Knowledge, Attitude and Practice regarding the effect of yoga on periodontal health questionnaire

Authors

Purpose

The primary objective of this instrument is to address a distinct measurement gap in the fields of public health dentistry and behavioral medicine: the lack of standardized tools to evaluate patient perspectives on mind-body interventions for oral health. While numerous scales exist to measure standard oral hygiene behaviors like brushing and flossing, there has been no validated method to assess how patients view the impact of stress-reducing practices, such as Yoga, on their periodontal status.

This matters significantly for modern clinical practice, where periodontal disease is increasingly recognized as a multifactorial condition exacerbated by systemic inflammation and psychological stress. By utilizing this scale, researchers can quantify baseline awareness and openness to complementary therapies among diverse populations. Clinicians can use the insights generated to design targeted psychoeducational programs that promote holistic lifestyle modifications, thereby supporting conventional periodontal therapies with evidence-based behavioral Stress management.

Construct

The questionnaire is grounded in the Knowledge, Attitude, and Practice (KAP) theoretical framework, a staple in health psychology and public health research used to understand health-seeking behaviors. In this specific application, the construct is tripartite. 'Knowledge' represents the cognitive domain, measuring the respondent's factual understanding of Yoga, its physiological effects on systemic diseases, and its specific mechanisms related to oral health (e.g., stress reduction lowering salivary cortisol and inflammation).

'Attitude' captures the affective and evaluative domain, assessing the respondent's beliefs, openness, and general disposition toward integrating Yoga into their healthcare regimen. Finally, 'Practice' evaluates the behavioral domain, documenting the actual implementation and frequency of yogic techniques in the individual's daily life. Together, these three dimensions interact to predict health behavior change; theoretical models suggest that adequate knowledge and a positive attitude are necessary, though not always sufficient, precursors to the sustained practice of health-promoting behaviors.

Validity

The development team established robust content validity during the initial stages of scale construction. By employing a deductive approach and consulting a panel of experts in both Yoga and periodontology, they ensured the items accurately reflected the target constructs. The Scale-level Content Validity Index based on the average method (S-CVI/Ave) reached a strong 0.88, indicating high expert consensus on item relevance.

Furthermore, the researchers utilized a one-parameter logistic (1-PL) Item Response Theory model, specifically the Rasch model, to evaluate the structural properties of the knowledge domain. The item difficulty parameters fell within an acceptable range of 1.01 to 2.16. In psychometric terms, this means the items are appropriately calibrated to differentiate between individuals with varying levels of knowledge regarding Yoga and oral health, without being excessively easy or impossibly difficult for the target demographic.

Reliability

Reliability was evaluated through both temporal stability and internal consistency metrics. Test-retest reliability, assessed over a one-month interval, demonstrated satisfactory stability, with Intraclass Correlation Coefficients (ICC) exceeding 0.60 for the attitude and practice items. Items that failed to meet acceptable agreement thresholds (showing poor or slight agreement via Kappa statistics) were systematically eliminated to strengthen the final tool.

Internal consistency varied across the domains, which is a common psychometric phenomenon in KAP surveys. The attitude subscale demonstrated excellent reliability with a Cronbach's alpha of 0.923. Conversely, the knowledge and practice domains yielded lower alpha coefficients of 0.632 and 0.591, respectively, resulting in a total scale alpha of 0.632. As a graduate student in psychometrics, it is important to recognize that lower alphas in knowledge and practice domains often occur because these items assess a broad inventory of distinct facts or behaviors, rather than a single, highly correlated psychological trait. Guttman Split-Half coefficients provided additional support, showing satisfactory reliability for knowledge (0.600) and attitude (0.781).

Factor Analysis

Rather than relying on traditional Exploratory or Confirmatory Factor Analysis (EFA/CFA) to determine dimensionality, the authors applied Item Response Theory (IRT) to evaluate the psychometric structure of the knowledge domain. Specifically, they utilized a 1-PL Rasch model using JMETRIK software, treating the responses as dichotomous (correct/incorrect) outputs.

The Rasch model is particularly advantageous here because it places both person ability and item difficulty on the same latent continuum. The analysis confirmed that the knowledge items functioned well together to measure the underlying construct, with difficulty parameters ranging from 1.01 to 2.16. This approach ensures that the items contribute meaningfully to the total knowledge score and provides a more nuanced understanding of item performance than classical test theory alone would allow.

Subscales

Instrument

Scoring & Interpretation Guidelines

Knowledge, Attitude and Practice regarding the effect of yoga on periodontal health questionnaire Items

Sample

The psychometric evaluation utilized a sample of 199 Indian Adults (from an initial pool of 300 approached via convenience and snowball sampling). The majority were aged 31-40 years (39.7%), with a slight female majority (50.8%). Most participants were highly educated (56.3% post-graduates) and generally healthy, with 80.9% reporting no systemic illnesses.

Permissions & Test Year

The questionnaire is provided as a supplementary file in the extended data of the original open-access publication.

Test Year: 2023