Development and validation of a Malay questionnaire on nurses’ knowledge, attitudes, and practices in fall prevention in a teaching hospital in Kelantan: a cross-sectional study

Patient falls remain a major and preventable patient safety concern in hospitals. This study aimed to develop and validate the Malay version of the Knowledge, Attitude, and Preventive Measure of Fall (KAP-PMF) questionnaire, a comprehensive instrument for assessing nurses’ fall-prevention knowledge, attitudes, and preventive measures. An instrument development and validation study was conducted among registered nurses in a teaching hospital in Kelantan, Malaysia. Questionnaire items were developed through literature review, existing fall-prevention instruments, and clinical guidelines. Content validity was evaluated by 10 experts and face validity by 30 nurses. Construct validity was assessed using Exploratory Factor Analysis (EFA; n = 200) and Confirmatory Factor Analysis (CFA; n = 200 independent sample). Reliability and convergent validity were evaluated using Cronbach’s alpha, Composite Reliability (CR), and Average Variance Extracted (AVE). The initial questionnaire comprised 33 items across three domains. Following psychometric refinement, the final validated instrument consisted of 20 items: Knowledge (4 items), Attitude (6 items), and Preventive Measures (10 items). EFA supported the three-domain structure, explaining 48.7%, 61.3%, and 68.5% of the variance, respectively. The final CFA model demonstrated satisfactory fit (χ²/df = 1.46, CFI = 0.96, TLI = 0.95, RMSEA = 0.07, SRMR = 0.03). Cronbach’s alpha ranged from 0.78 to 0.86, with CR ranging from 0.79 to 0.95 and AVE from 0.50 to 0.67. The Malay KAP-PMF questionnaire demonstrated satisfactory validity and reliability and provides preliminary evidence supporting its use for assessing nurses’ knowledge, attitudes, and preventive measures related to fall prevention in Malaysian healthcare settings.