-CVI/Ave = 1.0) and strong inter-rater agreement (Gwet’s AC2 = 0.82). EFA supported a three-factor structure for the attitude and practice domains—Clinical Practice, Professional Responsibilities, and Preventive Awareness—accounting for 75.53% of the total variance. CFA confirmed good model fit (CFI = 0.951, TLI = 0.940, RMSEA = 0.077), with all standardized factor loadings exceeding recommended thresholds. Internal consistency reliability ranged from acceptable to excellent across factors (Cronbach’s α = 0.646–0.920). Conclusion The SureHepB for obstetric nurses is a valid and reliable instrument for assessing PMTCT-related competencies among obstetric nurses, with potential applications in training evaluation, policy planning, and future research. Nurses Maternal and Child PMTCT Hepatitis B Scale development Validation Study Figures Figure 1 Figure 2 Introduction Hepatitis B virus (HBV) infection remains a major global public health challenge, accounting for an estimated 820,000 deaths annually, largely due to complications such as liver cirrhosis and hepatocellular carcinoma [1, 2]. Despite the availability of effective vaccines and antiviral therapies, HBV continues to persist globally, primarily through vertical transmission, also known as mother-to-child transmission (MTCT). This mode of transmission occurs predominantly during the perinatal period and represents the principal mechanism sustaining the global reservoir of chronic HBV infection. Infants infected through MTCT have an approximately 90% risk of developing chronic hepatitis B, compared to less than 5% among adults, highlighting the critical importance of preventing MTCT as a cornerstone of global HBV elimination strategies [3]. In Malaysia, the prevention of MTCT of HBV has been formally incorporated into the national Triple Elimination Initiative, which targets the elimination of MTCT of three priority infections: Human Immunodeficiency Virus (HIV), syphilis, and hepatitis B [4, 5]. The inclusion of HBV within this framework reflects its public health significance and the shared prevention strategies required across these infections, including universal antenatal screening, early identification of infected mothers, and timely neonatal immunoprophylaxis. Achieving the elimination of HBV MTCT is therefore integral to Malaysia’s broader maternal and child health agenda and aligns with global elimination targets. Obstetric nurses play a pivotal role in the successful implementation of PMTCT strategies and represent one of the key pillars of the Malaysian healthcare system. Within the Triple Elimination framework, nurses are responsible for a wide range of critical tasks, including antenatal screening and risk assessment, patient education and counselling, reinforcement of adherence to antiviral therapy, strict implementation of infection control measures during labour and delivery, and ensuring the correct and timely administration of the hepatitis B birth dose vaccine and hepatitis B immunoglobulin (HBIG) to exposed newborns. Given the complexity and time-sensitive nature of these responsibilities, optimal PMTCT outcomes depend heavily on nurses’ knowledge, attitudes, and clinical practices. The Knowledge, Attitudes, and Practices (KAP) framework has been widely used in cross-sectional studies to examine healthcare providers’ competencies and behavioural determinants in public health and clinical settings. Previous studies have demonstrated that inadequate knowledge and negative attitudes may adversely influence clinical practices, thereby compromising the effectiveness of PMTCT interventions [6–9]. These relationships are often examined using descriptive or inferential analyses linking KAP domains to screening behaviours and preventive practices, underscoring the utility of the KAP framework in identifying gaps that can be addressed through targeted interventions. However, despite the widespread application of KAP-based studies in PMTCT hepatitis B research, a critical limitation persists: many existing instruments lack rigorous psychometric validation. Without systematic validation, it remains uncertain whether such instruments accurately and reliably measure the intended constructs, potentially limiting the interpretability and comparability of findings. This gap is particularly evident within the Malaysian context, where culturally relevant and psychometrically sound instruments for assessing PMTCT-related KAP among obstetric nurses are scarce. Instrument validation is therefore essential to ensure content relevance, construct validity, and measurement reliability, particularly when findings are intended to inform policy development, training programmes, and quality improvement initiatives. In response to this gap, the present study aimed to develop and validate a KAP measurement instrument for PMTCT of hepatitis B among obstetric nurses in Malaysia. Exploratory factor analysis (EFA) was conducted to identify the underlying factor structure of the attitude and practice domains, followed by confirmatory factor analysis (CFA) to assess structural validity and internal consistency reliability. By establishing a validated, context-specific instrument, this study seeks to provide a standardized and reliable tool for assessing PMTCT-related competencies among obstetric nurses, thereby supporting evidence-based educational planning, policy formulation, and future research. Methods Study design A cross-sectional study conducted for the validation of the questionnaire (SureHepB). The methodology in this study was adhered to the recommended principles outlined in AMEE Guide No. 87, including defining the construct, conducting a comprehensive literature review, iterative item generation, expert content validation, face validation, and psychometric testing through EFA and CFA [10]. Study setting and participants The study was conducted in a tertiary hospital in Terengganu, Malaysia. This setting was selected because the hospital functions as the principal referral center for maternal and child health services in the region, providing comprehensive obstetric care and employing a large cohort of obstetric nurses with varied levels of experience. Participants were eligible if they met the following criteria: (1) Registered nurses currently working in obstetric practice; (2) At least one year of experience in obstetric care; (3) Employed at Hospital Sultanah Nur Zahirah; and (4) Able and willing to provide informed consent. Participants were selected using a random sampling. A total of 410 were recruited across two independent samples. After excluding ineligible and incomplete responses, 207 participants were included in the dataset for EFA, and 203 participants in the dataset for CFA. Sample size determination Exploratory factor analysis The sample size for the EFA was determined using the N:p ratio, which represents the number of participants (N) relative to the number of variables (p). Traditionally, a ratio of 5:1 is applied [11]. However, recent methodological literature highlights that the stability, reliability, and replicability of factor solutions depend not only on sample size but also on factors such as the strength of item loadings, the uniformity of communalities, and the number of items per factor [11, 12]. Some researchers recommended a minimum of 100 participants with an N/p ratio of at least 5 [13–15]. Drawing on these guidelines and broader methodological consensus, many authors suggest that a minimum sample size of 200 is appropriate for exploratory factor analysis [15, 16]. Therefore, a threshold of 200 participants was adopted for this study, reflecting a combination of methodological recommendations and practical constraints. Confirmatory Factor Analysis The study utilized a sample size of N = 200. This sample size is considered adequate for conducting Confirmatory Factor Analysis (CFA) on the 30-item instrument, based on established psychometric guidelines. The absolute minimum threshold for factor analysis is widely suggested to be N = 200, which classified as a "fair" sample size [16, 17]. Furthermore, the number of participants satisfies the generally accepted cases-to-variables ratio (N:p) criteria [18]. With 30 observed items, the N = 200 sample yields a ratio of approximately 6.67:1 (200/30). This ratio comfortably exceeds the conservative minimum ratio of 5:1 often cited for Structural Equation Modeling (SEM) [19], thus providing a statistically sound foundation for the stability of the CFA model and its parameter estimates. Instrument development and measures The SureHepB questionnaire was newly developed for this study to assess obstetric nurses’ KAP regarding the PMTCT of hepatitis B. The instrument development and validation were conducted in two phases: Phase 1 involved questionnaire development, and Phase 2 involved psychometric validation using exploratory and confirmatory factor analyses. Phase 1: Questionnaire Development The development of the questionnaire followed a structured, multi-step process to ensure comprehensive coverage of constructs related to knowledge, attitudes, and practices (KAP) on the prevention of mother-to-child transmission (PMTCT) of hepatitis B in obstetric practice. Step 1: Identification of Constructs A detailed review of national and international guidelines was undertaken, including: Malaysian National Strategic Plan for Hepatitis B, Ministry of Health Malaysia protocols, WHO PMTCT recommendations and published literature on hepatitis B vertical transmission. Both electronic search of the database (Scopus, the Web of Science, Science Direct and Google Scholar) and manual search of references of relevant studies published between January 2005 and December 2024 were carried out to identify articles containing information on KAP. Term and phrases like “nurse’s knowledge on vertical transmission of hepatitis B”, “nurse’s knowledge on PMTCT of hepatitis B”, “nurse’s attitudes towards PMTCT of hepatitis B” and “practices on PMTCT on hepatitis B” were systematically searched. Three main constructs were identified: Knowledge: factual understanding of hepatitis B, including its etiology, modes of transmission, clinical presentation, recommended antenatal screening, antiviral therapy, neonatal immunoprophylaxis, breastfeeding practices, vaccination schedules, and potential complications. Attitude: nurses’s belief, perceptions of importance, and professional dispositions toward PMTCT, reflected in their views on the severity of hepatitis B complications, perceived benefits of preventive interventions, commitment to maternal counselling, belief in effectiveness of early vaccination and antiviral therapy, and confidence in communicating with mothers. Practice: routine clinical behaviours aligned with recommended PMTCT protocols, including screening pregnant women for hepatitis B, educating mothers, administering vaccines and hepatitis B immunoglobulin (HBIG), documenting care, activating referrals, adhering to infection control procedures, and ensuring post-vaccination follow-up. Step 2: Item Generation Initial items for the questionnaire were drafted based on an extensive review of current literature, national guidelines, and previously validated instruments related to hepatitis B and the prevention of mother-to-child transmission. The knowledge domain was constructed using multiple-choice questions, each comprising four response options (A, B, C, and D) with a single correct answer. The attitude domain consisted of items measured on a five-point Likert scale to capture the respondents’ level of agreement toward recommended practices. Meanwhile, the practice domain was designed using frequency-based Likert scale items to assess how often specific preventive behaviours were performed in clinical settings. Overall, a total of 15 knowledge items, 15 attitude items, and 15 practice items were initially generated to represent the key constructs of the questionnaire. Step 3: Content Validity (CVI) Following the item generation process, content validity was assessed by a panel of 10 subject-matter experts in fields related to hepatitis, infectious diseases, obstetrics, and nursing education. The experts rated each item on relevance, clarity, simplicity and ambiguity. The experts rated each item on a four-point scale (1 = not relevant, 2 = need major revision, 3 = need minor revision, 4 = very relevant) [20, 21]. For analysis, items rated as 3 or 4 were considered “relevant”, while ratings of 1 or 2 were treated as “not relevant” [22]. The Item-Level Content Validity Index (I-CVI) was calculated as the proportion of experts who rated the item as relevant. In accordance with established recommendations, an I-CVI value of 0.78 or higher was considered acceptable when more than five experts are involved [21–23]. Items not meeting the threshold were reviewed, refined, or removed following expert feedback. In addition to the Content Validity Index (CVI), Gwet’s AC2 coefficient was employed to assess the level of inter-rater agreement among expert reviewers. Unlike traditional agreement statistics such as Cohen’s kappa or Fleiss’ kappa, which tend to produce paradoxically low agreement values in cases of high or imbalanced rater consensus, Gwet’s AC2 offers a more robust and stable alternative, particularly in multi-rater settings [24, 25]. Gwet’s AC2 is less influenced by the prevalence of agreement and the distribution of ratings, which makes it highly suitable for content validation studies where experts tend to agree on most items [23]. In this study, with 10 raters evaluating 45 items across three domains, Gwet’s AC2 was selected to ensure accurate estimation of inter-rater reliability without underestimating agreement due to statistical bias inherent in other coefficients. Step 4: Face Validity (FVI) Face validity assessment involved a group of 12 obstetric nurses who represented the target population. Participants rated the clarity, comprehensibility, and readability of each item. An S-FVI/Ave ≥ 0.80 was considered acceptable. Minor wording revisions were made based on feedback. Phase 2: Validation Studies Phase 2 consisted of a series of psychometric validation procedures aimed at establishing the construct validity, reliability and structural integrity of the questionnaire. The validation phases involved two independent samples of obstetric nurses; one for exploratory factor analysis (EFA) and another for confirmatory factor analysis (CFA). Only the attitude and practice domains, which were measured using Likert-scale items, were subjected to factor analysis. For the knowledge domain, validation was conducted using content validity, face validity, and item-level analysis only. Ceiling and floor effects were examined, and boxplots were generated for all items to ensure adequate response variation. No item showed complete ceiling or floor effects, indicating that all knowledge items were functioning appropriately. Validation study 1: Exploratory An Exploratory Factor Analysis (EFA) was conducted to identify the underlying factorial structure of the attitude and practice domains of Hepatitis B PMTCT. Before factor extraction, the dataset was assessed for suitability using the Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy and Bartlett’s Test of Sphericity. A KMO value greater than 0.80 was considered indicative of meritorious adequacy, while a significant Bartlett’s test supported the presence of sufficient inter-item correlations for factor analysis [12, 26]. EFA was performed using Principal Component Analysis (PCA) as the extraction method, consistent with the exploratory aim of deriving the preliminary factor structure for a newly developed instrument. A varimax orthogonal rotation was applied to enhance factor interpretability by maximising the variance of loadings across factors [27]. Factors were retained based on a combination of criteria, including eigenvalues greater than 1.0, inspection of the scree plot, percentage of variance explained, and theoretical coherence with the Knowledge–Attitude–Practice (KAP) framework [12]. Items were evaluated for retention based on factor loadings ≥ 0.40, communalities ≥ 0.50, and the absence of substantial cross-loadings [12, 26]. The extracted factors were subsequently labelled based on the thematic content of their constituent items. The EFA results were used to establish the preliminary construct structure, which served as the foundation for subsequent confirmatory factor analysis (CFA) to verify model fit and psychometric robustness. Validations study 2: Confirmatory Confirmatory Factor Analysis (CFA) was performed to validate the proposed factor structure following EFA. Model fit was evaluated using several fit indices. The recommended cutoff values for model fit indices are: Chi-square goodness-of-fit (χ²/df) 0.90, the Tucker-Lewis Indexes (TLI) > 0.90, and root mean square error of approximation (RMSEA) 0.5 [28]. The CFA results confirmed the final factor structure of the SureHepB instrument. The final validated version of the questionnaire is provided in English as Supplementary File 1. The Reliability was assessed using Cronbach’s alpha with values of 0.70 or higher considered acceptable [29]. The validated factor structure provided a robust measurement framework for assessing KAP related to PMTCT of hepatitis B among obstetric nurses. Data collection procedure Data were collected between 29 August 2025 and 18 September 2025 after site approval was obtained. Eligible nurses were approached, provided with verbal and written information about the study, and invited to sign a written consent form. Participants received clear instructions on completing the questionnaire, and confidentiality and anonymity were assured. Statistical analysis Descriptive statistics were performed using IBM SPSS Statistics version 25.0 to summarize participant’s demographic characteristics and responses to KAP questionnaire. For continuous variables, means and standard were calculated, while categorical variables were summarized using frequencies and percentages. EFA were conducted using dimension reduction in IBM SPSS Statistics version 25.0. A conceptual path diagram representing the final CFA model was manually constructed using IBM SPSS Amos 28.0 (Analysis of Moment Structure) to illustrate the relationships between latent variables and their corresponding observed indicators. Results Participant characteristics A total of 207 obstetric nurses participated in the EFA, with a mean age of 43.46 years (SD = 5.28) and ages ranging from 31 to 55 years. Most respondents were aged 41–50 years (60.4%) and worked primarily in the maternity ward (76.4%). Nearly half held a Diploma in Nursing with an Advanced Diploma in Midwifery (46.4%), and the majority had over 10 years of experience in maternal and child health. More than half (57.5%) had received training related to PMTCT of hepatitis B, although 42.5% reported no training. Most nurses had experience handling women with hepatitis B-positive status (89.5%), administering the hepatitis B vaccine (77.8%), and HBIG (59.4%). The majority reported normal hepatitis B immunity levels (80.2%). A detailed summary of participant characteristics is presented in Table 1 . Table 1 The socio-demographic of the respondents (EFA) ( N = 207) Socio-demographic Characteristics n (%) Age (years) Mean (SD) 43.46 (5.28) Range 31–55 Age Groups 31–40 64 (30.9%) 41–50 125 (60.4%) 51–60 18 (8.7%) Working Place Maternity Ward 158 (76.4%) Labour Room 24 (11.6%) Patient Assessment Center 11 (5.3%) Maternity Operation Theatre 10 (4.8%) Obstetric Clinic 4 (1.9%) Education High School 54 (26.1) Diploma in Nursing 52 (25.1) Diploma in Nursing + Advanced Diploma in Midwifery 96 (46.4%) Degree in Nursing 5 (2.4%) Years of experience in maternal and child care 1–5 25 (12.1%) 6–10 36 (17.4%) 11–15 79 (38.2%) 16–20 41 (19.8%) 21–25 26 (12.6%) Receive training on PMTCT Hep B Yes 119 (57.5%) No 88 (42.5%) Types of training No training 88 (42.5%) Workshop 5 (2.4%) Course 3 (1.4%) Continuous Nursing Education (CNE) 88 (42.5%) Online Training 11 (5.3%) Others 12 (5.8%) Frequency handles mother with Hep B positive status 1–2 cases per week 1 (0.5%) 1–2 cases per month 44 (21.3%) 1–2 cases per year 140 (67.6%) Never handled 22 (10.6%) Give Hepatitis B vaccine to newborn 1–2 babies per week 46 (22.2%) 3–5 babies per week 14 (6.8%) More than 5 babies per week 123 (59.4%) None 46 (22.2%) Give Hepatitis B Immunoglobulin (HBIG) to newborn Yes 161 (77.8%) No 46 (22.2%) Hepatitis B immune status > 10mlU/ml (Normal) 166 (80.2%) < 10mlU/ml (Low) 2 (1.4%) Not sure 38 (18.4%) Complete 3 doses of hepatitis B vaccination Yes 163 (78.7%) No 2 (1.0%) Not sure 42 (20.3%) A total of 203 obstetric nurses participated in the CFA, with a mean age of 42.77 years (SD = 5.89), ranging from 30 to 56 years, and over half were between 41–50 years of age (50.7%). Almost half worked in the maternity ward (48.8%), followed by the labour room (31.0%), and most held a Diploma in Nursing with Advanced Diploma in Midwifery (46.8%). One-third had 11–15 years of maternal and child health experience (32.5%), while more than half (55.2%) reported not receiving any prior training on PMTCT of hepatitis B. Most respondents managed 1–2 hepatitis B–positive mothers per year (60.1%), and over half routinely administered hepatitis B vaccine (51.2%) and HBIG (55.7%). The majority reported normal hepatitis B immunity levels (71.9%) and had completed the full three-dose hepatitis B vaccination series (84.7%). Detailed socio-demographic characteristics of the CFA sample are presented in Table 2 . Table 2 The socio-demographic of the respondents (CFA) ( N = 203) Socio-demographic Characteristics n (%) Age (years) Mean (SD) 42.77 (5.89) Range 30–56 Age Groups 25–30 1 (0.5%) 31–40 79 (38.9%) 41–50 103 (50.7%) 51–60 20 (9.9%) Working Place Maternity Ward 99 (48.8%) Labour Room 63 (31.0%) Patient Assessment Center 11 (5.4%) Maternity Operation Theatre 19 (9.4%) Obstetric Clinic 7 (3.4%) Education High School 49 (24.1%) Diploma in Nursing 53 (26.1%) Diploma in Nursing + Advanced Diploma in Midwifery 95 (46.8%) Degree in Nursing 5 (2.5%) Master in Nursing 1 (0.5%) Years of experience in maternal and child care 1–5 34 (16.7%) 6–10 46 (22.7%) 11–15 66 (32.5%) 16–20 41 (20.2%) 21–25 16 (7.9%) Receive training on PMTCT Hep B Yes 91 (44.8%) No 112 (55.2%) Types of training No training 112 (55.2%) Workshop 7 (3.4%) Course 14 (6.9%) Continuous Nursing Education (CNE) 57 (28.15) Online Training 6 (3.0%) Others 7 (3.4%) Frequency handles mother with Hep B positive status 1–2 cases per week 2 (1.0%) 1–2 cases per month 46 (22.7%) 1–2 cases per year 122 (60.1%) Never handled 33 (16.3%) Give Hepatitis B vaccine to newborn 1–2 babies per week 27 (13.3%) 3–5 babies per week 8 (3.9%) More than 5 babies per week 104 (51.2%) None 64 (31.5%) Give Hepatitis B Immunoglobulin (HBIG) to newborn Yes 113 (55.7%) No 90 (44.3%) Hepatitis B immune status > 10mlU/ml (Normal) 146 (71.9%) < 10mlU/ml (Low) 4 (2.0%) Not sure 53 (26.1%) Complete 3 doses of hepatitis B vaccination Yes 172 (84.7%) No 4 (2.0%) Not sure 27 (13.3%) 3.2 Content and Face Validity and Item-level analysis for knowledge domain. The overall content validity of the knowledge domain was excellent with S-CVI/Ave = 1.00 and S-CVI/UA = 1.00. Inter-rater agreement was also strong, with Gwet’s AC2 = 0.82 indicating good consistency among experts. Similarly, the face validity index for the scale was also high (S-FVI/Ave = 1.00), indicating that all items were deemed clear, comprehensible, and appropriate by the target respondents. Table 3 summarises the item-level evaluation of the knowledge domain. All items achieved perfect content validity (I-CVI = 1.00) and face validity (I-FVI = 1.00), indicating unanimous agreement among experts and respondents regarding item relevance and clarity. In terms of item difficulty, six items (K1, K2, K4, K5, K13 and K15) demonstrated ceiling effects (> 80% correct), reflecting very easy items. The remaining items showed acceptable difficulty levels within the expected range. Item discrimination values ranged from 0.095 to 0.705. Most items demonstrated good discrimination (r ≥ 0.30), suggesting that they were able to differentiate between respondents with higher and lower knowledge levels. Only a few items (K1, K2, K4 and K5) showed poor discrimination, consistent with their high difficulty indices. Overall, the knowledge items were judged to be relevant, clear and psychometrically adequate for assessing knowledge related to PMTCT of hepatitis B. Table 3 Content Validity, Face Validity and Item Functioning for Knowledge Items Item I-CVI I-FVI % Correct Effect Discrimination (r) Interpretation K1 The hepatitis B virus typically affects the organ of (a) heart; (b) liver; (c) kidney; (d) lung 1.00 1.00 96.8 Ceiling 0.0951 Easy item, Ceiling effect, low discrimination K2 Routes of transmission of hepatitis B are as follows, except (a) sharing food and drinks; (b) sexual contact; (c) sharing needles; (d) mother-to-child transmission during delivery process 1.00 1.00 92.2 Ceiling 0.2002 Easy item, Ceiling Effect, borderline discrimination K3 The usual presentation in a mother with hepatitis B is (a) severe diarrhea; (b) persistent itchiness; (c) frontal headache; (d) no symptoms 1.00 1.00 52.7 Normal 0.4945 Functioning well, moderate difficulty K4 The first step in preventing mother-to-child transmission is to (a) give antibiotics during pregnancy; (b) screen pregnant women for hepatitis B early in antenatal care; (c) give immediate antiviral therapy to all women; (d) screen all family members for hepatitis B 1.00 1.00 93.4 Ceiling 0.3751 Easy item, Ceiling Effect K5 The test used to screen pregnant women for hepatitis B is (a) Vanereal Disease Research Laboratory; (b) Hepatitis B surface antigen test; (c) Human Immunodeficieny virus test; (d) full blood picture 1.00 1.00 92.7 Ceiling 0.4887 Easy item, Ceiling Effect K6 The most common time of transmission of hepatitis B from mother-to-child is during (a) pregnancy; (b) delivery; (c) breastfeed; (d) childhood 1.00 1.00 76.1 Normal 0.3527 Functioning well K7 The recommended action if a pregnant woman is diagnosed with high viral load hepatitis B (HBV DNA ≥ 200 000 IU/mL or ≥ 5.3 log10 IU/mL) is (a) elective caesarean section; (b) antiviral therapy during pregnancy; (c) early induction of labour; (d) no intervention needed 1.00 1.00 49.5 Normal 0.501 Functioning well K8 Antiviral medication is most commonly prescribed to pregnant women with hepatitis B to reduce vertical transmission is (a) ribavirin; (b) acyclovir; (c) efavirenz; (d) tenofovir 1.00 1.00 73.9 Normal 0.6995 Functioning well K9 Hepatitis B vaccine consists of (a) liver hepatitis B virus; (b) inactivated virus; (c) recombinant hepatitis B surface antigen (HbsAg) produced yeast cell; (d) pork-derived gelatin 1.00 1.00 73.2 Normal 0.7055 Functioning well K10 Newborns of hepatitis B-positive mothers should be given the birth dose of hepatitis B vaccine within (a) 12 hours; (b) 24 hours; (c) 48 hours; (d) 7 days 1.00 1.00 27.1 Normal 0.4967 Harder item, functioning K11 The standard birth dose for hepatitis B vaccination is (a) 5 micrograms; (b) 10 micrograms; (c) 20 micrograms; (d) 40 micrograms 1.00 1.00 30.7 Normal 0.4161 Harder item, functioning K12 When educating patients about side effects of the hepatitis B vaccine, nurses should emphasize that (a) all vaccines are completely free from any side effects; (b) minor side effects are normal and a sign that the body is building protection; (c) major organ failure is expected after vaccination; (d) vaccination is only necessary if symptoms appear 1.00 1.00 66.3 Normal 0.556 Functioning well K13 The additional treatment is recommended for newborns of hepatitis B positive mothers besides the vaccine is (a) antibiotics; (b) vitamin K injection; (c) hepatitis B immunoglobulin; (d) oral antiviral syrup 1.00 1.00 94.4 Ceiling 0.3567 Easy item, Ceiling Effect K14 The correct statement about breastfeeding among women with hepatitis B is (a) it is not allowed; (b) safe with proper immunoprophylaxis; (c) it is only allowed after the baby is 6 months old; (d) it should be avoided if the mother receives antiviral therapy 1.00 1.00 77.1 Normal 0.7037 Functioning well K15 Inadequate hepatitis B prevention among the children can lead to (a) chronic hepatitis B; (b) HIV infection; (c) malnutrition; (d) childhood asthma 1.00 1.00 88.3 Ceiling 0.6702 Easy item, Ceiling Effect I−CVI = Item Content Validity Index; I−FVI = Item Face Validity Index . Item difficulty (% correct) classified as: Ceiling (≥80%), Normal (20–79%), Floor (≤20%) . Discrimination (point−biserial correlation) classified as: Good (≥0.30), Borderline (0.20–0.29), Poor (<0.20) . Interpretation integrates difficulty, discrimination, and response patterns . The boxplot (Fig. 1 ) shows the distribution of dichotomous responses (0 = incorrect, 1 = correct) for each item. Items K1, K2, K4, K5, K13 and K15 demonstrate clustering near 1.0, reflecting ceiling effects, while the remaining items show adequate variability with no floor effects. Construct Validity Exploratory Factor Analysis An exploratory factor analysis (EFA) was performed to examine the underlying structure of the Hepatitis B PMTCT questionnaire using Principal Component Analysis. Sampling adequacy was confirmed with a Kaiser–Meyer–Olkin (KMO) value of 0.870, indicating meritorious adequacy for factor analysis. Bartlett’s Test of Sphericity was statistically significant (χ² = 9838.440, df = 435, p < .001), demonstrating that the correlation matrix was not an identity matrix and confirming that the items were sufficiently interrelated to proceed. Based on eigenvalues greater than 1.0 and inspection of the scree plot, a three-factor solution was retained. The three extracted components collectively accounted for 75.53% of the total variance, indicating a strong factor structure. Specifically, Factor 1 contributed 59.07%, Factor 2 contributed 9.96%, and Factor 3 contributed 6.50% of explained variance. Interpretation of factor loadings and item content resulted in the labelling of three meaningful constructs aligned with the theoretical KAP framework. The first factor, Clinical Practice, consisted of items representing routine clinical behaviours such as HBV screening, timely administration of hepatitis B vaccine and HBIG, infection control, documentation, and neonatal referral. The second factor, Professional Responsibility, captured items reflecting perceived duty, confidence, and provider accountability in counselling mothers regarding hepatitis B. The third factor, Preventive Awareness, encompassed items reflecting beliefs regarding the importance of timely vaccination, antenatal counselling, guideline adherence, and the preventive impact on maternal and community health. All items demonstrated acceptable communalities (> 0.50) and strong factor loadings (> 0.40), with minimal cross-loadings, supporting a clean and interpretable factor structure (Table 3 ). Although PCA initially extracted four factors, the fourth component explained only 4.06% of variance and was not theoretically coherent; therefore, the three-factor solution was retained based on theoretical justification and parsimony. Table 3 Factor structure and loading of 30 items in KAP PMTCT Hep B (N = 207) Item No Items Factor 1 Factor 2 Factor 3 Factor 4 A1 In my opinion preventing mother-to-child transmission of hepatitis B is crucial for protecting the health of the community. 0.527 A2 In my opinion hepatitis B related complications are severe enough to justify strict adherence to vaccination guidelines. 0.871 A3 In my opinion antiviral therapy during pregnancy will benefit hepatitis B-positive mothers and their newborns 0.803 A4 In my opinion timely vaccination within 24 hours after birth is essential to prevent hepatitis B transmission to the infant. 0.792 A5 In my opinion breastfeeding should be encouraged even if the mother is hepatitis B positive. 0.561 A6 In my opinion counselling the mothers about hepatitis B virus transmission is part of my duty. 0.859 A7 In my opinion I am confident in handling mothers who are unsure or worried about the hepatitis B vaccine. 0.795 A8 In my opinion I am capable of providing clear and effective guidance to mothers regarding the importance of completing the hepatitis B vaccination for their newborns. 0.863 A9 In my opinion every healthcare provider should actively promote hepatitis B prevention during antenatal care. 0.839 A10 In my opinion routine hepatitis B screening should be carried out for all pregnant women to prevent transmission 0.769 A11 In my opinion educating mothers about hepatitis B can significantly reduce the risk of mother-to-child transmission. 0.772 A12 In my opinion early identification of hepatitis B-positive mothers is key to successful prevention strategies. 0.807 A13 In my opinion effective communication with pregnant mothers improves hepatitis B prevention efforts. 0.781 A14 In my opinion healthcare providers have an important responsibility in preventing hepatitis B transmission to newborns 0.574 A15 In my opinion comprehensive antenatal counselling on hepatitis B is essential to prevent transmission to the baby. 0.869 P1 I routinely check the hepatitis B status of pregnant women during admission 0.718 P2 I routinely assume a pregnant woman does not have hepatitis B if her status is unknown, so I do not test her. 0.969 P3 I routinely educate pregnant women on the importance of the hepatitis B vaccination for their newborns 0.645 P4 I routinely inform parents about the importance of completing the full hepatitis B vaccination series for their child. 0.709 P5 I routinely counsel mothers on the safety of breastfeeding for hepatitis B positive women under appropriate care. 0.659 P6 I routinely administer the hepatitis B vaccine to newborns within 24 hours. 0.856 P7 I routinely administer hepatitis B immunoglobulin(HBIG) to newborns born to hepatitis B-positive mothers. 0.749 P8 I routinely adhere to infection control protocols to reduce the risk of hepatitis B transmission in the labour and delivery unit. 0.862 P9 I routinely document the administration of the hepatitis B vaccine in the patient’s record after giving the vaccine. 0.900 P10 I routinely alert the neonatal team when a baby is born to a hepatitis B-positive mother. 0.894 P11 I routinely report any missed hepatitis B vaccination or prophylaxis for newborns. 0.860 P12 I routinely provide counselling or education to mothers who are unsure or hesitant about giving the hepatitis B vaccine to their baby. 0.716 P13 I routinely verify that hepatitis B immunoglobulin (HBIG) administration is documented accurately for exposed newborns. 0.679 P14 I routinely reinforce to mothers the importance of post-vaccination follow-up for their babies. 0.688 P15 I routinely update my knowledge on the latest protocols for managing Hepatitis B in pregnant women. 0.819 Overall, the EFA supported a robust three-factor structure comprising Clinical Practice, Professional Responsibility, and Preventive Awareness, which provides a strong psychometric foundation for further validation through confirmatory factor analysis (CFA). 3.3.2 Confirmatory Factor Analysis (CFA) CFA validated the three-factor structure identified by EFA. The proposed measurement model demonstrated acceptable to good fit across multiple fit indices. (χ² = 186.015, df = 85, χ²/df = 2.19, CFI = 0.951, TLI = 0.940, RMSEA = 0.077 (90% CI: 0.062–0.092), RMR = 0.026, Table 5 ). The standardized CFA model with factor loadings and correlations between latent constructs is presented in Fig. 2 . Table 5 Model fit indices for CFA Model χ² df χ²/df CFI TLI RMSEA (90% CI) SRMR CFA Model 186.015 2.19 2.19 0.951 0.940 0.077 0.026 Factor loadings Standardized factor loadings ranged from 0.559 to 0.913, exceeding the minimum recommended threshold (≥ 0.50), confirming the robustness of the identified factors (Table 6 ). Table 6 Standardized factor loading from CFA Item Factor Standardized Loadings SE p-value P1 Clinical Practice 0.559 0.119 < 0.001 P6 0.771 0.080 P7 0.567 0.117 P8 0.789 Fixed Fixed P10 0.901 0.075 P11 0.873 0.082 A3 Professional Responsibilties 0.722 Fixed Fixed A7 0.605 A9 0.834 0.096 A10 0.878 0.085 A11 0.913 0.089 A12 0.897 0.088 A13 0.778 0.093 A1 Preventive Awareness 0.725 Fixed Fixed A2 0.661 0.117 Inter-Factor Correlations Inter-factor correlations from CFA are presented in Table 7 . Inter-factor correlations indicated that the constructs were related yet sufficiently distinct. The correlation between Professional Responsibilities and Preventive Awareness was high but theoretically justifiable, as both domains relate to provider motivation, beliefs and attitudinal orientation toward PMTCT. Table 7 Inter-Factor correlation matrix Factor Clinical Practice Professional Responsibilities Preventive Awareness Clinical Practice 1.00 0.44 0.33 Professional Responsibilities 0.44 1.00 0.78 Preventive Awareness 0.33 0.78 1.00 Reliability Table 8 summarised the internal consistency reliability of the final CFA model. The Clinical Practice and Professional Responsibilities factors demonstrated good to excellent reliability (α = .874 and α = .920, respectively). The Preventive Awareness factor, comprising two items, yielded a lower alpha (α = .646), which is expected for very short subscales; therefore, corrected item–total correlation (r = .479) and intraclass correlation coefficient (ICC = .646) were used to support its reliability. Overall, Cronbach’s alpha coefficients ranged from 0.646 to 0.920, indicating acceptable to excellent reliability across the retained factors. Table 8 Internal Consistency Reliability of the Final CFA Model Factor Category Items Cronbach’s Alpha (α) Clinical Practice P1, P6, P7, P8, P10, P11 0.874 Professional Responsibilities A3, A7, A9, A10, A11, A12, A13 0.920 Preventive Awareness A1, A2 0.646* *Corrected item−total r = 0.479; ICC = 0.646 Discussion This study successfully developed and validated a theoretically grounded instrument to assess obstetric nurses’ Knowledge, Attitudes, and Practices (KAP) related to the prevention of mother-to-child transmission (PMTCT) of hepatitis B. Using a structured two-phase approach that combined rigorous content validation with comprehensive factor analytic techniques, the findings provide strong evidence for the psychometric robustness of the Obs-Nurse KAP PMTCT Hepatitis B Questionnaire. Excellent content and face validity indices, together with strong inter-rater agreement assessed using Gwet’s AC2, indicate a high level of expert consensus on item relevance and clarity. The use of Gwet’s AC2 strengthens the methodological rigor of the validation process, as it mitigates limitations associated with traditional kappa statistics when agreement among experts is high, thereby providing a more accurate estimate of concordance [24]. These results confirm that the instrument adequately captures essential PMTCT-related constructs within the local obstetric nursing context. Exploratory factor analysis supported a coherent three-factor structure comprising Clinical Practice, Professional Responsibilities, and Preventive Awareness, accounting for a substantial proportion of explained variance. While grounded within the overarching KAP framework, the empirical refinement of the attitudinal domain into Professional Responsibilities and Preventive Awareness highlights the multidimensional nature of attitudes in PMTCT practice. This distinction suggests that professional motivation encompasses both an internal sense of duty and an external preventive belief orientation, which has important implications for the design of targeted educational and training interventions. Confirmatory factor analysis further validated the proposed measurement model, demonstrating acceptable to good model fit and strong standardized factor loadings across all retained items. Inter-factor correlations indicated that the constructs were related yet sufficiently distinct, supporting discriminant validity. The relatively strong association between Professional Responsibilities and Preventive Awareness is theoretically plausible, as nurses who perceive PMTCT as a professional obligation are also likely to hold strong preventive beliefs regarding hepatitis B transmission. Internal consistency reliability was acceptable to excellent across the retained factors. Although the Preventive Awareness subscale demonstrated a lower Cronbach’s alpha due to its limited number of items, supplementary reliability evidence supported its internal consistency. Collectively, these findings indicate that the Obs-Nurse KAP PMTCT Hepatitis B Questionnaire is a valid and reliable instrument for assessing PMTCT-related KAP among obstetric nurses and is suitable for use in clinical practice, training evaluation, and future research. Implications for Practice and Future Research Consequently, the successful development and validation of the SureHepB questionnaire within the Malaysian context carries several important implications for local clinical practice. First, the validated instrument demonstrates strong contextual relevance for maternity healthcare settings in Malaysia, providing a reliable tool to assess obstetric nurses’ knowledge attitude and practice (KAP) related to the prevention of PMTCT of hepatitis B. The appropriate application of this psychometrically sound instrument in clinical environments may enhance clinical decision-making, particularly enabling the identification of competency gaps and training needs among healthcare providers directly involved in maternal and neonatal care. Second, the developed scale offers a clinically meaningful measurement framework to support clinical audit, quality improvement monitoring, and evaluation of PMTCT-related training programmes and interventions at the healthcare facility level. Its ability to detect variability in KAP levels among obstetric nurses allows for the design of more targeted educational strategies, thereby strengthening adherence to PMTCT guidelines and reducing the risk of preventable vertical transmission. Limitations and Future Recommendations This study has several limitations. First, the sample sizes for the exploratory factor analysis (n = 207) and confirmatory factor analysis (n = 203) met the minimum recommended thresholds but remain relatively modest. Although adequate, smaller samples may affect the stability of factor loadings and the precision of fit indices. Second, data collection was limited to obstetric nurses in a single tertiary hospital, which may restrict generalisability. Practices, training exposure, and organisational factors in other healthcare settings within Terengganu and across Malaysia may differ, and the findings may not fully represent the wider obstetric nursing population. Additionally, the use of a self-administered questionnaire may introduce response bias despite efforts to ensure anonymity. Future studies should include larger, multi-centre samples from district hospitals, health clinics, and diverse geographical regions to enhance external validity and strengthen the robustness of the instrument. Further psychometric assessments—such as test–retest reliability, measurement invariance, and predictive validity—are recommended to establish long-term stability. Qualitative exploration of contextual factors influencing attitudes and practices may also support continuous refinement of the questionnaire. Conclusion The study demonstrated that the developed KAP-PMTCT Hepatitis B instrument possessed acceptable internal consistency, stability, and validity. Therefore, it can be considered suitable for use in KAP-related assessments on PMTCT of hepatitis B among obstetric nurses. Abbreviations KAP Knowledge, Attitude and Practice PMTCT Prevention of mother-to-child transmission HBV Hepatitis B virus MTCT Mother-to-child transmission HBIG hepatitis B immunoglobulin EFA Exploratory Factor Analysis CFA Confirmatory Factor Analysis CVI Content Validity Index FVI Face Validity Index RMSEA Root Mean Square Error of Approximation GFI Goodness-of-fit Index CFI Comparative Fit Index NFI Normed Fit Index WHO World Health Organization Declarations Ethics approval and consent to participate This study received ethical approval from the UniSZA Human Research Ethics Committee (Protocol Code: UniSZA/UHREC/2024/763) and the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR ID: 24-00570-HY4). All prospective participants were provided with clear explanations regarding the study objectives, procedures, potential risks, and confidentiality measures through a standardised Participant Information Sheet and Informed Consent Form (ICF). Written informed consent was obtained from all participants prior to data collection. Individual who voluntarily agreed to participate indicated their consent by signing the ICF prior to data collection. The research was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets used and analysed during this study are available from the corresponding author upon reasonable request. Competing interest The authors declare no competing interests. Funding This research received no specific grant from funding agencies in the public, commercial, or not-for profit sectors. Authors’ contribution All the authors contributed in the conceptualization, review of related literature, data collection and analysis, writing of the manuscript and approved the final output. Acknowledgments The authors would like to thank to the Director General of Health Malaysia for granting permission to publish this study. Special thanks are extended to the Director of Hospital Sultanah Nur Zahirah (HSNZ), the Head of the Department of Obstetrics and Gynaecology, and the Chief Matron for their approval to conduct this research. The authors are also grateful to the expert panels, co-authors, Clinical Research Centre (CRC) staff, ward manager, and the obstetric nurses involved in the data collection process. Heartfelt appreciation is also extended to all individuals who contributed, directly or indirectly, to the successful completion of this study. Authors’ information 1 Faculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu Malaysia 2 Department of Obstetrics and Gynaecology, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Terengganu, Malaysia References Cao, G., et al., Countdown on hepatitis B elimination by 2030: the global burden of liver disease related to hepatitis B and association with socioeconomic status. Hepatology International, 2022. 16: p. 1-15. WHO. Hepatitis B. 2024 [cited 2024 July 30th]; Available from: https://www.who.int/news-room/fact-sheets/detail/hepatitis-b#:~:text=WHO%20estimates%20that%20254%20million,carcinoma%20(primary%20liver%20cancer). Villa, D. and M.-C. Navas, Vertical Transmission of Hepatitis B Virus—An Update. Microorganisms, 2023. 11: p. 1140. WHO, Country guidance for planning triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus programmes. 2025, World Health Organization: Geneva. KKM, National Strategic Plan for Hepatitis B and C 2019 - 2023. 2019, Ministry of Health Malaysia: Putrajaya, Malaysia. Paul, T., T.P. Marie, and E. Bechem, Knowledge, attitude and practice of staff of 4 hospitals in Yaoundé on the prevention of vertical transmission of hepatitis B. Pan Afr Med J, 2017. 28: p. 174. Gonçalves, I.C.D. and M.J.F. Gonçalves, Knowledge, attitudes and practices of nurses and doctors about the vertical transmission of hepatitis B. Revista Latino-Americana De Enfermagem, 2013. 21(5): p. 1030-1038. Chao, S.D., et al., Low Levels of Knowledge and Preventive Practices Regarding Vertical Hepatitis B Transmission among Perinatal Nurses. Journal of Obstetric, Gynecologic & Neonatal Nursing, 2012. 41(4): p. 494-505. Adjei, C.A., et al., Determinants and preventive practices of midwives and physicians toward vertical transmission of hepatitis B in Ghana: a cross-sectional survey. Pan Afr Med J, 2022. 43: p. 183. Artino, A.R., Jr., et al., Developing questionnaires for educational research: AMEE Guide No. 87. Med Teach, 2014. 36(6): p. 463-74. Bujang, M.A., et al., Sample size guideline for exploratory factor analysis when using small sample: Taking into considerations of different measurement scales. 2012. 1-5. Dalawi, I., M.R. Isa, and N. Aimran, Exploratory factor analysis on the development and validation of the understanding, attitude, practice and health literacy questionnaire on COVID-19 in Malay language. Scientific Reports, 2025. 15(1): p. 19654. Suhr, D., Exploratory or Confirmatory Factor Analysis. 2006. Bryant, F.B. and P.R. Yarnold, Principal-components analysis and exploratory and confirmatory factor analysis, in Reading and understanding multivariate statistics. 1995, American Psychological Association: Washington, DC, US. p. 99-136. Sürücü, L., İ. Yikilmaz, and A. Maslakci, Exploratory Factor Analysis (EFA) in Quantitative Researches and Practical Considerations. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2024. 13: p. 947-965. Kyriazos, T., Applied Psychometrics: Sample Size and Sample Power Considerations in Factor Analysis (EFA, CFA) and SEM in General. Psychology, 2018. 09: p. 2207-2230. Comrey, A.L. and H.B. Lee, A first course in factor analysis, 2nd ed. A first course in factor analysis, 2nd ed. 1992, Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc. xii, 430-xii, 430. Jackson, D.L., J.A. Gillaspy, and R. Purc-Stephenson, Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychol Methods, 2009. 14(1): p. 6-23. Bentler, P. and C.-P. Chou, Practical Issues in Structural Equation Modeling. Sociological Methods & Research, 1987. 16. De Vet, H., et al., Measurement in Medicine: A Practical Guide. Measurement in Medicine: A Practical Guide, 2011: p. 1-338. Lynn, M.R., Determination and Quantification Of Content Validity. Nursing Research, 1986. 35(6). Yusoff, M.S.B., ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal, 2019. 11: p. 49-54. Polit, D.F., C.T. Beck, and S.V. Owen, Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health, 2007. 30(4): p. 459-67. Gwet, K.L., Testing the Difference of Correlated Agreement Coefficients for Statistical Significance. Handbook of Inter-Rater Reliability. 5th ed. Vol. 1. 2021, United States of America: AgreeStat Analytics. 52. Han, K. and L. Ryu, Statistical Methods for the Analysis of Inter-Reader Agreement Among Three or More Readers. Korean J Radiol, 2024. 25(4): p. 325-327. Chan, L. and N. Idris, Validity and Reliability of The Instrument Using Exploratory Factor Analysis and Cronbach’s alpha. International Journal of Academic Research in Business and Social Sciences, 2017. 7. Ahmed, A. and W. Maruod, Comparative analysis of varimax and Promax rotation methods in exploratory factor analysis. Edelweiss Applied Science and Technology, 2025. 9: p. 501-513. S S, S. and M. Thangamuthu, Fit Indices in Structural Equation Modeling and Confirmatory Factor Analysis: Reporting Guidelines. Asian Journal of Economics, Business and Accounting, 2024. 24: p. 561-577. Yun, V., N. Ulang, and S. Husain, Measuring the internal consistency and reliability of the hierarchy of controls in preventing infectious diseases on construction sites: The Kuder-Richardson (KR-20) and Cronbach’s Alpha. Journal of Advanced Research in Applied Sciences and Engineering Technology, 2023. 33(1): p. 392-405. Additional Declarations No competing interests reported. Supplementary Files SureHepB.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 14 Apr, 2026 Reviewers agreed at journal 04 Apr, 2026 Reviewers agreed at journal 02 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 09 Mar, 2026 Submission checks completed at journal 07 Mar, 2026 First submitted to journal 07 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8974224","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617456711,"identity":"2e94bee1-ae52-488d-8ee3-11dd4126359a","order_by":0,"name":"SITI HAJAR MUDA","email":"","orcid":"","institution":"Sultan Zainal Abidin University","correspondingAuthor":false,"prefix":"","firstName":"SITI","middleName":"HAJAR","lastName":"MUDA","suffix":""},{"id":617456712,"identity":"0ade1c4a-9a2d-473e-9d56-f525ed642288","order_by":1,"name":"MALINI MAT NAPES","email":"data:image/png;base64,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","orcid":"","institution":"Sultan Zainal Abidin University","correspondingAuthor":true,"prefix":"","firstName":"MALINI","middleName":"MAT","lastName":"NAPES","suffix":""},{"id":617456713,"identity":"5f082553-88e4-4ccd-bec8-501580f636e6","order_by":2,"name":"MOHD SALAMI IBRAHIM","email":"","orcid":"","institution":"Sultan Zainal Abidin University","correspondingAuthor":false,"prefix":"","firstName":"MOHD","middleName":"SALAMI","lastName":"IBRAHIM","suffix":""}],"badges":[],"createdAt":"2026-02-26 06:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8974224/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8974224/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106404223,"identity":"c998bcb2-02a3-4281-aebf-d48152f1c36d","added_by":"auto","created_at":"2026-04-08 09:15:41","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38882,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot for knowledge items (K1-K15)\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8974224/v1/f749eb704037e5eb3c87e235.jpg"},{"id":106348313,"identity":"49e8fd8c-0719-4eb4-860a-5e41ff7e0954","added_by":"auto","created_at":"2026-04-07 16:45:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":104656,"visible":true,"origin":"","legend":"\u003cp\u003eConfirmatory factor analysis model for the measurement structure of latent constructs.\u003c/p\u003e\n\u003cp\u003eNote: Standardized factor loadings are displayed on each path. All observed variables are represented by rectangles. Numbers inside small circles represent residual variance. All paths are significant at p \u0026lt;0.05. 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Despite the availability of effective vaccines and antiviral therapies, HBV continues to persist globally, primarily through vertical transmission, also known as mother-to-child transmission (MTCT). This mode of transmission occurs predominantly during the perinatal period and represents the principal mechanism sustaining the global reservoir of chronic HBV infection. Infants infected through MTCT have an approximately 90% risk of developing chronic hepatitis B, compared to less than 5% among adults, highlighting the critical importance of preventing MTCT as a cornerstone of global HBV elimination strategies [3].\u003c/p\u003e \u003cp\u003eIn Malaysia, the prevention of MTCT of HBV has been formally incorporated into the national Triple Elimination Initiative, which targets the elimination of MTCT of three priority infections: Human Immunodeficiency Virus (HIV), syphilis, and hepatitis B [4, 5]. The inclusion of HBV within this framework reflects its public health significance and the shared prevention strategies required across these infections, including universal antenatal screening, early identification of infected mothers, and timely neonatal immunoprophylaxis. Achieving the elimination of HBV MTCT is therefore integral to Malaysia\u0026rsquo;s broader maternal and child health agenda and aligns with global elimination targets.\u003c/p\u003e \u003cp\u003eObstetric nurses play a pivotal role in the successful implementation of PMTCT strategies and represent one of the key pillars of the Malaysian healthcare system. Within the Triple Elimination framework, nurses are responsible for a wide range of critical tasks, including antenatal screening and risk assessment, patient education and counselling, reinforcement of adherence to antiviral therapy, strict implementation of infection control measures during labour and delivery, and ensuring the correct and timely administration of the hepatitis B birth dose vaccine and hepatitis B immunoglobulin (HBIG) to exposed newborns. Given the complexity and time-sensitive nature of these responsibilities, optimal PMTCT outcomes depend heavily on nurses\u0026rsquo; knowledge, attitudes, and clinical practices.\u003c/p\u003e \u003cp\u003eThe Knowledge, Attitudes, and Practices (KAP) framework has been widely used in cross-sectional studies to examine healthcare providers\u0026rsquo; competencies and behavioural determinants in public health and clinical settings. Previous studies have demonstrated that inadequate knowledge and negative attitudes may adversely influence clinical practices, thereby compromising the effectiveness of PMTCT interventions [6\u0026ndash;9]. These relationships are often examined using descriptive or inferential analyses linking KAP domains to screening behaviours and preventive practices, underscoring the utility of the KAP framework in identifying gaps that can be addressed through targeted interventions.\u003c/p\u003e \u003cp\u003eHowever, despite the widespread application of KAP-based studies in PMTCT hepatitis B research, a critical limitation persists: many existing instruments lack rigorous psychometric validation. Without systematic validation, it remains uncertain whether such instruments accurately and reliably measure the intended constructs, potentially limiting the interpretability and comparability of findings. This gap is particularly evident within the Malaysian context, where culturally relevant and psychometrically sound instruments for assessing PMTCT-related KAP among obstetric nurses are scarce. Instrument validation is therefore essential to ensure content relevance, construct validity, and measurement reliability, particularly when findings are intended to inform policy development, training programmes, and quality improvement initiatives.\u003c/p\u003e \u003cp\u003eIn response to this gap, the present study aimed to develop and validate a KAP measurement instrument for PMTCT of hepatitis B among obstetric nurses in Malaysia. Exploratory factor analysis (EFA) was conducted to identify the underlying factor structure of the attitude and practice domains, followed by confirmatory factor analysis (CFA) to assess structural validity and internal consistency reliability. By establishing a validated, context-specific instrument, this study seeks to provide a standardized and reliable tool for assessing PMTCT-related competencies among obstetric nurses, thereby supporting evidence-based educational planning, policy formulation, and future research.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA cross-sectional study conducted for the validation of the questionnaire (SureHepB). The methodology in this study was adhered to the recommended principles outlined in AMEE Guide No. 87, including defining the construct, conducting a comprehensive literature review, iterative item generation, expert content validation, face validation, and psychometric testing through EFA and CFA [10].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting and participants\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in a tertiary hospital in Terengganu, Malaysia. This setting was selected because the hospital functions as the principal referral center for maternal and child health services in the region, providing comprehensive obstetric care and employing a large cohort of obstetric nurses with varied levels of experience.\u003c/p\u003e \u003cp\u003eParticipants were eligible if they met the following criteria: (1) Registered nurses currently working in obstetric practice; (2) At least one year of experience in obstetric care; (3) Employed at Hospital Sultanah Nur Zahirah; and (4) Able and willing to provide informed consent. Participants were selected using a random sampling.\u003c/p\u003e \u003cp\u003eA total of 410 were recruited across two independent samples. After excluding ineligible and incomplete responses, 207 participants were included in the dataset for EFA, and 203 participants in the dataset for CFA.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eExploratory factor analysis\u003c/h2\u003e \u003cp\u003eThe sample size for the EFA was determined using the N:p ratio, which represents the number of participants (N) relative to the number of variables (p). Traditionally, a ratio of 5:1 is applied [11]. However, recent methodological literature highlights that the stability, reliability, and replicability of factor solutions depend not only on sample size but also on factors such as the strength of item loadings, the uniformity of communalities, and the number of items per factor [11, 12]. Some researchers recommended a minimum of 100 participants with an N/p ratio of at least 5 [13\u0026ndash;15]. Drawing on these guidelines and broader methodological consensus, many authors suggest that a minimum sample size of 200 is appropriate for exploratory factor analysis [15, 16]. Therefore, a threshold of 200 participants was adopted for this study, reflecting a combination of methodological recommendations and practical constraints.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConfirmatory Factor Analysis\u003c/h3\u003e\n\u003cp\u003eThe study utilized a sample size of \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;200. This sample size is considered adequate for conducting Confirmatory Factor Analysis (CFA) on the 30-item instrument, based on established psychometric guidelines. The absolute minimum threshold for factor analysis is widely suggested to be N\u0026thinsp;=\u0026thinsp;200, which classified as a \"fair\" sample size [16, 17]. Furthermore, the number of participants satisfies the generally accepted cases-to-variables ratio (N:p) criteria [18]. With 30 observed items, the N\u0026thinsp;=\u0026thinsp;200 sample yields a ratio of approximately 6.67:1 (200/30). This ratio comfortably exceeds the conservative minimum ratio of 5:1 often cited for Structural Equation Modeling (SEM) [19], thus providing a statistically sound foundation for the stability of the CFA model and its parameter estimates.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInstrument development and measures\u003c/h2\u003e \u003cp\u003eThe SureHepB questionnaire was newly developed for this study to assess obstetric nurses\u0026rsquo; KAP regarding the PMTCT of hepatitis B. The instrument development and validation were conducted in two phases: Phase 1 involved questionnaire development, and Phase 2 involved psychometric validation using exploratory and confirmatory factor analyses.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePhase 1: Questionnaire Development\u003c/h3\u003e\n\u003cp\u003eThe development of the questionnaire followed a structured, multi-step process to ensure comprehensive coverage of constructs related to knowledge, attitudes, and practices (KAP) on the prevention of mother-to-child transmission (PMTCT) of hepatitis B in obstetric practice.\u003c/p\u003e \u003cp\u003eStep 1: Identification of Constructs\u003c/p\u003e \u003cp\u003e A detailed review of national and international guidelines was undertaken, including: Malaysian National Strategic Plan for Hepatitis B, Ministry of Health Malaysia protocols, WHO PMTCT recommendations and published literature on hepatitis B vertical transmission. Both electronic search of the database (Scopus, the Web of Science, Science Direct and Google Scholar) and manual search of references of relevant studies published between January 2005 and December 2024 were carried out to identify articles containing information on KAP. Term and phrases like \u0026ldquo;nurse\u0026rsquo;s knowledge on vertical transmission of hepatitis B\u0026rdquo;, \u0026ldquo;nurse\u0026rsquo;s knowledge on PMTCT of hepatitis B\u0026rdquo;, \u0026ldquo;nurse\u0026rsquo;s attitudes towards PMTCT of hepatitis B\u0026rdquo; and \u0026ldquo;practices on PMTCT on hepatitis B\u0026rdquo; were systematically searched.\u003c/p\u003e \u003cp\u003eThree main constructs were identified:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnowledge: factual understanding of hepatitis B, including its etiology, modes of transmission, clinical presentation, recommended antenatal screening, antiviral therapy, neonatal immunoprophylaxis, breastfeeding practices, vaccination schedules, and potential complications.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAttitude: nurses\u0026rsquo;s belief, perceptions of importance, and professional dispositions toward PMTCT, reflected in their views on the severity of hepatitis B complications, perceived benefits of preventive interventions, commitment to maternal counselling, belief in effectiveness of early vaccination and antiviral therapy, and confidence in communicating with mothers.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePractice: routine clinical behaviours aligned with recommended PMTCT protocols, including screening pregnant women for hepatitis B, educating mothers, administering vaccines and hepatitis B immunoglobulin (HBIG), documenting care, activating referrals, adhering to infection control procedures, and ensuring post-vaccination follow-up.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eStep 2: Item Generation\u003c/p\u003e \u003cp\u003e Initial items for the questionnaire were drafted based on an extensive review of current literature, national guidelines, and previously validated instruments related to hepatitis B and the prevention of mother-to-child transmission. The knowledge domain was constructed using multiple-choice questions, each comprising four response options (A, B, C, and D) with a single correct answer. The attitude domain consisted of items measured on a five-point Likert scale to capture the respondents\u0026rsquo; level of agreement toward recommended practices. Meanwhile, the practice domain was designed using frequency-based Likert scale items to assess how often specific preventive behaviours were performed in clinical settings.\u003c/p\u003e \u003cp\u003eOverall, a total of 15 knowledge items, 15 attitude items, and 15 practice items were initially generated to represent the key constructs of the questionnaire.\u003c/p\u003e \u003cp\u003eStep 3: Content Validity (CVI)\u003c/p\u003e \u003cp\u003eFollowing the item generation process, content validity was assessed by a panel of 10 subject-matter experts in fields related to hepatitis, infectious diseases, obstetrics, and nursing education. The experts rated each item on relevance, clarity, simplicity and ambiguity. The experts rated each item on a four-point scale (1\u0026thinsp;=\u0026thinsp;not relevant, 2\u0026thinsp;=\u0026thinsp;need major revision, 3\u0026thinsp;=\u0026thinsp;need minor revision, 4\u0026thinsp;=\u0026thinsp;very relevant) [20, 21]. For analysis, items rated as 3 or 4 were considered \u0026ldquo;relevant\u0026rdquo;, while ratings of 1 or 2 were treated as \u0026ldquo;not relevant\u0026rdquo; [22]. The Item-Level Content Validity Index (I-CVI) was calculated as the proportion of experts who rated the item as relevant. In accordance with established recommendations, an I-CVI value of 0.78 or higher was considered acceptable when more than five experts are involved [21\u0026ndash;23]. Items not meeting the threshold were reviewed, refined, or removed following expert feedback.\u003c/p\u003e \u003cp\u003eIn addition to the Content Validity Index (CVI), Gwet\u0026rsquo;s AC2 coefficient was employed to assess the level of inter-rater agreement among expert reviewers. Unlike traditional agreement statistics such as Cohen\u0026rsquo;s kappa or Fleiss\u0026rsquo; kappa, which tend to produce paradoxically low agreement values in cases of high or imbalanced rater consensus, Gwet\u0026rsquo;s AC2 offers a more robust and stable alternative, particularly in multi-rater settings [24, 25].\u003c/p\u003e \u003cp\u003eGwet\u0026rsquo;s AC2 is less influenced by the prevalence of agreement and the distribution of ratings, which makes it highly suitable for content validation studies where experts tend to agree on most items [23]. In this study, with 10 raters evaluating 45 items across three domains, Gwet\u0026rsquo;s AC2 was selected to ensure accurate estimation of inter-rater reliability without underestimating agreement due to statistical bias inherent in other coefficients.\u003c/p\u003e \u003cp\u003eStep 4: Face Validity (FVI)\u003c/p\u003e \u003cp\u003eFace validity assessment involved a group of 12 obstetric nurses who represented the target population. Participants rated the clarity, comprehensibility, and readability of each item. An S-FVI/Ave\u0026thinsp;\u0026ge;\u0026thinsp;0.80 was considered acceptable. Minor wording revisions were made based on feedback.\u003c/p\u003e\n\u003ch3\u003ePhase 2: Validation Studies\u003c/h3\u003e\n\u003cp\u003ePhase 2 consisted of a series of psychometric validation procedures aimed at establishing the construct validity, reliability and structural integrity of the questionnaire. The validation phases involved two independent samples of obstetric nurses; one for exploratory factor analysis (EFA) and another for confirmatory factor analysis (CFA). Only the attitude and practice domains, which were measured using Likert-scale items, were subjected to factor analysis.\u003c/p\u003e \u003cp\u003eFor the knowledge domain, validation was conducted using content validity, face validity, and item-level analysis only. Ceiling and floor effects were examined, and boxplots were generated for all items to ensure adequate response variation. No item showed complete ceiling or floor effects, indicating that all knowledge items were functioning appropriately.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eValidation study 1: Exploratory\u003c/h2\u003e \u003cp\u003eAn Exploratory Factor Analysis (EFA) was conducted to identify the underlying factorial structure of the attitude and practice domains of Hepatitis B PMTCT. Before factor extraction, the dataset was assessed for suitability using the Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) measure of sampling adequacy and Bartlett\u0026rsquo;s Test of Sphericity. A KMO value greater than 0.80 was considered indicative of meritorious adequacy, while a significant Bartlett\u0026rsquo;s test supported the presence of sufficient inter-item correlations for factor analysis [12, 26].\u003c/p\u003e \u003cp\u003eEFA was performed using Principal Component Analysis (PCA) as the extraction method, consistent with the exploratory aim of deriving the preliminary factor structure for a newly developed instrument. A varimax orthogonal rotation was applied to enhance factor interpretability by maximising the variance of loadings across factors [27]. Factors were retained based on a combination of criteria, including eigenvalues greater than 1.0, inspection of the scree plot, percentage of variance explained, and theoretical coherence with the Knowledge\u0026ndash;Attitude\u0026ndash;Practice (KAP) framework [12].\u003c/p\u003e \u003cp\u003eItems were evaluated for retention based on factor loadings\u0026thinsp;\u0026ge;\u0026thinsp;0.40, communalities\u0026thinsp;\u0026ge;\u0026thinsp;0.50, and the absence of substantial cross-loadings [12, 26]. The extracted factors were subsequently labelled based on the thematic content of their constituent items.\u003c/p\u003e \u003cp\u003eThe EFA results were used to establish the preliminary construct structure, which served as the foundation for subsequent confirmatory factor analysis (CFA) to verify model fit and psychometric robustness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eValidations study 2: Confirmatory\u003c/h2\u003e \u003cp\u003eConfirmatory Factor Analysis (CFA) was performed to validate the proposed factor structure following EFA. Model fit was evaluated using several fit indices. The recommended cutoff values for model fit indices are: Chi-square goodness-of-fit (χ\u0026sup2;/df)\u0026thinsp;\u0026lt;\u0026thinsp;3.0, the Comparative Fit Indexes (CFI)\u0026thinsp;\u0026gt;\u0026thinsp;0.90, the Tucker-Lewis Indexes (TLI)\u0026thinsp;\u0026gt;\u0026thinsp;0.90, and root mean square error of approximation (RMSEA)\u0026thinsp;\u0026lt;\u0026thinsp;0.08. The Parsimony Fit Measure (PCFI)\u0026thinsp;\u0026gt;\u0026thinsp;0.5 [28]. The CFA results confirmed the final factor structure of the SureHepB instrument. The final validated version of the questionnaire is provided in English as Supplementary File 1.\u003c/p\u003e \u003cp\u003eThe Reliability was assessed using Cronbach\u0026rsquo;s alpha with values of 0.70 or higher considered acceptable [29]. The validated factor structure provided a robust measurement framework for assessing KAP related to PMTCT of hepatitis B among obstetric nurses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eData were collected between 29 August 2025 and 18 September 2025 after site approval was obtained. Eligible nurses were approached, provided with verbal and written information about the study, and invited to sign a written consent form. Participants received clear instructions on completing the questionnaire, and confidentiality and anonymity were assured.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were performed using IBM SPSS Statistics version 25.0 to summarize participant\u0026rsquo;s demographic characteristics and responses to KAP questionnaire. For continuous variables, means and standard were calculated, while categorical variables were summarized using frequencies and percentages. EFA were conducted using dimension reduction in IBM SPSS Statistics version 25.0. A conceptual path diagram representing the final CFA model was manually constructed using IBM SPSS Amos 28.0 (Analysis of Moment Structure) to illustrate the relationships between latent variables and their corresponding observed indicators.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eParticipant characteristics\u003c/h2\u003e \u003cp\u003eA total of 207 obstetric nurses participated in the EFA, with a mean age of 43.46 years (SD\u0026thinsp;=\u0026thinsp;5.28) and ages ranging from 31 to 55 years. Most respondents were aged 41\u0026ndash;50 years (60.4%) and worked primarily in the maternity ward (76.4%). Nearly half held a Diploma in Nursing with an Advanced Diploma in Midwifery (46.4%), and the majority had over 10 years of experience in maternal and child health. More than half (57.5%) had received training related to PMTCT of hepatitis B, although 42.5% reported no training. Most nurses had experience handling women with hepatitis B-positive status (89.5%), administering the hepatitis B vaccine (77.8%), and HBIG (59.4%). The majority reported normal hepatitis B immunity levels (80.2%). A detailed summary of participant characteristics is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe socio-demographic of the respondents (EFA) (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;207)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-demographic Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.46 (5.28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e125 (60.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWorking Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternity Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (76.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabour Room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Assessment Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternity Operation Theatre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetric Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (26.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (25.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma in Nursing\u0026thinsp;+\u0026thinsp;Advanced Diploma in Midwifery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYears of experience in maternal and child care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (17.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (19.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eReceive training on PMTCT Hep B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e119 (57.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTypes of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorkshop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous Nursing Education (CNE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFrequency handles mother with Hep B positive status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (21.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (67.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever handled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGive Hepatitis B vaccine to newborn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 5 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGive Hepatitis B Immunoglobulin (HBIG) to newborn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161 (77.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHepatitis B immune status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10mlU/ml (Normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (80.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10mlU/ml (Low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eComplete 3 doses of hepatitis B vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (78.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA total of 203 obstetric nurses participated in the CFA, with a mean age of 42.77 years (SD\u0026thinsp;=\u0026thinsp;5.89), ranging from 30 to 56 years, and over half were between 41\u0026ndash;50 years of age (50.7%). Almost half worked in the maternity ward (48.8%), followed by the labour room (31.0%), and most held a Diploma in Nursing with Advanced Diploma in Midwifery (46.8%). One-third had 11\u0026ndash;15 years of maternal and child health experience (32.5%), while more than half (55.2%) reported not receiving any prior training on PMTCT of hepatitis B. Most respondents managed 1\u0026ndash;2 hepatitis B\u0026ndash;positive mothers per year (60.1%), and over half routinely administered hepatitis B vaccine (51.2%) and HBIG (55.7%). The majority reported normal hepatitis B immunity levels (71.9%) and had completed the full three-dose hepatitis B vaccination series (84.7%). Detailed socio-demographic characteristics of the CFA sample are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe socio-demographic of the respondents (CFA) (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;203)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSocio-demographic Characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.77 (5.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u0026ndash;56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge Groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eWorking Place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternity Ward\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLabour Room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Assessment Center\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaternity Operation Theatre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObstetric Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma in Nursing\u0026thinsp;+\u0026thinsp;Advanced Diploma in Midwifery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (46.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDegree in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster in Nursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eYears of experience in maternal and child care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (32.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eReceive training on PMTCT Hep B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTypes of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112 (55.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorkshop\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (6.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuous Nursing Education (CNE)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (28.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOnline Training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFrequency handles mother with Hep B positive status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 cases per year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (60.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever handled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGive Hepatitis B vaccine to newborn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;2 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 5 babies per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGive Hepatitis B Immunoglobulin (HBIG) to newborn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113 (55.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (44.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHepatitis B immune status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10mlU/ml (Normal)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146 (71.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10mlU/ml (Low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (26.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eComplete 3 doses of hepatitis B vaccination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e172 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Content and Face Validity and Item-level analysis for knowledge domain.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe overall content validity of the knowledge domain was excellent with S-CVI/Ave\u0026thinsp;=\u0026thinsp;1.00 and S-CVI/UA\u0026thinsp;=\u0026thinsp;1.00. Inter-rater agreement was also strong, with Gwet\u0026rsquo;s AC2\u0026thinsp;=\u0026thinsp;0.82 indicating good consistency among experts. Similarly, the face validity index for the scale was also high (S-FVI/Ave\u0026thinsp;=\u0026thinsp;1.00), indicating that all items were deemed clear, comprehensible, and appropriate by the target respondents.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the item-level evaluation of the knowledge domain. All items achieved perfect content validity (I-CVI\u0026thinsp;=\u0026thinsp;1.00) and face validity (I-FVI\u0026thinsp;=\u0026thinsp;1.00), indicating unanimous agreement among experts and respondents regarding item relevance and clarity. In terms of item difficulty, six items (K1, K2, K4, K5, K13 and K15) demonstrated ceiling effects (\u0026gt;\u0026thinsp;80% correct), reflecting very easy items. The remaining items showed acceptable difficulty levels within the expected range.\u003c/p\u003e \u003cp\u003eItem discrimination values ranged from 0.095 to 0.705. Most items demonstrated good discrimination (r\u0026thinsp;\u0026ge;\u0026thinsp;0.30), suggesting that they were able to differentiate between respondents with higher and lower knowledge levels. Only a few items (K1, K2, K4 and K5) showed poor discrimination, consistent with their high difficulty indices. Overall, the knowledge items were judged to be relevant, clear and psychometrically adequate for assessing knowledge related to PMTCT of hepatitis B.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eContent Validity, Face Validity and Item Functioning for Knowledge Items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eI-CVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eI-FVI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e% Correct\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiscrimination (r)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe hepatitis B virus typically affects the organ of (a) heart; (b) liver; (c) kidney; (d) lung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling effect, low discrimination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoutes of transmission of hepatitis B are as follows, except (a) sharing food and drinks; (b) sexual contact; (c) sharing needles; (d) mother-to-child transmission during delivery process\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.2002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling Effect, borderline discrimination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe usual presentation in a mother with hepatitis B is (a) severe diarrhea; (b) persistent itchiness; (c) frontal headache; (d) no symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.4945\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well, moderate difficulty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe first step in preventing mother-to-child transmission is to (a) give antibiotics during pregnancy; (b) screen pregnant women for hepatitis B early in antenatal care; (c) give immediate antiviral therapy to all women; (d) screen all family members for hepatitis B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e93.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.3751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling Effect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe test used to screen pregnant women for hepatitis B is (a) Vanereal Disease Research Laboratory; (b) Hepatitis B surface antigen test; (c) Human Immunodeficieny virus test; (d) full blood picture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.4887\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling Effect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe most common time of transmission of hepatitis B from mother-to-child is during (a) pregnancy; (b) delivery; (c) breastfeed; (d) childhood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.3527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe recommended action if a pregnant woman is diagnosed with high viral load hepatitis B (HBV DNA\u0026thinsp;\u0026ge;\u0026thinsp;200 000 IU/mL or \u0026ge;\u0026thinsp;5.3 log10 IU/mL) is (a) elective caesarean section; (b) antiviral therapy during pregnancy; (c) early induction of labour; (d) no intervention needed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAntiviral medication is most commonly prescribed to pregnant women with hepatitis B to reduce vertical transmission is (a) ribavirin; (b) acyclovir; (c) efavirenz; (d) tenofovir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.6995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHepatitis B vaccine consists of (a) liver hepatitis B virus; (b) inactivated virus; (c) recombinant hepatitis B surface antigen (HbsAg) produced yeast cell; (d) pork-derived gelatin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e73.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.7055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNewborns of hepatitis B-positive mothers should be given the birth dose of hepatitis B vaccine within (a) 12 hours; (b) 24 hours; (c) 48 hours; (d) 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.4967\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHarder item, functioning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe standard birth dose for hepatitis B vaccination is (a) 5 micrograms; (b) 10 micrograms; (c) 20 micrograms; (d) 40 micrograms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.4161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHarder item, functioning\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhen educating patients about side effects of the hepatitis B vaccine, nurses should emphasize that (a) all vaccines are completely free from any side effects; (b) minor side effects are normal and a sign that the body is building protection; (c) major organ failure is expected after vaccination; (d) vaccination is only necessary if symptoms appear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe additional treatment is recommended for newborns of hepatitis B positive mothers besides the vaccine is (a) antibiotics; (b) vitamin K injection; (c) hepatitis B immunoglobulin; (d) oral antiviral syrup\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.3567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling Effect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe correct statement about breastfeeding among women with hepatitis B is (a) it is not allowed; (b) safe with proper immunoprophylaxis; (c) it is only allowed after the baby is 6 months old; (d) it should be avoided if the mother receives antiviral therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.7037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFunctioning well\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInadequate hepatitis B prevention among the children can lead to (a) chronic hepatitis B; (b) HIV infection; (c) malnutrition; (d) childhood asthma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e88.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCeiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.6702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEasy item, Ceiling Effect\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003eI\u0026minus;CVI = Item Content Validity Index; I\u0026minus;FVI = Item Face Validity Index\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003csup\u003eItem difficulty (% correct) classified as: Ceiling (\u0026ge;80%), Normal (20\u0026ndash;79%), Floor (\u0026le;20%)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003csup\u003eDiscrimination (point\u0026minus;biserial correlation) classified as: Good (\u0026ge;0.30), Borderline (0.20\u0026ndash;0.29), Poor (\u0026lt;0.20)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003csup\u003eInterpretation integrates difficulty, discrimination, and response patterns\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe boxplot (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) shows the distribution of dichotomous responses (0\u0026thinsp;=\u0026thinsp;incorrect, 1\u0026thinsp;=\u0026thinsp;correct) for each item. Items K1, K2, K4, K5, K13 and K15 demonstrate clustering near 1.0, reflecting ceiling effects, while the remaining items show adequate variability with no floor effects.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eConstruct Validity\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eExploratory Factor Analysis\u003c/h2\u003e \u003cp\u003eAn exploratory factor analysis (EFA) was performed to examine the underlying structure of the Hepatitis B PMTCT questionnaire using Principal Component Analysis. Sampling adequacy was confirmed with a Kaiser\u0026ndash;Meyer\u0026ndash;Olkin (KMO) value of 0.870, indicating meritorious adequacy for factor analysis. Bartlett\u0026rsquo;s Test of Sphericity was statistically significant (χ\u0026sup2; = 9838.440, df\u0026thinsp;=\u0026thinsp;435, p \u0026lt; .001), demonstrating that the correlation matrix was not an identity matrix and confirming that the items were sufficiently interrelated to proceed.\u003c/p\u003e \u003cp\u003eBased on eigenvalues greater than 1.0 and inspection of the scree plot, a three-factor solution was retained. The three extracted components collectively accounted for 75.53% of the total variance, indicating a strong factor structure. Specifically, Factor 1 contributed 59.07%, Factor 2 contributed 9.96%, and Factor 3 contributed 6.50% of explained variance.\u003c/p\u003e \u003cp\u003eInterpretation of factor loadings and item content resulted in the labelling of three meaningful constructs aligned with the theoretical KAP framework. The first factor, Clinical Practice, consisted of items representing routine clinical behaviours such as HBV screening, timely administration of hepatitis B vaccine and HBIG, infection control, documentation, and neonatal referral. The second factor, Professional Responsibility, captured items reflecting perceived duty, confidence, and provider accountability in counselling mothers regarding hepatitis B. The third factor, Preventive Awareness, encompassed items reflecting beliefs regarding the importance of timely vaccination, antenatal counselling, guideline adherence, and the preventive impact on maternal and community health.\u003c/p\u003e \u003cp\u003eAll items demonstrated acceptable communalities (\u0026gt;\u0026thinsp;0.50) and strong factor loadings (\u0026gt;\u0026thinsp;0.40), with minimal cross-loadings, supporting a clean and interpretable factor structure (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Although PCA initially extracted four factors, the fourth component explained only 4.06% of variance and was not theoretically coherent; therefore, the three-factor solution was retained based on theoretical justification and parsimony.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor structure and loading of 30 items in KAP PMTCT Hep B (N\u0026thinsp;=\u0026thinsp;207)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFactor 1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFactor 2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFactor 3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFactor 4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion preventing mother-to-child transmission of hepatitis B is crucial for protecting the health of the community.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion hepatitis B related complications are severe enough to justify strict adherence to vaccination guidelines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.871\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion antiviral therapy during pregnancy will benefit hepatitis B-positive mothers and their newborns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion timely vaccination within 24 hours after birth is essential to prevent hepatitis B transmission to the infant.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion breastfeeding should be encouraged even if the mother is hepatitis B positive.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion counselling the mothers about hepatitis B virus transmission is part of my duty.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion I am confident in handling mothers who are unsure or worried about the hepatitis B vaccine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.795\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion I am capable of providing clear and effective guidance to mothers regarding the importance of completing the hepatitis B vaccination for their newborns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion every healthcare provider should actively promote hepatitis B prevention during antenatal care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion routine hepatitis B screening should be carried out for all pregnant women to prevent transmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion educating mothers about hepatitis B can significantly reduce the risk of mother-to-child transmission.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion early identification of hepatitis B-positive mothers is key to successful prevention strategies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion effective communication with pregnant mothers improves hepatitis B prevention efforts.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion healthcare providers have an important responsibility in preventing hepatitis B transmission to newborns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn my opinion comprehensive antenatal counselling on hepatitis B is essential to prevent transmission to the baby.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.869\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely check the hepatitis B status of pregnant women during admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely assume a pregnant woman does not have hepatitis B if her status is unknown, so I do not test her.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.969\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely educate pregnant women on the importance of the hepatitis B vaccination for their newborns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely inform parents about the importance of completing the full hepatitis B vaccination series for their child.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely counsel mothers on the safety of breastfeeding for hepatitis B positive women under appropriate care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely administer the hepatitis B vaccine to newborns within 24 hours.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.856\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely administer hepatitis B immunoglobulin(HBIG) to newborns born to hepatitis B-positive mothers.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely adhere to infection control protocols to reduce the risk of hepatitis B transmission in the labour and delivery unit.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely document the administration of the hepatitis B vaccine in the patient\u0026rsquo;s record after giving the vaccine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely alert the neonatal team when a baby is born to a hepatitis B-positive mother.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely report any missed hepatitis B vaccination or prophylaxis for newborns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely provide counselling or education to mothers who are unsure or hesitant about giving the hepatitis B vaccine to their baby.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely verify that hepatitis B immunoglobulin (HBIG) administration is documented accurately for exposed newborns.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely reinforce to mothers the importance of post-vaccination follow-up for their babies.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI routinely update my knowledge on the latest protocols for managing Hepatitis B in pregnant women.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall, the EFA supported a robust three-factor structure comprising Clinical Practice, Professional Responsibility, and Preventive Awareness, which provides a strong psychometric foundation for further validation through confirmatory factor analysis (CFA).\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.3.2 Confirmatory Factor Analysis (CFA)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eCFA validated the three-factor structure identified by EFA. The proposed measurement model demonstrated acceptable to good fit across multiple fit indices. (χ\u0026sup2; = 186.015, df\u0026thinsp;=\u0026thinsp;85, χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;2.19, CFI\u0026thinsp;=\u0026thinsp;0.951, TLI\u0026thinsp;=\u0026thinsp;0.940, RMSEA\u0026thinsp;=\u0026thinsp;0.077 (90% CI: 0.062\u0026ndash;0.092), RMR\u0026thinsp;=\u0026thinsp;0.026, Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The standardized CFA model with factor loadings and correlations between latent constructs is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModel fit indices for CFA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;/df\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA (90% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFA Model\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.940\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eFactor loadings\u003c/h2\u003e \u003cp\u003eStandardized factor loadings ranged from 0.559 to 0.913, exceeding the minimum recommended threshold (\u0026ge;\u0026thinsp;0.50), confirming the robustness of the identified factors (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStandardized factor loading from CFA\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStandardized Loadings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional Responsibilties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.878\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.897\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreventive Awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFixed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInter-Factor Correlations\u003c/h2\u003e \u003cp\u003eInter-factor correlations from CFA are presented in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. Inter-factor correlations indicated that the constructs were related yet sufficiently distinct. The correlation between Professional Responsibilities and Preventive Awareness was high but theoretically justifiable, as both domains relate to provider motivation, beliefs and attitudinal orientation toward PMTCT.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInter-Factor correlation matrix\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Practice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProfessional Responsibilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePreventive Awareness\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eClinical Practice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional Responsibilities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePreventive Awareness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e summarised the internal consistency reliability of the final CFA model. The Clinical Practice and Professional Responsibilities factors demonstrated good to excellent reliability (α\u0026thinsp;=\u0026thinsp;.874 and α\u0026thinsp;=\u0026thinsp;.920, respectively). The Preventive Awareness factor, comprising two items, yielded a lower alpha (α\u0026thinsp;=\u0026thinsp;.646), which is expected for very short subscales; therefore, corrected item\u0026ndash;total correlation (r = .479) and intraclass correlation coefficient (ICC = .646) were used to support its reliability. Overall, Cronbach\u0026rsquo;s alpha coefficients ranged from 0.646 to 0.920, indicating acceptable to excellent reliability across the retained factors.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInternal Consistency Reliability of the Final CFA Model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCronbach\u0026rsquo;s Alpha (α)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical Practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP1, P6, P7, P8, P10, P11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.874\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA3, A7, A9, A10, A11, A12, A13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive Awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA1, A2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.646*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003csup\u003e*Corrected item\u0026minus;total r = 0.479; ICC = 0.646\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study successfully developed and validated a theoretically grounded instrument to assess obstetric nurses\u0026rsquo; Knowledge, Attitudes, and Practices (KAP) related to the prevention of mother-to-child transmission (PMTCT) of hepatitis B. Using a structured two-phase approach that combined rigorous content validation with comprehensive factor analytic techniques, the findings provide strong evidence for the psychometric robustness of the Obs-Nurse KAP PMTCT Hepatitis B Questionnaire.\u003c/p\u003e \u003cp\u003eExcellent content and face validity indices, together with strong inter-rater agreement assessed using Gwet\u0026rsquo;s AC2, indicate a high level of expert consensus on item relevance and clarity. The use of Gwet\u0026rsquo;s AC2 strengthens the methodological rigor of the validation process, as it mitigates limitations associated with traditional kappa statistics when agreement among experts is high, thereby providing a more accurate estimate of concordance [24]. These results confirm that the instrument adequately captures essential PMTCT-related constructs within the local obstetric nursing context.\u003c/p\u003e \u003cp\u003eExploratory factor analysis supported a coherent three-factor structure comprising Clinical Practice, Professional Responsibilities, and Preventive Awareness, accounting for a substantial proportion of explained variance. While grounded within the overarching KAP framework, the empirical refinement of the attitudinal domain into Professional Responsibilities and Preventive Awareness highlights the multidimensional nature of attitudes in PMTCT practice. This distinction suggests that professional motivation encompasses both an internal sense of duty and an external preventive belief orientation, which has important implications for the design of targeted educational and training interventions.\u003c/p\u003e \u003cp\u003eConfirmatory factor analysis further validated the proposed measurement model, demonstrating acceptable to good model fit and strong standardized factor loadings across all retained items. Inter-factor correlations indicated that the constructs were related yet sufficiently distinct, supporting discriminant validity. The relatively strong association between Professional Responsibilities and Preventive Awareness is theoretically plausible, as nurses who perceive PMTCT as a professional obligation are also likely to hold strong preventive beliefs regarding hepatitis B transmission.\u003c/p\u003e \u003cp\u003eInternal consistency reliability was acceptable to excellent across the retained factors. Although the Preventive Awareness subscale demonstrated a lower Cronbach\u0026rsquo;s alpha due to its limited number of items, supplementary reliability evidence supported its internal consistency. Collectively, these findings indicate that the Obs-Nurse KAP PMTCT Hepatitis B Questionnaire is a valid and reliable instrument for assessing PMTCT-related KAP among obstetric nurses and is suitable for use in clinical practice, training evaluation, and future research.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice and Future Research\u003c/h2\u003e \u003cp\u003eConsequently, the successful development and validation of the SureHepB questionnaire within the Malaysian context carries several important implications for local clinical practice. First, the validated instrument demonstrates strong contextual relevance for maternity healthcare settings in Malaysia, providing a reliable tool to assess obstetric nurses\u0026rsquo; knowledge attitude and practice (KAP) related to the prevention of PMTCT of hepatitis B. The appropriate application of this psychometrically sound instrument in clinical environments may enhance clinical decision-making, particularly enabling the identification of competency gaps and training needs among healthcare providers directly involved in maternal and neonatal care.\u003c/p\u003e \u003cp\u003eSecond, the developed scale offers a clinically meaningful measurement framework to support clinical audit, quality improvement monitoring, and evaluation of PMTCT-related training programmes and interventions at the healthcare facility level. Its ability to detect variability in KAP levels among obstetric nurses allows for the design of more targeted educational strategies, thereby strengthening adherence to PMTCT guidelines and reducing the risk of preventable vertical transmission.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Recommendations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, the sample sizes for the exploratory factor analysis (n\u0026thinsp;=\u0026thinsp;207) and confirmatory factor analysis (n\u0026thinsp;=\u0026thinsp;203) met the minimum recommended thresholds but remain relatively modest. Although adequate, smaller samples may affect the stability of factor loadings and the precision of fit indices. Second, data collection was limited to obstetric nurses in a single tertiary hospital, which may restrict generalisability. Practices, training exposure, and organisational factors in other healthcare settings within Terengganu and across Malaysia may differ, and the findings may not fully represent the wider obstetric nursing population. Additionally, the use of a self-administered questionnaire may introduce response bias despite efforts to ensure anonymity.\u003c/p\u003e \u003cp\u003eFuture studies should include larger, multi-centre samples from district hospitals, health clinics, and diverse geographical regions to enhance external validity and strengthen the robustness of the instrument. Further psychometric assessments\u0026mdash;such as test\u0026ndash;retest reliability, measurement invariance, and predictive validity\u0026mdash;are recommended to establish long-term stability. Qualitative exploration of contextual factors influencing attitudes and practices may also support continuous refinement of the questionnaire.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study demonstrated that the developed KAP-PMTCT Hepatitis B instrument possessed acceptable internal consistency, stability, and validity. Therefore, it can be considered suitable for use in KAP-related assessments on PMTCT of hepatitis B among obstetric nurses.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eKAP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Knowledge, Attitude and Practice\u003c/p\u003e\n\u003cp\u003ePMTCT\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Prevention of mother-to-child transmission\u003c/p\u003e\n\u003cp\u003eHBV \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hepatitis B virus\u003c/p\u003e\n\u003cp\u003eMTCT \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Mother-to-child transmission\u003c/p\u003e\n\u003cp\u003eHBIG\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;hepatitis B immunoglobulin\u003c/p\u003e\n\u003cp\u003eEFA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Exploratory Factor Analysis\u003c/p\u003e\n\u003cp\u003eCFA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Confirmatory Factor Analysis\u003c/p\u003e\n\u003cp\u003eCVI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Content Validity Index\u003c/p\u003e\n\u003cp\u003eFVI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Face Validity Index\u003c/p\u003e\n\u003cp\u003eRMSEA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Root Mean Square Error of Approximation\u003c/p\u003e\n\u003cp\u003eGFI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Goodness-of-fit Index\u003c/p\u003e\n\u003cp\u003eCFI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Comparative Fit Index\u003c/p\u003e\n\u003cp\u003eNFI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Normed Fit Index\u003c/p\u003e\n\u003cp\u003eWHO \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received ethical approval from the UniSZA Human Research Ethics Committee (Protocol Code: UniSZA/UHREC/2024/763) and the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR ID: 24-00570-HY4). All prospective participants were provided with clear explanations regarding the study objectives, procedures, potential risks, and confidentiality measures through a standardised Participant Information Sheet and Informed Consent Form (ICF). Written informed consent was obtained from all participants prior to data collection. Individual who voluntarily agreed to participate indicated their consent by signing the ICF prior to data collection. The research was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from funding agencies in the public, commercial, or not-for profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors contributed in the conceptualization, review of related literature, data collection and analysis, writing of the manuscript and approved the final output.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank to the Director General of Health Malaysia for granting permission to publish this study. Special thanks are extended to the Director of Hospital Sultanah Nur Zahirah (HSNZ), the Head of the Department of Obstetrics and Gynaecology, and the Chief Matron for their approval to conduct this research. The authors are also grateful to the expert panels, co-authors, Clinical Research Centre (CRC) staff, ward manager, and the obstetric nurses involved in the data collection process. Heartfelt appreciation is also extended to all individuals who contributed, directly or indirectly, to the successful completion of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eFaculty of Medicine, Universiti Sultan Zainal Abidin, Terengganu Malaysia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Obstetrics and Gynaecology, Hospital Sultanah Nur Zahirah, Ministry of Health Malaysia, Terengganu, Malaysia\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCao, G., et al., Countdown on hepatitis B elimination by 2030: the global burden of liver disease related to hepatitis B and association with socioeconomic status. Hepatology International, 2022. 16: p. 1-15.\u003c/li\u003e\n\u003cli\u003eWHO. 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Maslakci, Exploratory Factor Analysis (EFA) in Quantitative Researches and Practical Considerations. G\u0026uuml;m\u0026uuml;şhane \u0026Uuml;niversitesi Sağlık Bilimleri Dergisi, 2024. 13: p. 947-965.\u003c/li\u003e\n\u003cli\u003eKyriazos, T., Applied Psychometrics: Sample Size and Sample Power Considerations in Factor Analysis (EFA, CFA) and SEM in General. Psychology, 2018. 09: p. 2207-2230.\u003c/li\u003e\n\u003cli\u003eComrey, A.L. and H.B. Lee, A first course in factor analysis, 2nd ed. A first course in factor analysis, 2nd ed. 1992, Hillsdale, NJ, US: Lawrence Erlbaum Associates, Inc. xii, 430-xii, 430.\u003c/li\u003e\n\u003cli\u003eJackson, D.L., J.A. Gillaspy, and R. Purc-Stephenson, Reporting practices in confirmatory factor analysis: an overview and some recommendations. Psychol Methods, 2009. 14(1): p. 6-23.\u003c/li\u003e\n\u003cli\u003eBentler, P. and C.-P. Chou, Practical Issues in Structural Equation Modeling. 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Ryu, Statistical Methods for the Analysis of Inter-Reader Agreement Among Three or More Readers. Korean J Radiol, 2024. 25(4): p. 325-327.\u003c/li\u003e\n\u003cli\u003eChan, L. and N. Idris, Validity and Reliability of The Instrument Using Exploratory Factor Analysis and Cronbach\u0026rsquo;s alpha. International Journal of Academic Research in Business and Social Sciences, 2017. 7.\u003c/li\u003e\n\u003cli\u003eAhmed, A. and W. Maruod, Comparative analysis of varimax and Promax rotation methods in exploratory factor analysis. Edelweiss Applied Science and Technology, 2025. 9: p. 501-513.\u003c/li\u003e\n\u003cli\u003eS S, S. and M. Thangamuthu, Fit Indices in Structural Equation Modeling and Confirmatory Factor Analysis: Reporting Guidelines. Asian Journal of Economics, Business and Accounting, 2024. 24: p. 561-577.\u003c/li\u003e\n\u003cli\u003eYun, V., N. Ulang, and S. Husain, Measuring the internal consistency and reliability of the hierarchy of controls in preventing infectious diseases on construction sites: The Kuder-Richardson (KR-20) and Cronbach\u0026rsquo;s Alpha. Journal of Advanced Research in Applied Sciences and Engineering Technology, 2023. 33(1): p. 392-405.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Nurses, Maternal and Child, PMTCT, Hepatitis B, Scale development, Validation Study","lastPublishedDoi":"10.21203/rs.3.rs-8974224/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8974224/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePrevention of mother-to-child transmission (PMTCT) of hepatitis B remains a critical public health issue and a central component of Malaysia\u0026rsquo;s Triple Elimination Initiative. Obstetric nurses play a pivotal role in implementing PMTCT strategies; however, the absence of psychometrically validated instruments limits the accurate assessment of their knowledge, attitudes and practices (KAP).\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo develop KAP instrument for PMTCT of hepatitis B among obstetric nurses (SureHepB) and to assess its validity and reliability.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional validation study was conducted using a two-phase approach in a tertiary hospital setting. Phase 1 involved questionnaire development, content validation by a multidisciplinary expert panel, and face validation among obstetric nurses. Phase 2 comprised psychometric evaluation using two independent samples for exploratory factor analysis (EFA; n\u0026thinsp;=\u0026thinsp;207) and confirmatory factor analysis (CFA; n\u0026thinsp;=\u0026thinsp;203).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eContent validity indices indicated high relevance among expert (S-CVI/Ave\u0026thinsp;=\u0026thinsp;1.0) and strong inter-rater agreement (Gwet\u0026rsquo;s AC2\u0026thinsp;=\u0026thinsp;0.82). EFA supported a three-factor structure for the attitude and practice domains\u0026mdash;Clinical Practice, Professional Responsibilities, and Preventive Awareness\u0026mdash;accounting for 75.53% of the total variance. CFA confirmed good model fit (CFI\u0026thinsp;=\u0026thinsp;0.951, TLI\u0026thinsp;=\u0026thinsp;0.940, RMSEA\u0026thinsp;=\u0026thinsp;0.077), with all standardized factor loadings exceeding recommended thresholds. Internal consistency reliability ranged from acceptable to excellent across factors (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.646\u0026ndash;0.920).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe SureHepB for obstetric nurses is a valid and reliable instrument for assessing PMTCT-related competencies among obstetric nurses, with potential applications in training evaluation, policy planning, and future research.\u003c/p\u003e","manuscriptTitle":"Development and Validation of An Instrument for Assessing Obstetric Nurses’s Knowledge, Attitude and Practice (KAP) on Prevention of Maternal-To-Child Transmission of Hepatitis B","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 16:45:25","doi":"10.21203/rs.3.rs-8974224/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-14T10:01:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164964829644593798927224534631834739818","date":"2026-04-04T07:58:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174070284355615159903589414202019143051","date":"2026-04-02T11:57:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T05:07:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-31T08:58:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T13:48:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-07T05:26:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-07T05:22:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6d98f625-2067-495a-acf1-b8c5224b3da4","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:45:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 16:45:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8974224","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8974224","identity":"rs-8974224","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}