Pilot validation of a questionnaire on radon risk awareness and climate-related determinants of indoor radon exposure

Abstract

Introduction Indoor radon exposure is a major environmental risk factor for lung cancer, while climatic conditions and building characteristics can influence radon accumulation in residences. Assessing public awareness, perceptions, and behavioral responses requires reliable and methodologically validated survey instruments. However, validated questionnaires simultaneously addressing radon knowledge, housing characteristics, and climate-related perceptions remain limited. Aim of the study To pilot and evaluate a statistical validation framework for the questionnaire designed to assess radon awareness, perceived environmental and climatic influences, housing characteristics, and self-reported health indicators among residents. Material and methods A pilot cross-sectional study was conducted in 20 residential dwellings (10 detached houses and 10 apartments on first floors) in Chișinău, Republic of Moldova in summer 2025. The questionnaire comprised six thematic sections covering dwelling characteristics, indoor environmental conditions, health status of residents, knowledge of radon risks, perception of climate-related influences, and sources of environmental health information. Radon concentration and indoor microclimate parameters were measured instrumentally. Responses were coded using Likert-type scales. Due to nonnormal data distribution, nonparametric statistical methods were applied. Internal consistency was assessed using Cronbach’s alpha, construct and behavioral validity were examined using Spearman correlation, and differences between dwelling characteristics were analyzed using MannWhitney tests to evaluate the feasibility of the validation algorithm. Results The questionnaire demonstrated good internal consistency for radon knowledge items (Cronbach’s α=0.79) and moderate reliability for self-reported health indicators (α=0.61), while climate-related perception items showed low internal consistency (α=0.41). Radon concentrations differed significantly according to basement construction material (p=0.018. Radon awareness was positively associated with testing behavior (p<0.05) and reported mitigation measures (p<0.05), supporting behavioral validity. Conclusion The statistical validation algorithm proved feasible and informative for pilot testing of multidimensional environmental health questionnaires. The instrument demonstrated acceptable preliminary validity but requires refinement of conceptually heterogeneous item groups. To ensure robust validation, future revisions should expand and align climate-related items, increase the number of indicators, and confirm psychometric performance in larger and more heterogeneous population samples.