Development and validation of a tool to assess mothers’ knowledge, perception, and practice of child growth monitoring

Background: Child growth monitoring (CGM) is essential for the early detection and prevention of malnutrition and growth abnormalities. Despite its importance, there is a lack of validated instruments to assess mothers’ knowledge, perceptions, and practices related to CGM. This study aimed to develop and validate a comprehensive questionnaire to assess these domains among mothers of children under five years of age. Methods: The study was conducted in two stages. First, a theory-driven questionnaire was developed based on an extensive literature review, global and national guidelines, and expert consultation. Second, the questionnaire’s psychometric properties were evaluated using data from a cross-sectional survey of 436 mothers. An expert panel assessed content validity, internal consistency was examined using Cronbach’s alpha, and construct validity was evaluated using confirmatory factor analysis (CFA). Results: The final questionnaire comprised 67 items across three domains: knowledge (27 items), perception (14 items), and practice (11 items). The instrument demonstrated good overall internal consistency (Cronbach’s alpha = 0.82), with strong reliability across main domains (α = 0.81–0.92). CFA supported the hypothesized three-domain structure, with good model fit indices for the full measurement model (CMIN/DF = 1.62; CFI = 0.93; TLI = 0.93; RMSEA = 0.038). Conclusion: This study presents a valid and reliable questionnaire for assessing mothers’ knowledge, perceptions, and practices regarding CGM. The tool can support research, inform maternal education strategies, and guide public health interventions to improve early childhood growth outcomes.