The Turkish Version of the Kappi Scale: Validity and Reliability Study on Family Caregivers’ Knowledge Attitudes and Practices in Pressure Injury Prevention

The Turkish Version of the Kappi Scale: Validity and Reliability Study on Family Caregivers’ Knowledge Attitudes and Practices in Pressure Injury Prevention | 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 The Turkish Version of the Kappi Scale: Validity and Reliability Study on Family Caregivers’ Knowledge Attitudes and Practices in Pressure Injury Prevention Kerime ÖĞÜT DÜZEN, Ayşe SEZER BALCI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7798456/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 15 You are reading this latest preprint version Abstract Background Pressure injuries are a significant health concern among older adults, and family caregivers play a crucial role in their prevention. This study aimed to adapt the Knowledge, Attitudes, and Practices of Family Caregivers in Preventing Pressure Injury Scale (KAPPI) into Turkish and evaluate its psychometric properties, including validity and reliability. Methods A cross-sectional validation study was conducted between January and March 2023 with 330 family caregivers of patients aged 65 years and older in the internal medicine and surgical units of a state hospital in Turkey. The adaptation process was performed in two phases. In the first phase, the KAPPI was translated into Turkish and culturally adapted based on expert evaluations to ensure content validity. In the second phase, psychometric analyses were carried out. Internal consistency was assessed using Cronbach’s alpha, and test–retest reliability was examined using intraclass correlation coefficients (ICC). Construct validity was evaluated by confirmatory factor analysis (CFA) to test the original three-factor structure (knowledge, attitudes, and practices). Model fit indices demonstrated acceptable values (CFI = 0.96, SRMR = 0.09, RMSEA = 0.07). The KAPPI-T exhibited strong internal consistency (α = 0.88) and good test–retest reliability (ICC = 0.84). Results The Turkish version of the KAPPI confirmed the original three-factor structure knowledge, attitudes, and practices. The scale demonstrated satisfactory psychometric characteristics and factor loadings consistent with theoretical expectations. Reliability coefficients indicated strong internal consistency across subscales, and the CFA supported the construct validity of the adapted version. Conclusions The KAPPI-T is a valid and reliable instrument for assessing family caregivers’ knowledge, attitudes, and practices regarding pressure injury prevention. It can be used to identify educational needs and support the development of evidence-based caregiver training programs in clinical, community, and research settings. Clinical trial number Not applicable Family caregivers Older adults Pressure injury Reliability Validity Psychometric testing Figures Figure 1 Introduction Pressure injuries (PIs), also known as pressure ulcers or bedsores, are a significant public health concern, particularly among vulnerable populations such as older adults, individuals with spinal cord injuries, intensive care patients, and residents of long-term care facilities. According to data collected between 2006 and 2014, the incidence of PIs ranges between 11.8% and 19%, depending on differences in methodology, settings, and populations studied [ 1 , 2 ]. These injuries are defined by the National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP), and Pan Pacific Pressure Injury Alliance (PPPIA) as localized damage to the skin and/or underlying tissue resulting from pressure, or pressure in combination with shear, typically over bony prominences or in areas exposed to medical devices [ 3 ]. Recent epidemiological data show that the global prevalence of pressure injuries between 2008 and 2018 was approximately 12.8%, with regional variations 14.5% in Europe, 13.6% in North America, 12.7% in South America and 9% in Australia [ 4 , 5 ]. Older adults are at increased risk due to age-related factors such as reduced mobility, skin fragility, and chronic comorbidities [ 6 ]. Studies also suggest that older adults living at home are particularly vulnerable, often due to insufficient preventive care [ 7 ]. In the United States, for example, 70.6% of hospitalized patients with pressure injuries were older adults living at home [ 8 ]. Turkey, with a rapidly aging population, is similarly at risk. According to national statistics, 9.9% of the population (approximately 8.4 million people) is over the age of 65, and most of them (about 6.3 million) reside at home with their families [ 9 ]. In this context, family members often serve as the primary caregivers, bearing responsibility for the daily care of older adults [ 10 ]. Their involvement in caregiving is critical in preventing pressure injuries and reducing their prevalence [ 11 , 12 ]. Despite their essential role, family caregivers often lack sufficient knowledge, positive attitudes, and effective practices regarding pressure injury prevention [ 13 , 14 ]. In Turkey, pressure injuries have been reported in 8.2% to 31.4% of older adults living at home, and over half of these individuals receive care from family members [ 15 – 17 ]. However, most existing assessment tools for pressure injury prevention are developed for healthcare professionals and are not suitable for family caregivers with diverse educational backgrounds [ 18 – 20 ]. To address this gap, Sari et al. (2022) developed the Knowledge, Attitude, and Practice of Pressure Injury (KAPPI) scale specifically for family caregivers. KAPPI instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach’s Alpha values of 0.83, 0.93 and 0.89, respectively. The knowledge subscale consists of 12 items; measuring knowledge about the definition of PI and characteristics of older adults, symptoms, causes and consequences of PI, and preventive strategies that family caregivers can use for PI. The attitude subscale consists of 9 items: measuring family caregivers' beliefs and values ​​regarding the prevention of PI. The Practical subscale is consists of 12 items; covering basic support, support for repositioning and mobilisation, skin hygiene and support for moisturizing [ 21 ]. To date, no validity and reliability study of the KAPPI scale has been conducted in the Turkish language. Therefore, the aim of this study is to adapt the KAPPI scale into Turkish (KAPPI-T) and to evaluate its psychometric properties, including validity and reliability. The Turkish version of the KAPPI will provide a culturally appropriate instrument to assess family caregivers’ knowledge, attitudes, and practices regarding pressure injury prevention. This assessment will enable public health professionals and nurses to identify gaps in caregiver competencies and to develop evidence-based educational interventions tailored to the needs of family caregivers in Turkey. Research questions: Is the KAPPI-T Scale a valid scale in Turkish language? Is the KAPPI-T Scale a reliable scale in Turkish language? Methods Study design and sample, data collection, analysis Approval was obtained from both the hospital and the appropriate ethics committee prior to commencing the study, which employed a cross-sectional data collection approach. The study was conducted in the internal and surgical clinics of a state hospital in January-March 2023 with the family caregivers of patients aged 65 years and over who were hospitalized in the mentioned clinics. It is often suggested in the literature that the number of participants per item should be between 5 and 10 [ 22 , 23 ]. Therefore, instead of keeping the number of participants per item to a minimum, 10 participants per item were selected to ensure that the analyses were based on a more solid foundation. In this way, possible data loss or incomplete responses did not negatively affect the scale, and the results obtained were more reliable. Because the KAPPI Scale has 33 items, the sample included 330 participants. Data were collected from each clinic by the researchers. The purpose of the study was explained to the family caregivers and those who volunteered to participate were included in the study. The researchers read the questions for illiterate patients' family caregivers and marked their answers. Data collection instruments Demographic form The form created by the researchers in line with the literature includes variables such as age, gender, age of older people, their educational status, and history of pressure injuries. KAPPI Scale original form The KAPPI Scale developed by Sari et al. (2022) consists of 33 items [ 21 ]. The scale consists of 3 subscales: knowledge section (12 items), attitude section (9 items) and practice section (12 items). In the questions in the knowledge section, correct answers are scored as 1 point and incorrect answers are scored as 0 point. The attitude section is rated on a 4 point Likert-type scale ranging from 1 = Strongly disagree to 4 = Strongly agree. The practice section is scored on a Likert-type scale ranging from 1 = Never to 4 = Always. Each subscale is used separately. Cronbach's alpha for the knowledge section was reported to be 0.83, and 0.93 for the attitude section and 0.89 for the practice section. Data Analysis Data were analyzed using SPSS 21.0 and Lisrel 8.0 programs; Statistical significance was accepted as p < .05. Descriptive analyzes such as number percentage average were used for characteristics of the study sample. This study initially, a validity study was conducted for the KAPPI, followed by a reliability study (Table 1 ). Table 1 Statistical methods used in examining validity and reliability of the KAPPI-T Validity Language Validity Translation from English to Turkish Back-translation from Turkish to English Content Validity Content validity aking expert opinions (9 experts) Calculation of content validity index (CVI) using the Davis technique (1 = not appropriate at all to 4 = very appropriate) Construct Validity Expolaratory factor analysis (EFA) Confirmatory factor analysis (CFA) Reliability Internal consistency analysis Calculation of Cronbach's alpha reliability coefficient and Mc Donald's Omega (ω) coefficient Split-half reliability Spearman Brown reliability coefficient Item total corelation Validity analysis The process employed to adapt the KAP-PI for the Turkish context and to conduct the validity study involved three stages: Language validity Content validity Construct validity KAPPI-T language validity The scale was translated from English to Turkish and from Turkish to English by two experts in English education. Checking whether the back-translated version is correctly worded is an important task and should be done by translators who have not seen the content before [ 22 , 24 ]. The Turkish version was subsequently translated back into English by two impartial linguists who were not part of the study. KAPPI-T Content validity The Davis (1992) technique was used for content validity. This technique assesed the item is appropriate’, (3) ‘The item should be slightly revised’, (2) ‘The item should be considerably revised’, and (1) ‘The item is not appropriate’. The items on the final version of the KAP-PI, as recommended by 9 expert opinions (5 nurses working in intensive care clinics, 4 nurse academicians working in the departments of internal medicine nursing, surgical nursing and fundamentals of nursing). Following the content validity study, a pilot study was conducted with 33 family caregivers of older adults. The word pressure injuries, which the caregivers found difficult to understand, was changed to bed injuries. KAPPI-T Construct validity The suitability of the data for factor analysis was evaluated using the Kaiser-Meyer-Olkin (KMO) coefficient and Bartlett's sphericity test. In the Turkish adaptation of the KAPPI-T, CFA was used to verify the compatibility of the factors for the purpose of construct validity. The CFA goodness-of-fit index was evaluated using χ2/sd, CFI, RMSEA and SRMR [ 25 – 27 ]. Reliability analysis Reliability analysis was carried out in three stages: Internal consistency analysis Split half reliability Cronbach's alpha reliability coefficients and Mc Donald's Omega (ω) coefficient were calculated for the internal consistency analysis. Spearman Brown reliability coefficient was calculated to evaluate the split-half reliability analysis. Item total correlations calculated for item analysis. Results Characteristics of the participants The average age of family caregivers was 56.27 ± 12.20 years (min = 18, max = 85), the mean age of patients was 76.85 ± 7.85 years (min = 65, max = 97), 72.7% of family caregivers were women, 66.4% lived in the same home with older people, and 63% of them shared care of older people with family members. Family caregivers of 66.7% have been providing care to older people for less than 1 year, 65.8% of them have been supporting activities of living for less than 3 hours a day, 80.3% of them have never lived with an individual with pressure injuries, and 18.3% of have had pressure injuries and provided care (Table 2 ). Table 2 Characteristics of family caregiver’s (n = 330) Mean ± SD Min-Max Age of the older people 76.85 ± 7.85 65–97 Age of family caregivers 56.27 ± 12.20 18–85 n % Gender Women 90 27.3 Men 240 72.7 Education level Illiterate 17 5.2 Primary school graduate 225 68.2 High school graduate 45 13.6 Graduated from a University 43 13.0 Relationship with older people Child 94 28.9 Spouse 163 49.4 Other family caregivers 73 22.1 Living in the same home with older people Yes 163 49.4 No 167 50.6 Sharing responsibility with other in caring for older people Yes 208 63.0 No 122 37.0 Duration of caring for older people ≤ 1 year 220 66.7 > 1 - ≤ 3 years 50 15.2 > 3 - ≤ 5 years 37 11.2 > 5 years 23 7.0 Living with an older people with pressure injuries Yes 65 19.7 No 265 80.3 Providing pressure injures care Yes 62 18.8 No 268 81.2 SD: standard deviation Content validity of the KAPPI-T The content validity index of the scale was found to be 95% and the average item score was 3.48 (min = 2, max = 4) based on nine expert evaluations. In the pilot study conducted with thirty-three family caregivers caring for older people, the statements were corrected because there were a few items that were not understood . Construct validity of the KAPPI-T Exploratory factor analysis The Kaiser-Mayer-Olkin coefficient (KMO = 0.83) calculated before factor analysis showed that the sample size was adequate (n = 330), and Barlett's Sphericity test results showed that the data group was suitable for factor analysis (6761.872, p < 0.01). After exploratory factor analysis, items K1, K11, K8 and A9 with factor loadings below 0.20 were removed from the scale. Afterwards, it was determined that the scale had a three-factor structure. The first factor has 8 items with an eigenvalue of 6.88 and explains 23.74% of the average variance. The second factor has an eigenvalue of 4.15 and explains 14.32% of the average variance. The third factor has an eigenvalue of 2.72 and explains 9.41% of the mean variance (Table 3 ). Table 3 Exploratory factor analysis (n = 330) Items Factor Loads K A P K2 What is a bed injury? 0.50 K3 What are the symptoms of bed injuries? 0.40 K4 What are the causes of bed injuries? 0.49 K5 What can cause bed injuries in the older people? 0.49 K6 What should be done to prevent bed injuries in older people individuals? 0.54 K7 How can bed injuries be prevented in older people? 0.31 K9 What should be done when the skin is dry to prevent bed injuries in older people individuals? 0.43 K10 What should be done when the skin of the older people turns red? 0.43 K12 Can using a special mattress for older people individuals prevent bed injuries? 0.40 A1 I am responsible for the health of my older person relative in my home. 0.82 A2 I must take care of the personal cleanliness of my older person relative in my home. 0.95 A3 I have to pay attention to the skin moisture and cleanliness of my older person relative in my home. 0.95 A4 I have to pay attention to the nutrition of my older person relative in my home. 0.94 A5 I must to prevent bed injuries from developing in my older person relative at home. 0.94 A6 I must to help my older person relative at home with her/his activities (such as feeding, toilet, bathing) and movements. 0.90 A7 My bedridden older person relative in my home needs help with moving and relocating 0.41 A8 My older person relative with bed injuries in my home needs to be checked out by the home care service 0.41 P1 I cook healthy meals for older person relative in my home 0.80 P2 I give at least 8 glasses of water a day to the older person relative in my home 0.64 P3 I clean the home or room for my older person relative in my home. 0.86 P4 When the older person relative in my home is suffering from bed injuries, I take her/him to the health facility 0.85 P5 I help my older person relative at home to do activities (feeding, toilet, bath) that she/he cannot do on her/his own. 0.83 P6 If my older person relative in the home is not moving herself/himself, I help her/his. 0.50 P8 I buy a special mattress to prevent bed injuries for my bedridden older person relative at home. 0.47 P9 If my older person relative in my home uses diapers, I change her/his diapers regularly and prevent her/his clothes from getting damp or wet 0.48 P10 I prevent to prolonged pressure being applied to the body of my older person relative in my home. 0.46 P11 I moisturize the using lotions/oils skin of my older person relative in my home 0.49 P12 I check all the skin for redness of my older person relative in my home 0.31 Factor contribution 6.88 4.15 2.72 Cumulative proportion of variance explained 23.74 38.06 47.47 a Principal factor method: varimax rotation, K = knowledge, A = attitude, P = practice Confirmatory factor analysis The fit index values (RMSEA = 0.13; x 2 /sd = 6.71) of the first model obtained from confirmatory factor analysis were not acceptable. Therefore, error covariances were added to the model in line with the modification suggestions and the second model was created. The fit index values for the proposed model (CFI = 0.96 SRMR = 0.09, x 2 /sd = 3.06, RMSEA = 0.7) were found to be acceptable (Table 4 ). Table 4 Reliability and descriptive analysis values according to factors of KAPPI-T Factors Items Mean Sd Cronbach's Alpha if Item Deleted Item total Correlation Cronbach Alfa Mc Donald’s omega Spearman brown Knowledge K2 .72 .44 .60 .41 0.65 0.65 0.60 K3 .82 .37 .61 .36 K4 .82 .38 .60 .39 K5 .82 .38 .60 .41 K6 .76 .42 .58 .48 K7 .48 .50 .65 .39 K9 .83 .37 .63 .34 K10 .28 .45 .61 .35 K12 .67 .44 .66 .34 Attitude A1 3.64 .60 .88 .70 0.90 0.91 0.83 A2 3.66 .47 .87 .89 A3 3.65 .48 .87 .90 A4 3.64 .49 .87 .89 A5 3.64 .48 .87 .90 A6 3.62 .49 .87 .86 A7 3.28 .50 .91 .38 A8 3.32 .63 .93 .32 Practice P1 3.73 .46 .82 .56 0.83 0.74 0.71 P2 3.55 .61 .83 .34 P3 3.72 .46 .82 .58 P4 3.79 .42 .82 .62 P5 3.81 .40 .82 .64 P6 3.76 .44 .82 .60 P7 3.76 .44 .82 .60 P8 3.39 .92 .84 .39 P9 3.61 .51 .82 .57 P10 3.48 .53 .81 .59 P11 3.11 .82 .84 .39 P12 3.38 .57 .81 .58 The original three-factor structure of the Turkish version of KAPPI-T was confirmed. The first factor was defined as Knowledge (9 items), other factor as Attitude (8 items), and the last factor as Practice (12 items) in line with the original scale. The factor loadings of the subscales are in the range of (0.25–0.96) (Fig. 1 ). Reliability of KAPPI-T The Knowledge Subscale (K2-K7, K9-K10, K12) has nine items and Cronbach's Alpha (α) coefficient is 0.65, Mc Donald's Omega (ω) coefficient is 0.65, Spearman Brown reliability coefficient is 0.60. Attitude subscale (A1-A8) has 8 items and Cronbach's Alpha (α) coefficient is 0.90, Mc Donald's Omega (ω) coefficient is 0.91, Spearman Brown reliability coefficient is 0.83. The practice subscale (P1-P12) had 12 items and Cronbach's Alpha (α) coefficient was found to be 0.83, McDonald's Omega (ω) coefficient was found to be 0.74, and Spearman Brown reliability coefficient was found to be 0.71 (Table 5 ). Table 5 Confirmatory factor analysis Model \(\:{\varvec{\chi\:}}^{2}\) p df \(\:{\varvec{\chi\:}}^{2}\) /df CFI RMSEA SRMR Firs Model 2510.89 0.00 374 6.71 0.79 0.13 0.11 Second model 1117.02 0.00 364 3.06 0.96 0.07 0.09 *Acceptable fit - > 0.05 - χ2/sd˂5 0.95 ≤ CFI ≤ 0.97 0.05˂ RMSEA˂0.8 0.05 ≤ SRMR ≤ 0.10 Note. χ2: Chi-Square; df: degrees of freedom; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual; CFI: Comparative Fit Index Discussion This is the first study in which KAPPI-T was adapted to Turkish culture. The study confirmed the three-factor structure consisting of 29 items in the KAPPI-T through confirmatory factor analysis (CFA). All items demonstrated acceptable levels of t values and factor loadings. The values for two-half test reliability and internal consistency were within acceptable ranges. These results showed that the KAPPI-T scale is a valid and reliable instrument that can be used to evaluates the knowledge, attitudes and practice of family caregivers towards pressure injuries. Discussion of validity findings The validity of scales and items should be evaluated to test whether they measure the variable they are intended to measure. There are many methods to test scale validity. In this research, the content and structure of the performance were evaluated. The communication between experts being 0.80 and the average score being 3 and above standards were accepted as criteria for continuing the scope [ 23 ]. In the expert evaluation conducted in this research, the content validity of the Turkish KAPPI-T was found to be 95%, and the mean item score was 3.48, which was considered adequate. Exploratory factor analysis (EFA) is employed to uncover the relationships and patterns between variables within a scale, whereas confirmatory factor analysis (CFA) is utilized to test a pre-established theoretical model concerning the structure under investigation [ 28 ]. The Kaiser-Meyer-Olkin (KMO) value obtained because of the analysis tests the suitability of the sample for factor analysis for each variable in the model and for the whole model, this value should not be below 0.50. Barlett's Sphericity test evaluates the adequacy of the sample in the model for factor analysis and the test result should be p < 0.05 [ 27 , 29 ]. The values obtained in this study showed that the sample was suitable and sufficient for factor analysis. After exploratory factor analysis, items with factor loadings below 0.20 should be removed from the scale [ 28 , 29 ]. In this study, items K1, K8, K11 and A9 with factor loadings below 0.20 were removed from the scale. The reasons for the low factor loadings of these items may be as follows: While other items in the knowledge subscale ask for information about pressure injuries, item K1 asks about skin changes related to aging. Therefore, it is believed that the factor loading of item K1 is low. “What should be done to prevent pressure injuries in immobile/bedridden elderly people?" in item K8 may have a low factor loading because it has a very similar meaning to the statement in item K6 "What should be done to prevent pressure injuries in elderly people? " Answers such as "Honey should be applied to the wound" OR "The inside of the wound should be opened and examined" in the answer options for question K11 (What should be done when a deep pressure injury is seen on the skin of an elderly person?) may not be taken seriously or can be misunderstood by people who do not have medical knowledge. Item A9 ("Elderly relatives in my home who are at risk of developing pressure injuries need a special bed to prevent them from developing pressure injuries") may have a long and complex structure that makes it difficult for participants to understand what the question means. In scale development and adaptation studies, the explained variance ratio is a key indicator of construct validity. According to Finch (2019), this ratio should ideally exceed 40%. In this study, the explained variance ratio was found to be 47.47%, suggesting that the construct validity is at an acceptable level [ 30 ]. In the literature, acceptable fit index values for the model obtained by CFA were reported as SRMR < 0.10, x2/sd value .90, RMSEA < .08 [ 25 – 27 ]. In this study, it was determined that x 2 /sd and RMSEA values were not acceptable in the first model. In cases where the fit indices do not meet the acceptance levels in the confirmatory factor analysis model, it would be useful to examine the modification suggestions for the model [ 28 ]. In this study, error covariances were added to the model in line with the modification suggestions for the model. In this second model in which error covariances were added, the fit index values were found to be acceptable (CFI = 0.96 SRMR = 0.09, x 2 /sd = 3.06, RMSEA = 0.7). These results showed that the original three-dimensional structure of the Turkish version of the KAPPI-T was confirmed. The construct validity of this study could not be compared with other studies, since there were no other studies in the literature in which psychometric evaluation of the scale was performed other than the original study. Discussion of reliability findings Various methods are available to test the reliability of scales. In this study, for internal consistency, Cronbach's Alpha (α) and Mc Donald's Omega (ω) reliability coefficient were calculated, and these values express the correlation between scale items. For a measurement tool to be reliable, it is recommended that the internal consistency coefficient be close to 1 and above 0.70 [ 31 ]. The acceptable value of Mc Donald's Omega (ω) coefficient is between 0.70 and 0.90. This range indicates that the consistency between the items of the test is high [ 32 ]. The Spearman-Brown coefficient value calculated for the two-half test should be greater than 0.70. In this study, the Cronbach's Alpha (α), Mc Donald's Omega (ω) coefficient value and Spearman Brown coefficient value of the Attitude and Practice subscales were adequate. The Cronbach's Alpha (α), Mc Donald's Omega (ω) and Spearman Brown coefficient values of the Knowledge subscale were lower than 0.70. In Sari et al.'s (2022) study, the Cronbach Alpha (α) value of the knowledge scale was 0.83. In this study, the number of items in the knowledge scale decreased as three items were excluded from the scale. This may have affected the internal consistency coefficient values. In item analysis, the correlation coefficients between item scores and the total score of the scale are assessed. Item-total score correlations are expected to be between 0.30–0.70 [ 33 , 34 ]. In this study, the item-total score correlations of the KS (0.34–0.48), the item-total score correlations of the AS (0.32–0.90), and the item-total score correlations of the PS (0.34–0.64) were between the recommended values and were positive. Limitations Since the data were obtained from a single center, the generalizability of the results is limited. Due to the short-term hospitalization of the patients in the clinics covered by the study, the test-retest reliability of the scale could not be evaluated. Conclusion In conclusion, this study demonstrated that the KAPPI-T scale is a valid and reliable instrument for evaluating the knowledge, attitudes, and practices of family caregivers regarding pressure injury prevention in the Turkish cultural context. The scale provides a standardized means of assessment that can be employed in nursing education, community-based training programs, and research endeavors focused on caregiver roles in long-term care and pressure injury prevention. Declarations Acknowledgements I thank all participants who voluntarily contributed to this study Author contributions K.O.D. and A.S.B. contributed to the conception and design of the study. A.S.B. conducted the statistical analyses. K.O.D. and A.S.B. wrote the main manuscript text, K.O.D. and A.S.B. collected data and A.S.B. prepared figures and tables. All authors read and approved the final version of the manuscript and agreed to be accountable for the content of the work. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Data availability The datasets generated and analysed during the current study are not publicly available due but are available from the corresponding author on reasonable reques Ethics approval and consent to participate All procedures involving human participants were followed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration as well as its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee of the Burdur Mehmet Akif Ersoy University Non-Interventional Clinical Research Committe. Ethics Committee evaluated the ethics, safety, and scientific validity of the study and granted the ethics approval (Approval No: GO2022/944, date=07.12.2022). 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Development and psychometric evaluation of an instrument to assess Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) in Indonesian community-dwelling older adults. BMC Nurs. 2022;21:222. Gregoire J. ITC guidelines for translating and adapting tests (second edition). Int J Test. 2018;18(2):101–34. LoBiondo Wood G, Haber J. Reliability and validity Nursing Research Methods and Critical Appraisal for Evidence Based Practice. 9th ed. St. Louis, Missouri: Elsevier; 2018. World Health Organization. 2021. Process of translation and adaptation of instruments. https://www.who.int/substance_abuse/research_tools/translation/en/ Kline RB. Principles and practice of structural equation modeling. 4th ed. New York, NY, USA: Guilford; 2015. Durmus B, Zinc M, Yurtkoru ES. Spss Data Analysis in Social Sciences. 7th ed. Istanbul, Turkey: Beta; 2018. Esin N. Data collection methods and tools. In: Erdogan S, Nahcivan N, Esin N, editors. Research in Nursing: Process, Practice and Critical. Ankara: Nobel Tıp Publishing; 2014. pp. 193–232. Tabachnick BG, Fidell LS. Using multivariate statistics. Pearson Education. 6th ed. 2020. Costa V, Sarmento RP. Confirmatory factor analysis-A case study.2019. Finch HW. Exploratory factor analysis. SAGE; 2019. DeVellis RF. Scale Development: Theory and Applications. 4th ed. Thousand Oaks, CA: Sage; 2017. McNeish D. Thanks coefficient alpha, we'll take it from here. Psychol Methods. 2018;23(3):412–33. Buyukozturk S. Handbook of data analysis for social sciences. 17th ed. Ankara: Pegem Publishing; 2012. Tavsancil E. Measurement of attitudes and data analysis with SPSS. Ankara: Nobel Publishing; 2014. Additional Declarations No competing interests reported. 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01:28:50","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":124363,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7798456/v1/154f1f40aa4fae87787d72b1.html"},{"id":95065586,"identity":"da0c1dda-69ac-450e-8ea1-223d3827ddcf","added_by":"auto","created_at":"2025-11-04 01:28:49","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58471,"visible":true,"origin":"","legend":"\u003cp\u003eConfirmatory factor analysis (CFA) model of the KAPPI-T scale showing the three-factor structure: Knowledge (B items), Attitude (T items), and Practice (U items) subscales with standardized factor loadings\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7798456/v1/71bf447eec7df37772bd6214.jpg"},{"id":95230442,"identity":"41dec930-9d8c-4606-a6f2-1535439b9042","added_by":"auto","created_at":"2025-11-05 16:37:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1363392,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7798456/v1/a4458c4e-9735-4050-b1a5-b6920edddc11.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Turkish Version of the Kappi Scale: Validity and Reliability Study on Family Caregivers’ Knowledge Attitudes and Practices in Pressure Injury Prevention\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePressure injuries (PIs), also known as pressure ulcers or bedsores, are a significant public health concern, particularly among vulnerable populations such as older adults, individuals with spinal cord injuries, intensive care patients, and residents of long-term care facilities. According to data collected between 2006 and 2014, the incidence of PIs ranges between 11.8% and 19%, depending on differences in methodology, settings, and populations studied [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These injuries are defined by the National Pressure Injury Advisory Panel (NPIAP), European Pressure Ulcer Advisory Panel (EPUAP), and Pan Pacific Pressure Injury Alliance (PPPIA) as localized damage to the skin and/or underlying tissue resulting from pressure, or pressure in combination with shear, typically over bony prominences or in areas exposed to medical devices [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRecent epidemiological data show that the global prevalence of pressure injuries between 2008 and 2018 was approximately 12.8%, with regional variations 14.5% in Europe, 13.6% in North America, 12.7% in South America and 9% in Australia [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Older adults are at increased risk due to age-related factors such as reduced mobility, skin fragility, and chronic comorbidities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Studies also suggest that older adults living at home are particularly vulnerable, often due to insufficient preventive care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In the United States, for example, 70.6% of hospitalized patients with pressure injuries were older adults living at home [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTurkey, with a rapidly aging population, is similarly at risk. According to national statistics, 9.9% of the population (approximately 8.4\u0026nbsp;million people) is over the age of 65, and most of them (about 6.3\u0026nbsp;million) reside at home with their families [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this context, family members often serve as the primary caregivers, bearing responsibility for the daily care of older adults [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Their involvement in caregiving is critical in preventing pressure injuries and reducing their prevalence [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite their essential role, family caregivers often lack sufficient knowledge, positive attitudes, and effective practices regarding pressure injury prevention [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In Turkey, pressure injuries have been reported in 8.2% to 31.4% of older adults living at home, and over half of these individuals receive care from family members [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, most existing assessment tools for pressure injury prevention are developed for healthcare professionals and are not suitable for family caregivers with diverse educational backgrounds [\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo address this gap, Sari et al. (2022) developed the Knowledge, Attitude, and Practice of Pressure Injury (KAPPI) scale specifically for family caregivers. KAPPI instrument consists of a 12-item knowledge domain, a 9-item attitude domain, and a 12-item practice domain with Cronbach\u0026rsquo;s Alpha values of 0.83, 0.93 and 0.89, respectively. The knowledge subscale consists of 12 items; measuring knowledge about the definition of PI and characteristics of older adults, symptoms, causes and consequences of PI, and preventive strategies that family caregivers can use for PI. The attitude subscale consists of 9 items: measuring family caregivers' beliefs and values ​​regarding the prevention of PI. The Practical subscale is consists of 12 items; covering basic support, support for repositioning and mobilisation, skin hygiene and support for moisturizing [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo date, no validity and reliability study of the KAPPI scale has been conducted in the Turkish language. Therefore, the aim of this study is to adapt the KAPPI scale into Turkish (KAPPI-T) and to evaluate its psychometric properties, including validity and reliability. The Turkish version of the KAPPI will provide a culturally appropriate instrument to assess family caregivers\u0026rsquo; knowledge, attitudes, and practices regarding pressure injury prevention. This assessment will enable public health professionals and nurses to identify gaps in caregiver competencies and to develop evidence-based educational interventions tailored to the needs of family caregivers in Turkey.\u003c/p\u003e\n\u003ch3\u003eResearch questions:\u003c/h3\u003e\n\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIs the KAPPI-T Scale a valid scale in Turkish language?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIs the KAPPI-T Scale a reliable scale in Turkish language?\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003ch2\u003eStudy design and sample, data collection, analysis\u003c/h2\u003e\u003cp\u003e Approval was obtained from both the hospital and the appropriate ethics committee prior to commencing the study, which employed a cross-sectional data collection approach. The study was conducted in the internal and surgical clinics of a state hospital in January-March 2023 with the family caregivers of patients aged 65 years and over who were hospitalized in the mentioned clinics. It is often suggested in the literature that the number of participants per item should be between 5 and 10 [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Therefore, instead of keeping the number of participants per item to a minimum, 10 participants per item were selected to ensure that the analyses were based on a more solid foundation. In this way, possible data loss or incomplete responses did not negatively affect the scale, and the results obtained were more reliable. Because the KAPPI Scale has 33 items, the sample included 330 participants. Data were collected from each clinic by the researchers. The purpose of the study was explained to the family caregivers and those who volunteered to participate were included in the study. The researchers read the questions for illiterate patients' family caregivers and marked their answers.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\n\u003ch3\u003eData collection instruments\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eDemographic form\u003c/h2\u003e\u003cp\u003eThe form created by the researchers in line with the literature includes variables such as age, gender, age of older people, their educational status, and history of pressure injuries.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eKAPPI Scale original form\u003c/h3\u003e\n\u003cp\u003eThe KAPPI Scale developed by Sari et al. (2022) consists of 33 items [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The scale consists of 3 subscales: knowledge section (12 items), attitude section (9 items) and practice section (12 items). In the questions in the knowledge section, correct answers are scored as 1 point and incorrect answers are scored as 0 point. The attitude section is rated on a 4 point Likert-type scale ranging from 1\u0026thinsp;=\u0026thinsp;Strongly disagree to 4\u0026thinsp;=\u0026thinsp;Strongly agree. The practice section is scored on a Likert-type scale ranging from 1\u0026thinsp;=\u0026thinsp;Never to 4\u0026thinsp;=\u0026thinsp;Always. Each subscale is used separately. Cronbach's alpha for the knowledge section was reported to be 0.83, and 0.93 for the attitude section and 0.89 for the practice section.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS 21.0 and Lisrel 8.0 programs; Statistical significance was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;.05. Descriptive analyzes such as number percentage average were used for characteristics of the study sample. This study initially, a validity study was conducted for the KAPPI, followed by a reliability study (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\u003eStatistical methods used in examining validity and reliability of the KAPPI-T\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\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eValidity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLanguage Validity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTranslation from English to Turkish\u003c/p\u003e\u003cp\u003eBack-translation from Turkish to English\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eContent Validity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContent validity aking expert opinions (9 experts)\u003c/p\u003e\u003cp\u003eCalculation of content validity index (CVI) using the Davis technique (1\u0026thinsp;=\u0026thinsp;not appropriate at all to 4\u0026thinsp;=\u0026thinsp;very appropriate)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConstruct Validity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExpolaratory factor analysis (EFA)\u003c/p\u003e\u003cp\u003eConfirmatory factor analysis (CFA)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eReliability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInternal consistency analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCalculation of Cronbach's alpha reliability coefficient and Mc Donald's Omega (ω) coefficient\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSplit-half reliability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpearman Brown reliability coefficient\u003c/p\u003e\u003cp\u003eItem total corelation\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\n\u003ch3\u003eValidity analysis\u003c/h3\u003e\n\u003cp\u003eThe process employed to adapt the KAP-PI for the Turkish context and to conduct the validity study involved three stages:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eLanguage validity\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eContent validity\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eConstruct validity\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\n\u003ch3\u003eKAPPI-T language validity\u003c/h3\u003e\n\u003cp\u003eThe scale was translated from English to Turkish and from Turkish to English by two experts in English education. Checking whether the back-translated version is correctly worded is an important task and should be done by translators who have not seen the content before [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The Turkish version was subsequently translated back into English by two impartial linguists who were not part of the study.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eKAPPI-T Content validity\u003c/h2\u003e\u003cp\u003eThe Davis (1992) technique was used for content validity. This technique assesed the item is appropriate\u0026rsquo;, (3) \u0026lsquo;The item should be slightly revised\u0026rsquo;, (2) \u0026lsquo;The item should be considerably revised\u0026rsquo;, and (1) \u0026lsquo;The item is not appropriate\u0026rsquo;. The items on the final version of the KAP-PI, as recommended by 9 expert opinions (5 nurses working in intensive care clinics, 4 nurse academicians working in the departments of internal medicine nursing, surgical nursing and fundamentals of nursing).\u003c/p\u003e\u003cp\u003eFollowing the content validity study, a pilot study was conducted with 33 family caregivers of older adults. The word pressure injuries, which the caregivers found difficult to understand, was changed to bed injuries.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eKAPPI-T Construct validity\u003c/h2\u003e\u003cp\u003eThe suitability of the data for factor analysis was evaluated using the Kaiser-Meyer-Olkin (KMO) coefficient and Bartlett's sphericity test. In the Turkish adaptation of the KAPPI-T, CFA was used to verify the compatibility of the factors for the purpose of construct validity. The CFA goodness-of-fit index was evaluated using χ2/sd, CFI, RMSEA and SRMR [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eReliability analysis\u003c/h2\u003e\u003cp\u003eReliability analysis was carried out in three stages:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eInternal consistency analysis\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSplit half reliability\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eCronbach's alpha reliability coefficients and Mc Donald's Omega (ω) coefficient were calculated for the internal consistency analysis. Spearman Brown reliability coefficient was calculated to evaluate the split-half reliability analysis. Item total correlations calculated for item analysis.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eCharacteristics of the participants\u003c/h2\u003e\u003cp\u003eThe average age of family caregivers was 56.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.20 years (min\u0026thinsp;=\u0026thinsp;18, max\u0026thinsp;=\u0026thinsp;85), the mean age of patients was 76.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85 years (min\u0026thinsp;=\u0026thinsp;65, max\u0026thinsp;=\u0026thinsp;97), 72.7% of family caregivers were women, 66.4% lived in the same home with older people, and 63% of them shared care of older people with family members. Family caregivers of 66.7% have been providing care to older people for less than 1 year, 65.8% of them have been supporting activities of living for less than 3 hours a day, 80.3% of them have never lived with an individual with pressure injuries, and 18.3% of have had pressure injuries and provided care (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\u003eCharacteristics of family caregiver\u0026rsquo;s (n\u0026thinsp;=\u0026thinsp;330)\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=\"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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMin-Max\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\u003e\u003cb\u003eAge of the older people\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u0026ndash;97\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of family caregivers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.27\u0026thinsp;\u0026plusmn;\u0026thinsp;12.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;85\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWomen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMen\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e240\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIlliterate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary school graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e225\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school graduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGraduated from a University\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eRelationship with older people\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpouse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e163\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOther family caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLiving in the same home with older people\u003c/b\u003e\u003c/p\u003e\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\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e49.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eSharing responsibility with other in caring for older people\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eDuration of caring for older people\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;1 year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 - \u0026le; 3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3 - \u0026le; 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eLiving with an older people with pressure injuries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e265\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e80.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eProviding pressure injures care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e268\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eSD: standard deviation\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eContent validity of the KAPPI-T\u003c/h2\u003e\u003cp\u003eThe content validity index of the scale was found to be 95% and the average item score was 3.48 (min\u0026thinsp;=\u0026thinsp;2, max\u0026thinsp;=\u0026thinsp;4) based on nine expert evaluations. In the pilot study conducted with thirty-three family caregivers caring for older people, the statements were corrected because there were a few items that were not understood .\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eConstruct validity of the KAPPI-T\u003c/h2\u003e\u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\u003ch2\u003eExploratory factor analysis\u003c/h2\u003e\u003cp\u003eThe Kaiser-Mayer-Olkin coefficient (KMO\u0026thinsp;=\u0026thinsp;0.83) calculated before factor analysis showed that the sample size was adequate (n\u0026thinsp;=\u0026thinsp;330), and Barlett's Sphericity test results showed that the data group was suitable for factor analysis (6761.872, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). After exploratory factor analysis, items K1, K11, K8 and A9 with factor loadings below 0.20 were removed from the scale. Afterwards, it was determined that the scale had a three-factor structure. The first factor has 8 items with an eigenvalue of 6.88 and explains 23.74% of the average variance. The second factor has an eigenvalue of 4.15 and explains 14.32% of the average variance. The third factor has an eigenvalue of 2.72 and explains 9.41% of the mean variance (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\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\u003e Exploratory factor analysis (n\u0026thinsp;=\u0026thinsp;330)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eItems\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c7\" namest=\"c3\"\u003e\u003cp\u003eFactor Loads\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eK\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhat is a bed injury?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat are the symptoms of bed injuries?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat are the causes of bed injuries?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat can cause bed injuries in the older people?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat should be done to prevent bed injuries in older people individuals?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eHow can bed injuries be prevented in older people?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat should be done when the skin is dry to prevent bed injuries in older people individuals?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eWhat should be done when the skin of the older people turns red?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\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\u003eCan using a special mattress for older people individuals prevent bed injuries?\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI am responsible for the health of my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI must take care of the personal cleanliness of my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI have to pay attention to the skin moisture and cleanliness of my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI have to pay attention to the nutrition of my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI must to prevent bed injuries from developing in my older person relative at home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eI must to help my older person relative at home with her/his activities (such as feeding, toilet, bathing) and movements.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eMy bedridden older person relative in my home needs help with moving and relocating\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003eMy older person relative with bed injuries in my home needs to be checked out by the home care service\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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 cook healthy meals for older person relative in my home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.80\u003c/p\u003e\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 give at least 8 glasses of water a day to the older person relative in my home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.64\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 clean the home or room for my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.86\u003c/p\u003e\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\u003eWhen the older person relative in my home is suffering from bed injuries, I take her/him to the health facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.85\u003c/p\u003e\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 help my older person relative at home to do activities (feeding, toilet, bath) that she/he cannot do on her/his own.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.83\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\u003cp\u003eIf my older person relative in the home is not moving herself/himself, I help her/his.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.50\u003c/p\u003e\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 buy a special mattress to prevent bed injuries for my bedridden older person relative at home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.47\u003c/p\u003e\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\u003eIf my older person relative in my home uses diapers, I change her/his diapers regularly and prevent her/his clothes from getting damp or wet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.48\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\u003cp\u003eI prevent to prolonged pressure being applied to the body of my older person relative in my home.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.46\u003c/p\u003e\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 moisturize the using lotions/oils skin of my older person relative in my home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.49\u003c/p\u003e\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 check all the skin for redness of my older person relative in my home\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFactor contribution\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCumulative proportion of variance explained\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e38.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e47.47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e \u003cb\u003ePrincipal factor method: varimax rotation, K\u0026thinsp;=\u0026thinsp;knowledge, A\u0026thinsp;=\u0026thinsp;attitude, P\u0026thinsp;=\u0026thinsp;practice\u003c/b\u003e\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\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eConfirmatory factor analysis\u003c/h2\u003e\u003cp\u003eThe fit index values (RMSEA\u0026thinsp;=\u0026thinsp;0.13; x\u003csup\u003e2\u003c/sup\u003e/sd\u0026thinsp;=\u0026thinsp;6.71) of the first model obtained from confirmatory factor analysis were not acceptable. Therefore, error covariances were added to the model in line with the modification suggestions and the second model was created. The fit index values for the proposed model (CFI\u0026thinsp;=\u0026thinsp;0.96 SRMR\u0026thinsp;=\u0026thinsp;0.09, x\u003csup\u003e2\u003c/sup\u003e/sd\u0026thinsp;=\u0026thinsp;3.06, RMSEA\u0026thinsp;=\u0026thinsp;0.7) were found to be acceptable (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\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 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e Reliability and descriptive analysis values according to factors of KAPPI-T\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFactors\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\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSd\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCronbach's Alpha if Item Deleted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eItem\u003c/p\u003e\u003cp\u003etotal\u003c/p\u003e\u003cp\u003eCorrelation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCronbach\u003c/p\u003e\u003cp\u003eAlfa\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMc Donald\u0026rsquo;s omega\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSpearman brown\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e\u003cb\u003eKnowledge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"8\" rowspan=\"9\"\u003e\u003cp\u003e0.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eK12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e\u003cb\u003eAttitude\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"7\" rowspan=\"8\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003e\u003cb\u003ePractice\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"11\" rowspan=\"12\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.58\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\u003eThe original three-factor structure of the Turkish version of KAPPI-T was confirmed. The first factor was defined as Knowledge (9 items), other factor as Attitude (8 items), and the last factor as Practice (12 items) in line with the original scale. The factor loadings of the subscales are in the range of (0.25\u0026ndash;0.96) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003eReliability of KAPPI-T\u003c/h2\u003e\u003cp\u003eThe Knowledge Subscale (K2-K7, K9-K10, K12) has nine items and Cronbach's Alpha (α) coefficient is 0.65, Mc Donald's Omega (ω) coefficient is 0.65, Spearman Brown reliability coefficient is 0.60. Attitude subscale (A1-A8) has 8 items and Cronbach's Alpha (α) coefficient is 0.90, Mc Donald's Omega (ω) coefficient is 0.91, Spearman Brown reliability coefficient is 0.83. The practice subscale (P1-P12) had 12 items and Cronbach's Alpha (α) coefficient was found to be 0.83, McDonald's Omega (ω) coefficient was found to be 0.74, and Spearman Brown reliability coefficient was found to be 0.71 (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\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\u003eConfirmatory factor analysis\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\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\chi\\:}}^{2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\varvec{\\chi\\:}}^{2}\\)\u003c/span\u003e\u003c/span\u003e/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRMSEA\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\u003eFirs Model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2510.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSecond model\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e1117.02\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e364\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.06\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003e0.96\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0.07\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e0.09\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e*Acceptable fit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eχ2/sd˂5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.95\u0026thinsp;\u0026le;\u0026thinsp;CFI\u0026thinsp;\u0026le;\u0026thinsp;0.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.05˂ RMSEA˂0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.05\u0026thinsp;\u0026le;\u0026thinsp;SRMR\u0026thinsp;\u0026le;\u0026thinsp;0.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e\u003cp\u003e\u003cem\u003eNote.\u003c/em\u003e χ2: Chi-Square; df: degrees of freedom; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual; CFI: Comparative Fit Index\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"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study in which KAPPI-T was adapted to Turkish culture. The study confirmed the three-factor structure consisting of 29 items in the KAPPI-T through confirmatory factor analysis (CFA). All items demonstrated acceptable levels of t values and factor loadings. The values for two-half test reliability and internal consistency were within acceptable ranges. These results showed that the KAPPI-T scale is a valid and reliable instrument that can be used to evaluates the knowledge, attitudes and practice of family caregivers towards pressure injuries.\u003c/p\u003e\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\u003ch2\u003eDiscussion of validity findings\u003c/h2\u003e\u003cp\u003eThe validity of scales and items should be evaluated to test whether they measure the variable they are intended to measure. There are many methods to test scale validity. In this research, the content and structure of the performance were evaluated. The communication between experts being 0.80 and the average score being 3 and above standards were accepted as criteria for continuing the scope [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the expert evaluation conducted in this research, the content validity of the Turkish KAPPI-T was found to be 95%, and the mean item score was 3.48, which was considered adequate. Exploratory factor analysis (EFA) is employed to uncover the relationships and patterns between variables within a scale, whereas confirmatory factor analysis (CFA) is utilized to test a pre-established theoretical model concerning the structure under investigation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Kaiser-Meyer-Olkin (KMO) value obtained because of the analysis tests the suitability of the sample for factor analysis for each variable in the model and for the whole model, this value should not be below 0.50. Barlett's Sphericity test evaluates the adequacy of the sample in the model for factor analysis and the test result should be p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The values obtained in this study showed that the sample was suitable and sufficient for factor analysis. After exploratory factor analysis, items with factor loadings below 0.20 should be removed from the scale [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In this study, items K1, K8, K11 and A9 with factor loadings below 0.20 were removed from the scale.\u003c/p\u003e\u003cp\u003eThe reasons for the low factor loadings of these items may be as follows: While other items in the knowledge subscale ask for information about pressure injuries, item K1 asks about skin changes related to aging. Therefore, it is believed that the factor loading of item K1 is low. \u0026ldquo;What should be done to prevent pressure injuries in immobile/bedridden elderly people?\" in item K8 may have a low factor loading because it has a very similar meaning to the statement in item K6 \"What should be done to prevent pressure injuries in elderly people? \"\u003c/p\u003e\u003cp\u003eAnswers such as \"Honey should be applied to the wound\" OR \"The inside of the wound should be opened and examined\" in the answer options for question K11 (What should be done when a deep pressure injury is seen on the skin of an elderly person?) may not be taken seriously or can be misunderstood by people who do not have medical knowledge.\u003c/p\u003e\u003cp\u003eItem A9 (\"Elderly relatives in my home who are at risk of developing pressure injuries need a special bed to prevent them from developing pressure injuries\") may have a long and complex structure that makes it difficult for participants to understand what the question means.\u003c/p\u003e\u003cp\u003eIn scale development and adaptation studies, the explained variance ratio is a key indicator of construct validity. According to Finch (2019), this ratio should ideally exceed 40%. In this study, the explained variance ratio was found to be 47.47%, suggesting that the construct validity is at an acceptable level [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the literature, acceptable fit index values for the model obtained by CFA were reported as SRMR\u0026thinsp;\u0026lt;\u0026thinsp;0.10, x2/sd value\u0026thinsp;\u0026lt;\u0026thinsp;5, CFI\u0026thinsp;\u0026gt;\u0026thinsp;.90, RMSEA\u0026thinsp;\u0026lt;\u0026thinsp;.08 [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In this study, it was determined that x\u003csup\u003e2\u003c/sup\u003e/sd and RMSEA values were not acceptable in the first model. In cases where the fit indices do not meet the acceptance levels in the confirmatory factor analysis model, it would be useful to examine the modification suggestions for the model [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In this study, error covariances were added to the model in line with the modification suggestions for the model. In this second model in which error covariances were added, the fit index values were found to be acceptable (CFI\u0026thinsp;=\u0026thinsp;0.96 SRMR\u0026thinsp;=\u0026thinsp;0.09, x\u003csup\u003e2\u003c/sup\u003e/sd\u0026thinsp;=\u0026thinsp;3.06, RMSEA\u0026thinsp;=\u0026thinsp;0.7). These results showed that the original three-dimensional structure of the Turkish version of the KAPPI-T was confirmed. The construct validity of this study could not be compared with other studies, since there were no other studies in the literature in which psychometric evaluation of the scale was performed other than the original study.\u003c/p\u003e\u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\u003ch2\u003eDiscussion of reliability findings\u003c/h2\u003e\u003cp\u003eVarious methods are available to test the reliability of scales. In this study, for internal consistency, Cronbach's Alpha (α) and Mc Donald's Omega (ω) reliability coefficient were calculated, and these values express the correlation between scale items. For a measurement tool to be reliable, it is recommended that the internal consistency coefficient be close to 1 and above 0.70 [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The acceptable value of Mc Donald's Omega (ω) coefficient is between 0.70 and 0.90. This range indicates that the consistency between the items of the test is high [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. The Spearman-Brown coefficient value calculated for the two-half test should be greater than 0.70. In this study, the Cronbach's Alpha (α), Mc Donald's Omega (ω) coefficient value and Spearman Brown coefficient value of the Attitude and Practice subscales were adequate. The Cronbach's Alpha (α), Mc Donald's Omega (ω) and Spearman Brown coefficient values of the Knowledge subscale were lower than 0.70. In Sari et al.'s (2022) study, the Cronbach Alpha (α) value of the knowledge scale was 0.83. In this study, the number of items in the knowledge scale decreased as three items were excluded from the scale. This may have affected the internal consistency coefficient values.\u003c/p\u003e\u003cp\u003eIn item analysis, the correlation coefficients between item scores and the total score of the scale are assessed. Item-total score correlations are expected to be between 0.30\u0026ndash;0.70 [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In this study, the item-total score correlations of the KS (0.34\u0026ndash;0.48), the item-total score correlations of the AS (0.32\u0026ndash;0.90), and the item-total score correlations of the PS (0.34\u0026ndash;0.64) were between the recommended values and were positive.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eSince the data were obtained from a single center, the generalizability of the results is limited. Due to the short-term hospitalization of the patients in the clinics covered by the study, the test-retest reliability of the scale could not be evaluated.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, this study demonstrated that the KAPPI-T scale is a valid and reliable instrument for evaluating the knowledge, attitudes, and practices of family caregivers regarding pressure injury prevention in the Turkish cultural context. The scale provides a standardized means of assessment that can be employed in nursing education, community-based training programs, and research endeavors focused on caregiver roles in long-term care and pressure injury prevention.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eI thank all participants who voluntarily contributed to this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eK.O.D. and A.S.B. contributed to the conception and design of the study. A.S.B. conducted the statistical analyses. K.O.D. and A.S.B. wrote the main manuscript text, K.O.D. and A.S.B. collected data and A.S.B. prepared figures and tables. All authors read and approved the final version of the manuscript and agreed to be accountable for the content of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are not publicly available due but are available from the corresponding author on reasonable reques\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures involving human participants were followed in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration as well as its later amendments or comparable ethical standards. The study protocol was approved by the Ethics Committee of the Burdur Mehmet Akif Ersoy University Non-Interventional Clinical Research Committe. Ethics Committee evaluated the ethics, safety, and scientific validity of the study and granted the ethics approval (Approval No: GO2022/944, date=07.12.2022). Informed consent was obtained from the family caregivers who agreed to participate in the research.\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\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWilliams L, Wilkins L. Pressure injuries. In: Slatcha PA, ed. Wound care made incredibly easy! Lippincott Williams and Wilkins ProQuest Ebook; 2015:1\u0026ndash;43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://ebookcentral.proquest.com/lib/akif/detail.action?docID=4786087\u003c/span\u003e\u003cspan address=\"http://ebookcentral.proquest.com/lib/akif/detail.action?docID=4786087\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eŞendir M, B\u0026uuml;y\u0026uuml;kyılmaz F, Aktaş A. Doku b\u0026uuml;t\u0026uuml;nl\u0026uuml;ğ\u0026uuml;n\u0026uuml;n sağlanması ve yara bakımı. In: Atabek Aştı T, Karadağ A, editors. Hemşirelik esasları hemşirelik bilimi ve sanatı, İstanbul: Akademi Basın ve Yayıncılık; 2014:483\u0026ndash;529.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNational Pressure İnjuries Advisory Panel. European Pressure İnjuries Advisory Panel, Pan Pacific Pressure Injury Alliance (NPUAP, EPUAP, PPPIA). Prevention an treatment of pressure injuries: clinical practice guideline. Cambrighe Media Osborne Park, Western Australia; 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: A systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOlivo S, Canova C, Peghetti A, Rossi M, Zanotti R. Prevalence of pressure ulcers in hospitalized patients: A cross-sectional study. J Wound Care. 2020;29(Sup 3):20\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12968/jowc.2020.29.Sup3.S20\u003c/span\u003e\u003cspan address=\"10.12968/jowc.2020.29.Sup3.S20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSugathapala RDUP, Latimer S, Balasuriya A, Chaboyer W, Thalib L, Gillespie BM. Prevalence and incidence of pressure injuries among older people living in nursing homes: A systematic review and meta-analysis. Int J Nurs Stud. 2023;148:104605.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr. 2018;18:305.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCorbett LQ, Funk M, Fortunato G, et al. Pressure injury in a community population: a descriptive study. J Wound Ostomy Cont Nurs. 2017;44(3):221\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTUIK, İstatistiklerle Yaşlılar. 2022 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://data.tuik.gov.tr/Bulten/Index?p=%C4%B0statistiklerle-Ya%C5%9Fl%C4%B1lar\u003c/span\u003e\u003cspan address=\"https://data.tuik.gov.tr/Bulten/Index?p=%C4%B0statistiklerle-Ya%C5%9Fl%C4%B1lar\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e-2022-49667\u0026amp;dil=1.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSchulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family caregiving for older adults. Ann Rev Psychol. 2020;71:635\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoe NB, Guo J, Konetzka RT, et al. What is the marginal benefit of payment-induced family care? impact on medicaid spending and health of care recipients. Health Econ. 2019;28(5):678\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRafiei H, Vanaki Z, Mohammadi E, Hosseinzadeh K. The Role of family caregivers in pressure ınjury prevention guidelines: A scoping review. Home Healthc Now. 2021;39(5):253\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTharu NS, Alam M, Bajracharya S, Chaudhary GP, Pandey J, Kabir MA. Caregivers' knowledge, attitude, and practice towards pressure ınjuries in spinal cord ınjury at rehabilitation center in Bangladesh. Adv Orthop. 2022:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSari SP, Everink IH, Sari EA, et al. The prevalence of pressure injuries in community-dwelling older adults: a study in an Indonesian city. Int Wound J. 2019;16(2):534\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBekar AH, Tuncer O. Evaluation of nutritional status and pressure sores of elderly patients admitted to home health care services. Eur J Hum Health. 2022;2(1):19\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCubukcu M. Falling risk assessment in home care patients. Turkish J Family Med. 2018;22(2):50\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSahin AD, Seyrek S, Erturk A, Artantaş AB. Pressure ulcers among home care patients and their demographic features. Konuralp Med J. 2017;9(1):4\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nurs Res. 1987;36(4):205\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArboledas Bell\u0026oacute;n J, Pancorbo-Hidalgo PL. Questionnaire of knowledge of family caregivers about prevention of pressure ulcer and dependence-related skin lesions: Development and validation. Gerokomos. 2016;27(2):73\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAntony L, Thelly AS. Knowledge on prevention of pressure ulcers among caregivers of patients receiving home-based palliative care. Indian J Palliat Care. 2022;28(1):75\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSari SP, Everink IHJ, Lohrmann C, et al. Development and psychometric evaluation of an instrument to assess Knowledge, Attitude and Practice of Family Caregivers at Preventing Pressure Injuries (KAP-PI) in Indonesian community-dwelling older adults. BMC Nurs. 2022;21:222.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGregoire J. ITC guidelines for translating and adapting tests (second edition). Int J Test. 2018;18(2):101\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoBiondo Wood G, Haber J. Reliability and validity Nursing Research Methods and Critical Appraisal for Evidence Based Practice. 9th ed. St. Louis, Missouri: Elsevier; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 2021. Process of translation and adaptation of instruments. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/substance_abuse/research_tools/translation/en/\u003c/span\u003e\u003cspan address=\"https://www.who.int/substance_abuse/research_tools/translation/en/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKline RB. Principles and practice of structural equation modeling. 4th ed. New York, NY, USA: Guilford; 2015.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDurmus B, Zinc M, Yurtkoru ES. Spss Data Analysis in Social Sciences. 7th ed. Istanbul, Turkey: Beta; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEsin N. Data collection methods and tools. In: Erdogan S, Nahcivan N, Esin N, editors. Research in Nursing: Process, Practice and Critical. Ankara: Nobel Tıp Publishing; 2014. pp. 193\u0026ndash;232.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTabachnick BG, Fidell LS. Using multivariate statistics. Pearson Education. 6th ed. 2020.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCosta V, Sarmento RP. Confirmatory factor analysis-A case study.2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFinch HW. Exploratory factor analysis. SAGE; 2019.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDeVellis RF. Scale Development: Theory and Applications. 4th ed. Thousand Oaks, CA: Sage; 2017.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcNeish D. Thanks coefficient alpha, we'll take it from here. Psychol Methods. 2018;23(3):412\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuyukozturk S. Handbook of data analysis for social sciences. 17th ed. Ankara: Pegem Publishing; 2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTavsancil E. Measurement of attitudes and data analysis with SPSS. Ankara: Nobel Publishing; 2014.\u003c/span\u003e\u003c/li\u003e\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":"Family caregivers, Older adults, Pressure injury, Reliability, Validity, Psychometric testing","lastPublishedDoi":"10.21203/rs.3.rs-7798456/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7798456/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePressure injuries are a significant health concern among older adults, and family caregivers play a crucial role in their prevention. This study aimed to adapt the Knowledge, Attitudes, and Practices of Family Caregivers in Preventing Pressure Injury Scale (KAPPI) into Turkish and evaluate its psychometric properties, including validity and reliability.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional validation study was conducted between January and March 2023 with 330 family caregivers of patients aged 65 years and older in the internal medicine and surgical units of a state hospital in Turkey. The adaptation process was performed in two phases. In the first phase, the KAPPI was translated into Turkish and culturally adapted based on expert evaluations to ensure content validity. In the second phase, psychometric analyses were carried out. Internal consistency was assessed using Cronbach\u0026rsquo;s alpha, and test\u0026ndash;retest reliability was examined using intraclass correlation coefficients (ICC). Construct validity was evaluated by confirmatory factor analysis (CFA) to test the original three-factor structure (knowledge, attitudes, and practices). Model fit indices demonstrated acceptable values (CFI\u0026thinsp;=\u0026thinsp;0.96, SRMR\u0026thinsp;=\u0026thinsp;0.09, RMSEA\u0026thinsp;=\u0026thinsp;0.07). The KAPPI-T exhibited strong internal consistency (α\u0026thinsp;=\u0026thinsp;0.88) and good test\u0026ndash;retest reliability (ICC\u0026thinsp;=\u0026thinsp;0.84).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe Turkish version of the KAPPI confirmed the original three-factor structure knowledge, attitudes, and practices. The scale demonstrated satisfactory psychometric characteristics and factor loadings consistent with theoretical expectations. Reliability coefficients indicated strong internal consistency across subscales, and the CFA supported the construct validity of the adapted version.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe KAPPI-T is a valid and reliable instrument for assessing family caregivers\u0026rsquo; knowledge, attitudes, and practices regarding pressure injury prevention. It can be used to identify educational needs and support the development of evidence-based caregiver training programs in clinical, community, and research settings.\u003c/p\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"The Turkish Version of the Kappi Scale: Validity and Reliability Study on Family Caregivers’ Knowledge Attitudes and Practices in Pressure Injury Prevention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-04 01:28:45","doi":"10.21203/rs.3.rs-7798456/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-22T20:02:23+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"323235273383288244195895851046005886714","date":"2025-12-20T14:29:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-18T13:49:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"176162454336295159842604041924665176751","date":"2025-12-11T04:53:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T17:17:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103189578565675910949251908227650135816","date":"2025-12-09T16:35:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52522139691366072102269979816014838382","date":"2025-11-23T21:49:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"187837661777494999118395654548064665660","date":"2025-11-12T09:29:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-29T10:17:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261226352155315895306862302286852811885","date":"2025-10-23T11:18:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-23T09:50:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-10T18:09:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-10T11:04:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T11:02:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2025-10-07T10:11:36+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":"ed4a4945-0daf-448e-a11f-6a935d700bf5","owner":[],"postedDate":"November 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-28T15:38:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-04 01:28:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7798456","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7798456","identity":"rs-7798456","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}