Development, Validation, and Reliability Analysis of the Household-Related Air Pollution on the Childhood Bronchial Asthma Onset Checklist (HAPBAC-Checklist)

Introduction Most studies on indoor air pollution for childhood bronchial asthma (BA) were focused on institutions such as schools. However, many asthma triggers are household sources such as consumer products, smoking, and pets. In Malaysia, there is no specific checklist to evaluate the risk of childhood BA onset from household factors. Thus, the study aims to develop and validate an observation checklist for assessing household-related air pollution on childhood BA onset. Methodology The study was conducted in Kota Bharu Kelantan from March to November 2023. The development of the checklist was conducted in five stages: 1) the construction of domains and items from the existing literature, 2) interviews with the parents, 3) content validation by ten experts (item-level content validity index (I-CVI) and scale-level content validity index (S-CVI), 4) face validation by 12 experts (item-level face validity index (I-FVI) and scale-level face validity index (S-FVI)), and (5) reliability analysis (kappa agreement analysis) involving 20 houses assessed by two assessors. Results The initial draft of the checklist contained five domains with 57 items: sociodemographic (19 items), family history (three items), child's medical history (six items), household attributes (19 items), and outdoor attributes (10 items). The I-CVI scores ranged from 0.90 to 1.00, indicating good relevancy. The S-CVI value was 0.97, showing a satisfactory level. The I-FVI was at least 0.96, and the S-FVI of 0.98 indicating the participants easily understood the checklist. The kappa analysis for five domains combined was 0.92 (95%CI: 0.89-0.95). The final validated checklist consists of five domains with 59 items. Discussion and conclusion The Household-Related Air Pollution on the Childhood Bronchial Asthma Onset Checklist (HAPBAC-Checklist) was designed to address household air pollution originating from indoor sources. However, recognizing the impact of outdoor factors through various pathways, along with considering family history of atopy and medical conditions, is important. The checklist, developed in Malay, aims to enhance utilization and adoption, particularly among local healthcare professionals and authorities. The checklist is a valid and reliable tool for assessing household-related air pollution on childhood BA onset. This novel checklist significantly benefits screening indoor air quality, crucial for preventing childhood BA.