Assessment of Pregnant Women’s Knowledge, Attitudes, and Habits Regarding Oral Health: Development and Validation of a Measurement Instrument

Oral health during pregnancy is a critical factor in preventing caries in both mothers and children. Croatia currently lacks validated psychometric instruments for reliably assessing knowledge, attitudes, and oral hygiene practices in the general population. This study aimed to develop and provide initial psychometric evidence for a comprehensive instrument for this purpose in Croatia, with potential relevance for future cross-cultural adaptation. Following Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines, an initial item pool was generated through literature review and expert consultation. The study was conducted from May 2024 to February 2025 in primary healthcare settings across Primorje-Gorski Kotar County (PGC). The validation study included 319 pregnant women. Exploratory factor analysis (EFA) revealed a six-factor structure with acceptable to strong factor loadings (ranging from 0.423 to 0.984). The instrument showed acceptable to good internal consistency (Cronbach's α = 0.61-0.87) and excellent test-retest reliability (Pearson r = 0.993). Results indicated that knowledge about oral health was independent of attitudes and practices during pregnancy. Regression analyses were exploratory and did not provide evidence of predictive validity at this stage, suggesting that additional contextual and psychosocial factors should be considered in future modelling. The present study provides initial psychometric evidence supporting the proposed structure and reliability of the instrument; however, further confirmatory and longitudinal validation studies are required before broader implementation and generalization can be fully justified.