Design, development, and psychometric validation of a tool for measuring the economic burden of healthcare-associated infections

Background & Aims: Healthcare-associated infections (HCAIs) contribute to elevated healthcare expenditures and economic challenges for patients, healthcare systems, and communities. Despite their importance, no psychometrically validated instrument exists in Iran to comprehensively measure this burden. This study aimed to develop and evaluate the psychometric properties of a culturally adapted questionnaire assessing the economic impact of HCAIs. Materials and Methods: A mixed-methods study was conducted in ۲۰۲۴-۲۰۲۵ in Tehran City, Iran, comprising qualitative item generation from literature review and expert interviews, followed by quantitative validation. Content validity was assessed using content validity ratio (CVR) and content validity index (CVI); face validity through expert and participant feedback; construct validity through exploratory and confirmatory factor analyses (EFA, CFA); and reliability through internal consistency (Cronbach's alpha) and test-retest stability. Statistical analyses were performed using Stata (version ۱۷) and Amos (version ۲۴). Results: The initial item pool comprised ۱۰۱ items across three domains: direct medical, direct non-medical, and indirect costs. After validation, ۷۱ items remained with CVR and CVI values above acceptable thresholds. CFA supported a three-factor model with adequate fit indices (comparative fit index [CFI] = ۰.۷۰۱, goodness of fit index [GFI] = ۰.۷۳۰, adjusted goodness of fit index [AGFI] = ۰.۷۱۳, root mean square error of approximation [RMSEA] = ۰.۰۴). Cronbach's alpha was above ۰.۸۰, and test-retest reliability was indicated by an intraclass correlation coefficient (ICC) of ۰.۸۳, indicating good reliability . Conclusion: The developed questionnaire is a valid and reliable tool for assessing the economic burden of HCAIs in Iranian healthcare. This can aid policymakers, researchers, and healthcare providers in designing effective infection control strategies and allocating resources efficiently.

کلیدواژه ها:

Cost of illness ، Economic burden ، Healthcare-associated infections (HCAIs) ، Iran ، Psychometrics ، Questionnaires ، Validation study