{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:59:45Z","timestamp":1780898385113,"version":"3.54.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Existing skin health assessments predominantly focus on single topics or diseases, making it difficult to cover the complete \u201cKnowledge\u2013Self-efficacy\u2013Attitudes\u2013Behaviors (KSAB)\u201d continuum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and validate a skin health knowledge, attitudes, and behaviors questionnaire for the general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A cross-sectional online survey was conducted among the general population between October and November 2025. The questionnaire was developed based on a conceptual structure incorporating four dimensions: knowledge, self-efficacy, attitudes, and behaviors. Content validity was assessed by 13 experts, and the Item-level Content Validity Index (I\n                      <jats:sub>CVI<\/jats:sub>\n                      ) and modified Kappa (K\n                      <jats:sup>*<\/jats:sup>\n                      ) were calculated. Construct validity was examined using confirmatory factor analysis (CFA). Item-level evaluation was performed using item response theory (IRT), including the two-parameter logistic (2PL) model for dichotomous items and the graded response model (GRM) for ordered items.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 865 individuals were enrolled (men: women\u202f=\u202f1.24:1). Content validity was good (I\n                      <jats:sub>CVI<\/jats:sub>\n                      \u202f=\u202f0.846\u20131.000, K*\u202f=\u202f0.845\u20131.000). The five-factor model from CFA showed a good fit (CFI\u202f=\u202f0.969, TLI\u202f=\u202f0.960, RMSEA\u202f=\u202f0.070, SRMR\u202f=\u202f0.095). IRT analysis indicated that K1\u2013K5 had acceptable discrimination (\n                      <jats:italic>a<\/jats:italic>\n                      \u202f=\u202f0.59\u20132.40) and difficulty parameters ranging from \u22123.63 to \u22121.33. However, items K6, K7 and S1 were excluded due to insufficient threshold coverage. The proportion of women reporting frequent sunscreen use was higher than that of men. Self-efficacy levels showed a decreasing trend with age. Furthermore, individuals in service\/manual labor occupations exhibited lower proportions on certain items.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study developed and validated a KSAB questionnaire on skin health knowledge, attitudes, and behaviors, showing good validity and item-level performance. The findings support targeted health promotion for men, older adults, and service\/manual workers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1856843","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T05:33:43Z","timestamp":1780896823000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a skin health knowledge, attitudes, and behaviors questionnaire for the general population: a cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Xinquan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","place":["Haikou, Hainan, China"]},{"name":"Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liping","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","place":["Haikou, Hainan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","place":["Haikou, Hainan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhao","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","place":["Haikou, Hainan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minxue","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University","place":["Changsha, China"]},{"name":"Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)","place":["Haikou, Hainan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1007\/s13671-017-0192-7","article-title":"Global burden of skin disease: inequities and innovations","volume":"6","author":"Seth","year":"2017","journal-title":"Curr Dermatol Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1093\/inthealth\/ihaf070","article-title":"Global, regional and national burden of skin and subcutaneous diseases: a systematic analysis of the global burden of disease study 2021","volume":"18","author":"Li","year":"2025","journal-title":"Int Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e16688","DOI":"10.1111\/jocd.16688","article-title":"Influences on skin and intrinsic aging: biological, environmental, and therapeutic insights","volume":"24","author":"Hussein","year":"2025","journal-title":"J Cosmet Dermatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1016\/j.jid.2025.07.016","article-title":"Lifestyle determinants for facial aging: a population-based study","volume":"146","author":"Huang","year":"2026","journal-title":"J Invest Dermatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1239","DOI":"10.1111\/jdv.20316","article-title":"The risk of ultraviolet exposure for melanoma in Fitzpatrick skin types I-IV: a 20-year systematic review with meta-analysis for sunburns","volume":"39","author":"Kwa","year":"2025","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"325","DOI":"10.58727\/jshr.109781","article-title":"Skin care habits and skin cancer risk factors of Mexican physical education majors","volume":"17","author":"Barajas-Pineda","year":"2025","journal-title":"J Sport Health Res"},{"key":"ref7","first-page":"34","article-title":"Sun exposure habits and knowledge about skin care in Mexican, Honduran, and Costa Rican physical educators","volume":"13","author":"Jos\u00e9 Moncada-Jim\u00e9nez","year":"2004","journal-title":"Rev Costarric Salud Publica"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1471-2458-12-80","article-title":"Health literacy and public health: a systematic review and integration of definitions and models","volume":"12","author":"Sorensen","year":"2012","journal-title":"BMC Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1016\/j.ad.2020.02.002","article-title":"Validation of a questionnaire designed to study knowledge, attitudes, and habits related to Sun exposure among young adults: the CHACES questionnaire","volume":"111","author":"Blazquez-Sanchez","year":"2020","journal-title":"Actas Dermosifiliogr (Engl Ed)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1037\/\/0033-295x.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"Bandura","year":"1977","journal-title":"Psychol Rev"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1007\/s40615-022-01314-6","article-title":"Skin cancer knowledge, attitudes and sun protection practices in the Hispanic population: a cross-sectional survey","volume":"10","author":"Besch-Stokes","year":"2023","journal-title":"J Racial Ethn Health Disparities"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1002\/ped4.12374","article-title":"Development and validation of the atopic dermatitis and infant skincare knowledge, attitude, and practice (ADISKAP 1.0) scale","volume":"7","author":"Sun","year":"2023","journal-title":"Pediatr Investig"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.sapharm.2023.10.009","article-title":"Development and validation of a knowledge, attitude, and practice (KAP) questionnaire for skin cancer in the general public: KAP-SC-Q","volume":"20","author":"Mohammed","year":"2024","journal-title":"Res Social Adm Pharm"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1002\/nur.20147","article-title":"The content validity index: are you sure you know what's being reported? Critique and recommendations","volume":"29","author":"Polit","year":"2006","journal-title":"Res Nurs Health"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/nur.20199","article-title":"Is the CVI an acceptable indicator of content validity? Appraisal and recommendations","volume":"30","author":"Polit","year":"2007","journal-title":"Res Nurs Health"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1146\/annurev.clinpsy.032408.153553","article-title":"Item response theory and clinical measurement","volume":"5","author":"Reise","year":"2009","journal-title":"Annu Rev Clin Psychol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jad.2023.01.089","article-title":"Confirmatory factor analysis of acute suicidal affective disturbance in a sample of treatment-seeking eating disorder patients","volume":"326","author":"Velkoff","year":"2023","journal-title":"J Affect Disord"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1111\/jdv.20080","article-title":"Sun exposure and protection habits: self-reported attitudes, knowledge and behaviours","volume":"38","author":"Lim","year":"2024","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3093","DOI":"10.3390\/cancers16173093","article-title":"A comprehensive analysis of skin cancer concerns and protective practices in Manitoba, Canada, highlights lack of skin cancer awareness and predominance of high-risk sun exposure behaviors","volume":"16","author":"Lagace","year":"2024","journal-title":"Cancers (Basel)"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.ijwd.2018.11.005","article-title":"Knowledge, attitude, and practices toward sun exposure and use of sun protection among non-medical, female, university students in Saudi Arabia: a cross-sectional study","volume":"5","author":"Almuqati","year":"2019","journal-title":"Int J Womens Dermatol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3035274","DOI":"10.1155\/jskc\/3035274","article-title":"A study of skin cancer knowledge, attitudes, and preventive practices among healthcare professionals and the general population in Pakistan: insights for healthcare interventions and policy development","volume":"2025","author":"Aslam","year":"2025","journal-title":"J Skin Cancer"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"152","DOI":"10.3969\/j.issn.1672-7347.2012.02.007","article-title":"Content validity index in scale development","volume":"37","author":"Shi","year":"2012","journal-title":"Zhong Nan Da Xue Xue Bao Yi Xue Ban"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"E103","DOI":"10.1097\/BRS.0000000000005223","article-title":"The Arabic Oswestry disability index as a unidimensional measure: confirmatory factor analysis","volume":"50","author":"Alnahdi","year":"2025","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s40271-013-0041-0","article-title":"An introduction to item response theory for patient-reported outcome measurement","volume":"7","author":"Nguyen","year":"2014","journal-title":"Patient"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2854","DOI":"10.1002\/lary.32161","article-title":"Improving measurement efficiency of the voice handicap Index-10 with item response theory","volume":"135","author":"DeVore","year":"2025","journal-title":"Laryngoscope"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1177\/13591053241261349","article-title":"Cross-cultural validation of the Jenkins sleep scale in Spanish-speaking countries","volume":"30","author":"Palao-Loayza","year":"2025","journal-title":"J Health Psychol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1080\/10810730.2012.677301","article-title":"Health communication, genetic determinism, and perceived control: the roles of beliefs about susceptibility and severity versus disease essentialism","volume":"17","author":"Parrott","year":"2012","journal-title":"J Health 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Dermatol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1423","DOI":"10.1093\/ced\/llae225","article-title":"Are people more concerned about photoageing than skin cancer when raising awareness about risks of skin exposure?","volume":"50","author":"Dreno","year":"2025","journal-title":"Clin Exp Dermatol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1007\/s13671-021-00343-4","article-title":"Social media in dermatology and an overview of popular social media platforms","volume":"10","author":"Szeto","year":"2021","journal-title":"Curr Dermatol Rep."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"88","DOI":"10.36849\/JDD.5470","article-title":"Men's attitudes and behaviors about skincare and sunscreen use behaviors","volume":"20","author":"Roberts","year":"2021","journal-title":"J Drugs Dermatol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1186\/s12889-021-10600-7","article-title":"The relationship between socioeconomic position and health literacy among urban and rural adults in regional China","volume":"21","author":"Chen","year":"2021","journal-title":"BMC Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e34790","DOI":"10.2196\/34790","article-title":"Online health information seeking behaviors among older adults: systematic scoping review","volume":"24","author":"Zhao","year":"2022","journal-title":"J Med Internet Res"}],"container-title":["Frontiers in Public 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