Development and validation of a questionnaire to assess knowledge, attitudes, and practices regarding the addictive and detrimental effects of novel psychoactive substances among university students

Background: The misuse of novel psychoactive substances (NPSs) is highly prevalent among university students, leading to significant public health and social safety concerns. To improve our drug education efforts related to NPSs, we developed a knowledge, attitudes and practices (KAP)-based questionnaire for university students.

Methods: We developed a KAP-based questionnaire after performing a comprehensive literature review and consulting experts. The questionnaire was then administered to randomly selected college students in Fujian Province. The items were evaluated using the critical ratio, correlation analysis, and Cronbach's α coefficient. Furthermore, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess the construct validity of the questionnaire. Subsequently, the convergent validity, discriminant validity, and reliability of the questionnaire were evaluated.

Results: A total of 587 college students were enrolled, including 280 (47.7%) males and 550 (93.7%) students who had received anti-drug education. Item analysis revealed that 3 items did not meet the t value (t < 4) or correlation coefficient thresholds (r < 3) or that Cronbach's α coefficient increased after removing these items. After conducting EFA, 7 items with multiple loading factors above 0.4 or loading factors below 0.4 were removed, and 5 subdimensions were observed. CFA indicated that the questionnaire model exhibited a strong fit and acceptable convergent validity. However, there were some limitations in discriminant validity. The Cronbach's α coefficients for the overall questionnaire and each dimension exceeded 0.9, indicating excellent internal consistency. Additionally, the questionnaire exhibited excellent split-half reliability (Cronbach's α coefficients > 0.8, Spearman-Brown value = 0.982).

Conclusion: The questionnaire developed herein exhibited high levels of reliability and validity, making it a suitable KAP-based tool for evaluating NPS-related addiction and harm among university students. These findings can guide the development of drug education and behavioral interventions.