Table 3.

Characteristics of the instruments used to assess knowledge, skills or attitudes in relation to a given pandemic outbreak in the studies included in this review

Author(s), year, country, pandemic or threat referred to	Scale or concept measured	Underlying theoretical framework	Number of items	Item response format	Language & time to complete the questionnaire	Validity and reliability
Yonge et al., 2007, Yonge et al., 2010; Rosychuk et al., 2008, Canada, avian influenza	General knowledge about avian flu	Not reported	5 items	Five-point Likert scale (1 = very unlikely, 5 = very likely)	English; time not reported	Not reported
	Risk perception		4 items
	Willingness to volunteer		11 items
	Treatment		Not reported
	Allocation of resources		Not reported
Wu et al., 2009, Taiwan, SARS	Knowledge Scale about standard and additional infection control precautions	Items formulated and established based on CDC guidelines; Scales adapted from prior studies (Calabro et al., 1998; Chan et al., 2002)	15 items	11 true/false and 4 multiple-choice questions	Not reported; 20–35 min	Reliability: 0.79
	Application Scale: includes three different real-world clinical scenarios followed by statements based on CDC guidelines		13 statements	Yes/No		Not amenable to psychometric testing
	Confidence Scale		8 statements	Yes/No		Reliability: 0.86
Stirling et al., 2015, Saudi Arabia, MERS	Knowledge about MERS	Based on Ministry of Health	Not reported	Not reported	English and Arabic; time not reported	Not reported
	Lessons learned about MERS		Not reported	Not reported
Chilton et al., 2016, USA, EVD	Survey of Nursing Student Self-reported Knowledge of EVD	Based on CDC guidelines	1 item	Rated poor (0) to excellent (4)	English; time not reported	An exploratory factor analysis of the seven-item willingness-to-treat scale revealed a single-factor solution. Reliability: Cronbach's alpha of 0.92
	Willingness to Treat and Perceptions of Duty to Treat		7 items	Three items positively framed: How likely are you to take an action, rated from 0 (very unlikely) to 4 (very likely). Four items negatively framed: How likely are you to refuse to take a certain action, rated from 0 (very unlikely) to 4 (very likely).
Choi & Kim, 2016 Kim & Choi, 2016, South Korea, MERS	Knowledge about MERS-CoV: cause of MERS, test, treatment, prevention	MERS-related knowledge based on response guidelines of the CDC and the Korea Centres for Disease Control and Prevention and on the questions used to survey health care workers' knowledge in a previous study (Khan et al., 2014)	16 items	Likert scale from 1 (not relevant) to 4 (very relevant)	Not reported	Knowledge: reliability (Kuder-Richardson 20): 0.79 Attitude: reliability (Cronbach's alpha) 0.79 Preventive behaviour: reliability (Cronbach's alpha) 0.85
	Attitude towards MERS-CoV		9 items	Likert scale from 1 (Not at all) to 5 (Absolutely yes)
	Perceived risk of acquiring MERS-CoV		1 item	Descriptive 5-point scale from 1 (Not at all) to 5 (Absolutely yes)
	Preventive behaviour against MERS-CoV: use of public places, avoidance of people coughing, cleaning and disinfection, hand washing		10 items	Each item could be answered as “Performed” (1) or “Not performed”/“Not applicable” (0)
Ferranti et al., 2016, USA, EVD	Knowledge retention	According to CDC guidelines	13 items	Correct/Incorrect or True/False	English; 15 min	Not reported
	Concerns about the risk of EVD: risk as a health care provider; risk as a resident		2 items	Four ordinal categories (0 = not at all to 3 = extremely)		Cronbach's alpha coefficient of 0.865
	Confidence in addressing EVD: confidence in discussing EVD with family, in answering questions about EVD transmission, in conveying a calm message about the general public's risk for EVD		3 items	Not reported		Reliability: Cronbach's alpha of 0.905.
Elrggal et al., 2018, Saudi Arabia, MERS	Knowledge about MERS, including causes, sources of transmission, mortality, clinical manifestations, prevention strategies and risk groups for MERS	Structured questionnaire developed using the style and format of some of the questions used in two previous studies (Khan et al., 2014; Kharma et al., 2015)	9 items	Three possible levels (yes, no, I don't know). A score of 1 was given for each correct answer.	English; time not reported	Authors state that the presentation and validity of the questionnaire were undertaken by experienced academic and senior pharmacy students.
	Sources of knowledge about MERS		1 item	Open question
	Attitudes and beliefs about MERS		5 items	5-point Likert scale (1 = strongly agree, 2 = agree, 3 = neutral, 4 = disagree and 5 = strongly disagree).
Patel et al., 2018, USA, EVD	Knowledge about EVD: transmission	Questionnaire similar to the one developed by Akram et al. for leishmaniasis and by Arief et al. for the Zika virus	10 items	Yes/true, No/false, or unsure	English; 20–25 min	Not reported
	Knowledge about EVD: prevention		16 items	5-point Likert scale (1 = strongly agree; 5 = strongly disagree)
Etokidem et al., 2018, Nigeria, EVD	Sources of information about EVD	Not reported	1 item	Open question	Not reported	Not reported
	Knowledge about EVD		6 items	Open questions
	Attitude towards people with EVD		5 items	1 open question and 4 dichotomous yes/no
	Practice regarding EVD prevention		11 items	Dichotomous yes/no
Escalera-Antezana et al., 2020, Bolivia and Colombia, COVID-19	Knowledge about COVID-19	Not reported	5 items	Dichotomous correct/incorrect statement	Spanish; time not reported	Not reported
Modi et al., 2020, India, COVID-19	Knowledge and infection control	Adapted from the CDC guidelines	17 items	Not reported	Not reported	Not reported

CDC: Centers for Disease Control and Prevention, Atlanta, USA; COVID-19: Coronavirus disease 2019 caused by SARS-CoV-2; EVD: Ebola virus disease; MERS: Middle East respiratory syndrome; SARS: Severe acute respiratory syndrome.