title: Assessing the overuse of antibiotics in children in Saudi Arabia: validation of the Parental Perception on Antibiotics Scale (PAPA scale).
abstract: BACKGROUND
  Antibiotics overuse is a global public health issue influenced by several factors, of which some are parent-related psychosocial factors that can only be measured using valid and reliable psychosocial measurement instruments. The PAPA scale was developed to measure these factors and the content validity of this instrument was assessed.
  
  
  OBJECTIVE
  This study further validated the recently developed instrument in terms of (1) face validity and (2) construct validity including: deciding the number and nature of factors, and item selection.
  
  
  METHODS
  Questionnaires were self-administered to parents of children between the ages of 0 and 12 years old. Parents were conveniently recruited from schools' parental meetings in the Eastern Province, Saudi Arabia. Face validity was assessed with regards to questionnaire clarity and unambiguity. Construct validity and item selection processes were conducted using Exploratory factor analysis.
  
  
  RESULTS
  Parallel analysis and Exploratory factor analysis using principal axis factoring produced six factors in the developed instrument: knowledge and beliefs, behaviours, sources of information, adherence, awareness about antibiotics resistance, and parents' perception regarding doctors' prescribing behaviours. Reliability was assessed (Cronbach's alpha = 0.78) which demonstrates the instrument as being reliable.
  
  
  CONCLUSIONS
  The 'factors' produced in this study coincide with the constructs contextually identified in the development phase of other instruments used to study antibiotic use. However, no other study considering perceptions of antibiotic use had gone beyond content validation of such instruments. This study is the first to constructively validate the factors underlying perceptions regarding antibiotic use in any population and in parents in particular.
authors.affiliation: School of Public Health & Social Work, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059, Australia. Arwa.alumran@gmail.com
authors.forename: Arwa
authors.initials: A
authors.lastname: Alumran
authors.forename: Xiang-Yu
authors.initials: XY
authors.lastname: Hou
authors.forename: Cameron
authors.initials: C
authors.lastname: Hurst
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D002648:Child; D002669:Child Welfare; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000523:psychology*; D063487:Prescription Drug Misuse; D015203:Reproducibility of Results; D012529:Saudi Arabia; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents