Exploring Secondary Students' Knowledge and Misconceptions about Influenza: Development, Validation, and Implementation of a Multiple-Choice Influenza Knowledge Scale

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Understanding infectious diseases such as influenza is an important element of health literacy. We present a fully validated knowledge instrument called the Assessment of Knowledge of Influenza (AKI) and use it to evaluate knowledge of influenza, with a focus on misconceptions, in Midwestern United States high-school students. A two-phase validation process was used. In phase 1, an initial factor structure was calculated based on 205 students of grades 9–12 at a rural school. In phase 2, one- and two-dimensional factor structures were analyzed from the perspectives of classical test theory and the Rasch model using structural equation modeling and principal components analysis (PCA) on Rasch residuals, respectively. Rasch knowledge measures were calculated for 410 students from 6 school districts in the Midwest, and misconceptions were verified through the χ 2test. Eight items measured knowledge of flu transmission, and seven measured knowledge of flu management. While alpha reliability measures for the subscales were acceptable, Rasch person reliability measures and PCA on residuals advocated for a single-factor scale. Four misconceptions were found, which have not been previously documented in high-school students. The AKI is the first validated influenza knowledge assessment, and can be used by schools and health agencies to provide a quantitative measure of impact of interventions aimed at increasing understanding of influenza. This study also adds significantly to the literature on misconceptions about influenza in high-school students, a necessary step toward strategic development of educational interventions for these students.