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International Journal on Health and Medical Sciences

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Validity and reliability questionnaire test of knowledge,

Attitudes, and behavior on dengue fever prevention
Fitria Dewi Puspita Anggraini1, Aprianti2, Nor Amalia Muthoharoh3, Indah Permatasari4,
Jihan Listu Azalia5
1,2,3,4,5Faculty of Public Health, Universitas Dian Nuswantoro Semarang, Central Java, Indonesia

Article Info ABSTRACT

Article history: It is necessary to have standardized instruments that validity and
reliability to ensure the data to be collected. This research to test the
Received Mar 17, 2023
validity and reliability of the knowledge, attitude and behavior
Revised Mar 20, 2023
questionnaire on dengue fever prevention. This study used a
Accepted Apr 14, 2023
quantitative method with a cross sectional design. The population were
patients with diagnoses of DD, DHF, and DSS based on Rowosari Health
Keywords: Center medical record data for January 2022-January 2023 as many as
248 people. The samples taken were 30 people from Tembalang,
Dengue Fever; Meteseh, Bulusan and Kramas Villages by simple random sampling
Questionnaire; methode. Data collection was carried out using a questionnaire. Validity
Reliability; test is done by Pearson Product Moment test. The questionnaire valid if
Validity. the r count value is > from r table with a correlation value > 0,361. The
reliability test was declared reliable if value >0,600 with Cronbach's
Alpha analysis. Result for knowledge, attitude and behavior
questionnaire item are 16 from 20 statements, 14 from 15, and 9 from 10
statements item are valid with R Count Pearson Correlation Value >
0,361. Test the reliability of knowledge, attitude and behavior variables
with Cronbach's Alpha value of 0,774 ; 0,815 and 0,818 > 0,600 so that all
statement items are reliable. Questionnaire can be used as a reference to
measure knowledge, attitude and behavior on dengue fever prevention.
This is an open access article under the CC BY-NC license.

Corresponding Author:
Fitria Dewi Puspita Anggraini,
Departmen/Study Program/Departement,
Faculty of Public Health,
Nakula 1 Street No. 5-11, Pendrikan Kidul, Semarang Regency, Central Java, 50131, Indonesia.
Email: [email protected]

1. INTRODUCTION
Dengue infection is a group of diseases caused by dengue virus in humans. The disease is divided
into Dengue Fever (DD), Dengue Hemorrhagic Fever (DHF), and Dengue Shock Syndrome (DSS)
(Wang et al., 2020) . Dengue virus belongs to the group of arthropod-borne viruses, the genus
flavivirus, family flaviviridae. This virus has 4 serotypes (DENV-1, DENV-2, DENV-3 and DENV-4)
(Rosid et al., 2019) which have been identified as circulating in several parts of the world, especially
in tropical and subtropical regions, including Indonesia. Currently around 2.5 billion or
approximately 40% of the world's population live in areas that are at risk of transmitting dengue
infection. The World Health Organization or WHO estimates that there are around 50 to 100 million
cases of dengue infection each year (Ministry of Health, 2020).
Various efforts have been made to reduce dengue cases, including cutting contact with
humans through vector control programs. Efforts to control the DHF vector were carried out

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including through physical control (using mosquito rackets and gauze on windows), biological
control (raising larvae-eating fish), chemical control (using mosquito repellents), and self-protection
(using mosquito repellent lotions). There are other methods that are not currently used in large scale
control programs, such as the introduction of the bacteria Wolbachia and/or genetically modified
mosquitoes with the intent of replacing and/or reducing the naturally occurring vector with vectors
that have a limited capacity to reproduce and/or to transmit the dengue virus (Horstick et al., 2017).
Vector control remains the primary method to prevent dengue infections. Environmental
interventions represent sustainable and safe methods as there are limited risks of environmental
contamination and toxicity (Buhler et al., 2019). In addition to the efforts made by the community,
vector control activities are also carried out by local governments, including fogging of adult
mosquitoes (fogging), larvicidation, and eradication of mosquito nests (PSN) (Prasetyowati et al.,
2018). Integrated control measures have also been developed in the context of Integrated Vector
Management (IVM) with possible synergies between chemical, biological, and environmental
approaches (Horstick et al., 2017). PSN activities through the 3M plus movement have been
proclaimed by the government, namely closing water reservoirs, burying used items that can become
mosquito breeding grounds, and draining water reservoirs every week on a regular basis. The goal of
the PSN movement is to monitor and eliminate potential breeding sites for dengue vector
mosquitoes (Ambarita et al., 2020). Vector control efforts require the active and active participation
of the community so that they must be supported by good knowledge, attitudes and actions
regarding vector control (Mangindaan et al., 2018). Knowledge about DHF includes knowledge about
signs and symptoms, transmission, vectors that cause, prevention , as well as management.
Respondents' attitudes or tendencies regarding matters related to DHF, including: prevention of
DHF, awareness of DHF, actions to take if suspected of DHF (Simaremare et al., 2020). Attitudes are
strongly influenced by personal experience of dengue infection. When a person or relative has
experience of being infected with the dengue virus, that person will be more positive, alert and
careful about the spread of the dengue virus (Purnama et al., 2013).
Respondents' behavior related to prevention and control of DHF. Some preventive behaviors
in avoiding Aedes mosquitoes are using mosquito lotion containing DEET or picaridin during the
day, wearing long sleeves to avoid bites, using mosquito coils, insecticide spray, windows with cloth,
and using air conditioning when indoors (Putri et al., 2022). Health behavior is a person's response to
stimuli related to illness and disease, the health care system, food and the environment. The health
behavior domain can be measured from knowledge, attitudes, and practices or actions (Espiana et al.,
2022). In measuring knowledge, attitudes and behavior in preventing DHF, it is necessary to have
standardized measurement tools, this is done to ensure the accuracy of the data to be collected.
Measuring instruments that have standards must meet the requirements for validity and reliability
(Dewi & Sudaryanto, 2020). Therefore, the main focus of the research method is the validity and
reliability aspects of preparing the questionnaire that will be used as a data collection tool in the
field. The questionnaire is the instrument/tool most often used in the method of collecting and
evaluating research results (Bhattacharyya et al., 2017).
Validity describes how well the data collected covers the actual area of investigation. Validity
basically means "measuring something to be measured". The indicators in the questionnaire can be
said to be valid if the r count results are greater than r table (r count > r table) (Oktavia et al., 2018).
Validity is an index that shows the measuring instrument actually measures something that is to be
measured. Reliability related to the measurement of a phenomenon or data that provides stability to
the results is also related to the consistency of repetition (Bhattacharyya et al., 2017)
Previous research on testing the validity and reliability of knowledge questionnaires
regarding knowledge, attitudes, and dengue prevention behaviors found results that from testing the
validity of the instrument on 60 question items, there were 46 question items that were declared
valid with a correlation value greater than 0.361. While the reliability test of question items
knowledge, attitudes, and behavioral analysis regarding knowledge, attitudes and behavior shows a
Cronbach Alpha value > 0.60, so that the instrument being tested can be declared reliable or

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consistent (Dewi & Sudaryanto, 2020). Research related to validity and reliability tests concerning
knowledge, attitudes and behavior in preventing dengue hemorrhagic fever has indeed been carried
out before, but the results of previous studies have not included valid question items from the test
results, so researchers are still interested in testing the validity and reliability of knowledge
questionnaires, Dengue prevention attitudes and behavior.

2. RESEARCH METHOD
The method used in this study using quantitative research methods with cross sectional design. The
population used in this study were patients who were diagnosed with Dengue Fever, Dengue
Hemorrhagic Fever, and Dengue Shock Syndrome, based on medical record data at the Rowosari
Health Center for January 2022-January 2023, as many as 248 people. The samples taken in this study
were 30 people from Tembalang, Meteseh, Bulusan and Kramas Villages. Sampling was done by
simple random sampling. Data collection to obtain data about the results of the questionnaire test in
this study was carried out by making a list of statements that would be used to conduct the
questionnaire test. The list of statements or questionnaires was made by the researchers themselves
based on existing theories. The questionnaire that has been made consists of an informed consent
sheet which is on the main sheet as proof that someone is willing to be a respondent, then the
identity of the respondent and the next sheet, namely the knowledge level questionnaire which
consists of 20 questions used to measure the level of individual knowledge. in carrying out DHF
prevention, an attitude questionnaire with 15 statements to measure individual attitudes in carrying
out DHF prevention. Furthermore, the questionnaire regarding behavior consists of 10 statements
that are used to determine the efforts made by individuals in preventing DHF. Testing the validity of
the research instrument can be declared valid if each question item in the questionnaire can be used
to reveal something that will be measured by the questionnaire. The indicators in the questionnaire
can be said to be valid if the calculated r count is > from r table. If one of the questions on the
questionnaire list has a Pearson correlation value <0,361 then the question item cannot be used in
subsequent analysis, or it can be said to be invalid, while question items that have a correlation value
> 0,361 then the question item can be declared valid because it has been meet the criteria. Testing the
validity of the instrument in this study was carried out using Pearson Product Moment analysis
(Prastyo, 2017). Reliability test on a research instrument is a test used to find out whether the
questionnaire used in collecting research data can be said to be reliable or not. In the reliability test
of this study was carried out using Cronbach's Alpha analysis. If a variable shows a Cronbach Alpha
value > 0,600, it can be concluded that this variable can be said to be reliable or consistent in
measuring (F. D. P. Anggraini et al., 2020). Analysis of the validity and reliability of the study was
carried out using the SPSS version 26 computer program.

3. RESULTS AND DISCUSSIONS

After testing the validity using the SPSS 26 program, it can be seen that the statements that have met
the requirements can be reviewed from the results of their validity. The following are the results of
validity tests that have been carried out using the SPSS 26 computer program.
Table 1. Results of the Knowledge Questionnaire Item Validity Test
R Count Pearson
No. R Table Note
Correlation
1 0,437 0,361 Valid
2 0,566 0,361 Valid
3 0,589 0,361 Valid
4 0,346 0,361 Invalid
5 0,433 0,361 Valid
6 0,407 0,361 Valid
7 0,362 0,361 Valid
8 0,391 0,361 Valid
9 0,521 0,361 Valid
10 0,389 0,361 Valid

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11 0,339 0,361 Invalid

12 0,532 0,361 Valid
13 0,425 0,361 Valid
14 0,498 0,361 Valid
15 0,625 0,361 Valid
16 0,448 0,361 Valid
17 0,460 0,361 Valid
18 0,351 0,361 Invalid
19 0,551 0,361 Valid
20 0,204 0,361 Invalid
Source: (SPSS Processed Data, 2023)

Based on table 1 above, of the 20 statement items regarding knowledge, 16 of them are valid.
Invalid question items are indicated in questions number 4, 11, 18, and 20 because the value of r count
< r table. These four question items also have a Pearson correlation value < 0,361.
Table 2. Results of the Attitude Questionnaire Item Validity Test
R Count Pearson
No R Table Note
Correlation
1 0,507 0,361 Valid
2 0,560 0,361 Valid
3 0,746 0,361 Valid
4 0,640 0,361 Valid
5 0,735 0,361 Valid
6 0,535 0,361 Valid
7 0,492 0,361 Valid
8 0,698 0,361 Valid
9 0,625 0,361 Valid
10 0,368 0,361 Valid
11 0,328 0,361 Invalid
12 0,507 0,361 Valid
13 0,630 0,361 Valid
14 0,560 0,361 Valid
15 0,383 0,361 Valid
Source: (SPSS Processed Data, 2023)

Based on table 2 above, of the 15 statement items regarding attitudes, 14 of them are valid.
Invalid question items are shown in question number 11 because the value of r count < r table with a
Pearson correlation value < 0,361.
Table 3. Results of the Behavioral Questionnaire Item Validity Test
R Count Person
No R Table Note
Correlation
1 0,540 0,361 Valid
2 0,659 0,361 Valid
3 0,799 0,361 Valid
4 0,645 0,361 Valid
5 0,540 0,361 Valid
6 0,683 0,361 Valid
7 0,308 0,361 Invalid
8 0,539 0,361 Valid
9 0,636 0,361 Valid
10 0,737 0,361 Valid
Source: (SPSS Processed Data, 2023)

Based on table 3 above, of the 10 statement items regarding behavior, 9 of them are valid.
Invalid question items are shown in question number 7 because the value of r count < r table.
Table 4. Recapitulation of Knowledge, Attitude and Behavior Questionnaire Items for Prevention of Dengue Fever
Knowledge
No Instruction: Note
Each statement is filled with “yes” or “no”
1 The cause of DHF (Dengue Hemorrhagic Fever) is a virus Valid
2 Mosquito bites are a source of dengue transmission Valid

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3 Dengue cannot be prevented Valid

4 The mosquito that transmits Dengue infection only bites at night Invalid
5 The characteristics of the DHF mosquito are its wings and body with white Valid
stripes
6 The 3M Plus program is an effort to prevent dengue Valid
7 Bathtubs, drums, buckets, used cans, flower vases, trash bins can become Valid
breeding grounds for dengue mosquitoes
8 The first aid measure for DHF patients at home is giving fluids to prevent Valid
dehydration
9 Early signs or symptoms of DHF sufferers are high fever and red spots Valid
10 The type of mosquito that transmits dengue fever is the Anopheles Valid
mosquito
11 Fogging is an effort to eradicate mosquito larvae Invalid
12 Abatization (giving abate powder) is an effort to eradicate mosquito larvae Valid
13 Raising larvae-eating fish in the bath is included in PSN activities Valid
14 Sowing abate powder in a water reservoir is permissible without rules Valid
15 Dengue fever cannot be transmitted to other people Valid
16 Fogging or fumigation is more effective in tackling DHF than PSN Valid
17 Dengue mosquitoes breed in dirty water Valid
18 A good activity to drain the bath is 1-2 times a week Invalid
19 3M plus activities at home can only be done by certain people Valid
20 Dengue only attacks children Invalid
Attitude

No Instruction: Result
Each statement is filled with SS (Strongly Agree), or S (Agree) or TS
(Disagree) or STS (Strongly Disagree)
1 Believe that dengue fever can be prevented and controlled Valid
2 I will do the 3M Plus movement to prevent Dengue hemorrhagic fever Valid
3 Just drain the tub if it's dirty Valid
4 The water in the flower vase does not need to be replaced Valid
5 If there are family members who experience high fever, nosebleeds, and Valid
red spots on the skin, I will take my family members directly to health
services
6 Clothes are better hung indoors or Valid
room
7 Places that can collect water need to be covered Valid
8 Stagnant water in the home environment should be left alone Valid
9 Healthy people cannot be infected with dengue fever Valid
10 I will sprinkle abate powder on the water tank Valid
11 Raising larval predatory fish in water reservoirs which can eat Aedes Invalid
aegypti mosquito larvae
12 Planting mosquito repellent plants to prevent Dengue Hemorrhagic Fever Valid
13 Do not use mosquito coils or mosquito repellent to prevent Dengue Valid
Hemorrhagic Fever
14 Drains that are clogged or not smooth must be cleaned immediately Valid
15 Sleeping using mosquito nets can reduce Valid
bites from mosquitoes
Behaviour
Instruction:
Each behavior-related statement is filled with always or often or
sometimes or rarely or never

NO. Always : Always do (7 days a week) Note

Often : Do it often (5-6 days a week)
Sometimes : Once in a while (3-4 days a week)
Rarely : Not often (1-2 days a week)
Never : Absolutely never do
*Behavior of the last week
1 Wear long-sleeved clothing when on the move Valid
2 Close the water reservoir after use Valid
3 Draining and scrubbing the surface of the tub/water reservoir Valid
4 Sprinkle abate powder in the water reservoir Valid

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5 No hanging clothes Valid

6 Get rid of used items which can potentially hold water Valid
7 Use mosquito nets when going to sleep Invalid
8 Use lotion or spray or burn mosquito repellent while sleeping / on the Valid
move
9 Replacing water in flower vases, drinking containers Valid
birds or other similar places on a regular basis to prevent the development
of mosquito breeding
10 Clean up trash that causes drains or gutters to not run smoothly Valid
Source: (SPSS Processed Data, 2023)

The validity test was carried out to assess the level of accuracy of a question and statement in
the questionnaire, so that items that are not considered valid can be removed from the questionnaire
(Budiastuti & Bandur, 2018)
Table 5. Questionnaire Reliability Test Results
Cronbach’s N of
Variable
Alpha items
Knowledge 0,774 20
Attitude 0,815 15
Behaviour 0,818 10
Source: (SPSS Processed Data, 2023)

Test the reliability of knowledge, attitude and behavior variables with Cronbach's Alpha
value of 0,774 ; 0,815 and 0,818 > 0,600, it can be concluded that the questions for the questionnaire
measuring knowledge, attitudes and preventive behavior are reliable or consistent. Cronbach is the
most commonly used test to determine the reliability value of the questionnaire. Cronbach's result is
a number between 0 and 1. The acceptable reliability score is > 0,600 (Heale & Twycross, 2015).
This research is in line with the results of research conducted by (Dewi & Sudaryanto, 2020)
regarding the validity test in preparing a questionnaire of knowledge, attitudes and behavior for
dengue fever prevention. As a result, the validity test conducted on the knowledge questionnaire
obtained 5 invalid question items because the correlation value was less than 0,361 so that only 15 of
the 20 question items tested were declared valid. Test the validity of the attitude questionnaire from
the 20 questions tested, there are 6 question items that are invalid because the correlation value is
less than 0,361 and 14 question items are declared valid. Test the validity of the behavior
questionnaire of the 20 questions tested, there are 3 invalid question items and 17 question items that
are declared valid with a correlation value greater than 0,361. The limitation of this study is that it
does not show valid statement items from the questionnaire. As for the questionnaire test of
knowledge, attitudes and behavior in preventing dengue fever, the results obtained were Cronbach's
Alpha value of 0,765 ; 0,786 ; and 0,921 > 0,600 which indicates that the three questionnaires that
have been tested are declared reliable or consistent and can be used as a measuring tool in
conducting research related to knowledge, attitudes, and behavior in preventing dengue fever (Dewi
& Sudaryanto, 2020).
The results of another study were carried out to test the validity of preparing a knowledge
questionnaire related to Covid-19. Questions on the questionnaire are considered valid if the
calculated R count is greater than the R table. The R table value for 631 samples is 0,074. If the
calculated R count is greater than the R table value then the question is considered valid, and if the R
calculated value obtained is lower than the R table value then the question is considered invalid and
cannot be used. From the results of the validity test conducted, it was found that 14 questions were
invalid. After the instrument was repaired, the validity test was again carried out on 40 different
respondents with a total of 36 questions asked. The results of the validity test obtained 6 invalid
questions so that 6 invalid questions had to be dropped out. As for the results of the Cronbach Alpha
Coefficient statistical test conducted, it was found that the Cronbach Alpha Coefficient > 0,600, it
can be concluded that the knowledge questionnaire about Covid19 (SARS-CoV-2) is reliable to be
used as a research instrument to measure knowledge about Covid-19 (SARS-CoV) -2) (Darsini et al.,
2020).

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Another study conducted at SMPN 02 Limboto Gorontalo regarding the validity and
reliability of the knowledge, attitude, and nutritional behavior questionnaire in adolescents showed
that out of 21 items of nutritional knowledge questions, 2 items were invalid, from 27 question items,
2 items were not valid, 15 items of balanced nutrition attitude statement there are 2 invalid items, 13
items of valid balanced nutrition behavior statement. Internal reliability test for knowledge of
balanced nutrition, attitudes and behavior of balanced nutrition (cronbach α = 0,687 ; 0,653; 0.680
and 0,725 respectively (Nuryani, 2020).
Validity and reliability tests must be presented in a concise and precise research method.
Validity indicates the truth of a finding, while reliability refers to the consistency of findings (Putri et
al., 2022). Validity and reliability increase the value of transparency and reduce opportunities for bias
from research results in qualitative research (D. Anggraini et al., 2020). Without testing the validity
and reliability, researchers will find it difficult to describe the existence of measurement errors based
on the theory of the variable being measured (Santoso et al., 2017). There is a relationship between
validity and reliability (Azraii et al., 2021). Any instrument can be reliable even though the validity
test results are not valid. However, the research instrument will not be valid if the reliability test
results are not reliable. In other words, if an instrument is declared valid, then the results must be
reliable (Aithal & Aithal, 2020). In general, conducting an instrument validity test is more difficult to
do than conducting a reliability test because validity testing is a data measurement activity related to
knowledge while reliability testing only related to score consistency (Tsang et al., 2017). The
instrument can be validated when the previous theory or literature is a hypothesis that can be
concluded (Taherdoost, 2018).

4. CONCLUSION
The validity test showed that there were 16 knowledge question items, 14 attitude question items, and
9 behavior question items that were valid with a p value > 0,361. The reliability test showed that all
questionnaire items were reliable with Cronbach Alpha 0,774; 0,815 and 0,818 > 0.600. The limitation
of this study is that the number of samples taken only came from 1 working area of the public health
centre.

ACKNOWLEDGEMENTS
The research team would like to thank the Institute for Research and Community Service (LPPM),
Universitas Dian Nuswantoro, Semarang, which has fully funded this research. Thanks are also
conveyed to the researchers Undergraduate Public Health Study Program, Faculty of Health Science,
Universitas Dian Nuswantoro, Semarang, which has given permission to carry out this research.

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International Journal on Health and Medical Sciences, Vol.1, No. 2 April 2023, pp: 46-54