Content validity of the integrative medicine attitude questionnaire: Perspectives of a Hong Kong Chinese expert panel

Background: Although the Integrative Medicine Attitude Questionnaire (IMAQ) is a validated instrument developed in the United States for measuring allopathic physicians' attitudes toward complementary and alternative medicine, little is known about attitudes among western-trained doctors in other societies, particularly in the Far East. In Hong Kong, cultural and historical forces have created a unique environment for integration. Thus, consideration of such forces suggests that direct use of the original IMAQ for assessing attitudes of allopathic physicians' views on Traditional Chinese Medicine (TCM) in Hong Kong would be inappropriate. This hypothesis was tested using content validity judgment and local experts' opinions, to assess the three domains of IMAQ: "holism," "introspection and doctor-patient relationship," and "effectiveness of integrative treatment." Method: Standard content validity establishment methodologies were followed. An 8-member panel (4 with TCM and 4 with allopathic medicine backgrounds) was convened to assess the content validity of a modified Hong Kong TCM specific IMAQ. Experts were provided with explicit instructions on how to evaluate the content validity of individual items, and the instrument as a whole, both quantitatively and qualitatively. Result: Of 28 items, 12 items of the modified IMAQ were content validity adequate (Content Validity Index (CVI) > 0.70 and kappa > 0.4). Seven items were considered content invalid and removed. The overall CVI and kappa of the instrument were 0.71 and 0.09, respectively, indicating the need to modify 9 marginally valid items that remained in the questionnaire. Qualitative expert comments were used for the revision. Conclusion: The process of validation showed that it would be inappropriate for the U.S.-derived IMAQ to be used without modification in Hong Kong. Most of the content valid items were in the "effectiveness of integrative treatment" domain, which reflected the influence of the evidence-based TCM movement on the experts' judgment.