Development and preliminary psychometric evaluation of the Digestive Health Determinants Survey (DHDS-35): a cross-sectional study among adults in Southern Kazakhstan

Digestive diseases represent a substantial public health burden, particularly in settings where prevention-related awareness, health-related behaviours, and access to primary and specialised care may influence early recognition and management. This study aimed to develop and conduct a preliminary psychometric evaluation of the Digestive Health Determinants Survey (DHDS-35), a bilingual Kazakh–Russian multidomain survey designed to describe self-reported gastrointestinal health, selected dietary and lifestyle behaviours, perceived prevention-related awareness, and perceived healthcare accessibility. A cross-sectional instrument-development and preliminary psychometric evaluation study was conducted among adults living in the Turkestan Region of Kazakhstan using purposive and snowball recruitment through WhatsApp. The DHDS-35 was developed through a literature review, preliminary expert review, and Kazakh–Russian translation with back-translation. A single bilingual Google Forms questionnaire displayed all instructions, items, and response options simultaneously in Kazakh and Russian. Of 222 individuals who opened the questionnaire, 201 provided electronic informed consent and completed all 35 items. Exploratory psychometric analyses were conducted for 20 ordinal items, Q16–Q35. Horn’s parallel analysis used 5,000 simulated datasets. Principal axis factoring was based on the Pearson correlation matrix and used oblimin rotation. Internal consistency, corrected item–total correlations, bootstrap 95% confidence intervals, and item-level floor and ceiling effects were assessed. No confirmatory factor analysis was conducted. The Kaiser–Meyer–Olkin measure was 0.846, and Bartlett’s test of sphericity was significant (p<0.001). Parallel analysis supported retention of three factors. Oblimin-rotated principal axis factoring identified interpretable Perceived prevention-related awareness and Healthcare accessibility factors, with a factor correlation of 0.623, while dietary and lifestyle items remained heterogeneous. Cronbach’s alpha was 0.832 (95% CI 0.776–0.872) for Perceived prevention-related awareness and 0.882 (95% CI 0.844–0.910) for Healthcare accessibility. Dietary and lifestyle items were retained only as separate exploratory behavioural indicators. In this non-probability sample, 22.9% (95% CI 17.6–29.2) self-reported a previous digestive disease diagnosis, 50.2% (95% CI 43.4–57.1) reported abdominal pain or discomfort at least sometimes, and 55.7% (95% CI 48.8–62.4) endorsed the combined heartburn, bloating, or constipation item at least sometimes. The DHDS-35 should be positioned as a preliminary multidomain public health survey requiring further development and independent validation. The Perceived prevention-related awareness and Healthcare accessibility components showed the strongest preliminary measurement properties. Nutrition and lifestyle items should be interpreted separately as exploratory behavioural indicators rather than as validated scales, dietary assessment measures, or clinical risk indices. The present study does not establish screening thresholds, risk categories, or referral criteria.