The recruitment of the students took place in January 2019. The students of each semester were informed by two members of the working group (Preclinic HJW, Clinic KH) and invited to participate. The project group aimed at having a sample of dental students, divided into the pre-clinical semesters, 1st, 3rd and 5th semesters (35 students each) and the clinical semesters, 6th to 10th semesters (ideally, the full survey). The recruitment strategy was in accordance with recommendations by Terwee [37]. The participating students filled in the questionnaire and, in addition, they also answered the sociodemographic questions that had already been used. Please see the final questionnaire in additional file 2.

The analysis was performed using the statistical programme SPSS 25.0 (SPSS Inc., IBM).

The evaluation strategy included psychometric testing by means of a descriptive analysis, including an analysis of response distribution and item difficulty. For item difficulty, values from 20 to 80% were preferred. Values from 0 to 20% were interpreted as extremely difficult and values from 80 to 100% were interpreted as extremely easy [38].

Furthermore, principal component analysis with extraction of component loadings was performed. The component loadings were subjected to Varimax rotation, and their number was determined by eigenvalues > 1. Furthermore, sample suitability was evaluated according to the Kaiser-Meyer-Olkin (KMO) criterion, and Bartlett’s test was performed to examine sphericity (p < 0.05) [39]. All items with a component loading > 0.4 were assigned to the particular component. Internal consistency was determined by Cronbach’s α [40]. Values > 0.9 are regarded as excellent and > 0.8 represent good internal consistency, while values > 0.7 and values > 0.5 represent acceptable consistency and poor internal consistency respectively [41]. An overview of the development process, under consideration of the various steps, is presented in Fig. 1.

Flowchart of the development steps of the questionnaire

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