Development and validation of the OH-KAP survey for use with pastoral and other rural communities in Africa

BACKGROUND: Evaluating One Health at community-level requires robust, valid measures of what communities know, believe, and do about health risks shared by people, animals, and the environment. This study aimed to develop and validate a One Health Knowledge, Attitudes and Practices (OH-KAP) instrument tailored to (agro-)pastoralist and mixed-farming systems in Africa, covering key One Health topics including zoonoses, antimicrobial resistance, and food safety. METHODS: An initial pool of 156 items was derived from the literature and refined through expert content validation to 126 items. Subsequently, the questionnaire was translated into Somali and field-tested with 300 adults in Middle Shabelle, Somalia. Psychometric analysis of knowledge and attitudes items was undertaken using classical test theory, exploratory factor analysis, and bifactor item response theory (2-parameter logistic models for binary knowledge items; graded response models for Likert-scale attitudes items). Practice items were analysed using exploratory graph analysis and community detection. RESULTS: The final instrument included 27 knowledge, 19 attitude and 29 practice items. The knowledge sub-scale loaded onto a general One Health factor with 4 domain-specific subfactors: zoonotic transmission and environmental risks; animal bites and safe food handling; AMR; and direct contact and food contamination risks (reliability: α = 0.94; model fit: CFI = 0.96, RMSEA 0.08). The attitudes sub-domain loaded onto a general One Health factor with 5 domain-specific subfactors: hand hygiene; animal husbandry; zoonotic outbreaks; AMR; and antimicrobial use (AMU) (α = 0.93; CFI = 0.99, RMSEA 0.05). Practices clustered into four stable domains: animal management and AMU; direct contact and exposure control; responsible husbandry, food safety and stewardship; and hand hygiene and disease reporting (bootstrap stability > 65%). CONCLUSIONS: The developed OH-KAP is a concise, field-ready tool for quantifying integrated One Health knowledge, attitudes and practices. It supports baseline assessments and monitoring associated with awareness-creation and behaviour-change programming. Future work should extend coverage to additional One Health priorities and assess invariance across settings and languages.