Social accountability 3A model (awareness, action, achievement): a practical guide for clinical education planners

Introduction: Hypertension is the leading risk factor for global mortality. Hypertension treatment rates are low, partly due to inadequate linkage and retention to care. The LARK Study evaluates the use of community health workers (CHWs), equipped with a behavioral assessment and a tailored behavioral change strategy, to improve linkage and retention to hypertension care in Kenya. Here we describe the development and validation of the assessment tool used by CHWs to identify patients’ barriers to care, facilitating behavioral change communication. Methods: We derived behavioral assessment items from prior research on barriers to hypertension care in Kenya. Patients, CHWs, and clinicians scored each item for clarity and representativeness, and provided qualitative feedback during focus groups. A content validity index (CVI), representing inter-rater agreement of scores, was calculated for each item. Multivariable linear mixed-effects models were used to compare CVIs and level of modification (none, minor, major, or deleted) by participant category. Results: We tested 70 items in 9 focus groups. Mean CVIs were greater than 0.9 in all study groups (Table). Multivariable adjustment revealed that patients and CHWs had significantly higher CVIs than clinicians. Despite this, qualitative feedback from patients and CHWsled to higher item modification rates. 37 items were retained in the linkage assessment and 57 items in the retention assessment. Conclusions: The mean CVI was greater than 0.9 in all study populations, indicating excellent inter-rater agreement of the overall clarity and representativeness of assessment items. However, CVI alone could not account for modifications suggested during qualitative discussions. A combination of quantitative and qualitative methods yielded the most informative evaluation of assessment items. These findings may be relevant to the validation of similar assessment tools in other low-resource settings.

Background: The Breast Imaging-Reporting and Data System (BI-RADS ® ) is an international classification developed to systematize breast assessment, exam interpretation, and the preparation of reports of specific breast imaging exams. Objective: The objective of this study was to validate with experts a booklet directed to medical and nursing professionals in the Family Health Strategy on the categorization of Breast Imaging Reporting and Data System in order to describe the reports of mammography. Methods: This was a technology-validation study of the methodological-development type. The evaluation was performed with 11 experts, including seven radiologists and four mastologists, four men and seven women, with a mean age of 45 years, meantime of being in the profession of 22 years, and an average 15 years of working experience of in the field. Results: The individual, mean, and global Content Validity Index (CVI) was calculated. The booklet was validated with a CVI of 0.89. The suggestions of the experts were analyzed, and some of them were implemented for the final version of the booklet. Conclusion: The booklet was validated and will contribute significantly to the daily activities of medical and nursing professionals in the Family Health Strategy in relation to the interpretation of the mammographic report and the orientation regarding the referral, agility, and qualification of the patient to the specialized service.

Recertification and Reentry to Practice for Nurse Anesthetists Using High-Fidelity Simulation: Phase III

ObjectiveMenopause-related symptoms can strongly affect health-related quality of life (HRQOL) in most peri-menopausal women. The aim of the present study was to explore the psychometric properties of a culturally adapted and translated Persian version of the Menopause Rating Scale (MRS).Study DesignThe study was conducted on a random sample of 270 middle-aged women (age range 40–60 yrs) selected from 25 urban health service centers across Tabriz, Iran. Content validity was evaluated by a panel of 11 experts. Construct validity was assessed by exploratory factor analyses with Varimax rotation and principal axis factoring extraction method and by confirmatory factor analyses. Internal consistency and test–retest reliability were assessed with Cronbach’s alpha and intra-class correlation coefficient (ICC), respectively. In addition, the feasibility of the measure was judged based on ceiling and floor effects.ResultsContent validity of the measure was good with a mean content validity index (CVI) and mean content validity ratio (CVR) of 0.88 and 0.94, respectively. Exploratory factor analyses identified three factors accounting for 47.69% of the variance. Confirmatory factor analyses found the original three-factor model to have the best fit to the data. Cronbach’s alpha coefficient (0.85) and the test–retest reliability score (0.91) indicated good internal consistency.ConclusionThe Persian version of the MRS demonstrated excellent reliability and validity. It can therefore be used in both clinical and research settings to assess menopause-related symptoms and associated quality of life.

This study aimed to develop and implement a home economics career education teaching and learning plan to enhance the career development competencies of third-year middle school students and to evaluate its effectiveness. The research was conducted in five stages: analysis, design, development, implementation, and evaluation. In the analysis stage, the 2022 revised home economics curriculum was reviewed to establish connections with career development competencies. The design stage involved drafting a five-lesson plan based on this analysis. In the development stage, the plan was expanded to seven lessons through expert validation and systematic revisions of learning activities and materials. Expert validation involved five home economics education experts who evaluated the plan’s appropriateness, engagement potential, and linkage to career development competencies. The mean scores and Content Validity Index (CVI) indicated high validity, particularly in lesson activities and their integration with key competencies. A career development competency assessment tool was also revised and validated through a pilot test. The implementation stage involved delivering the lessons to students, incorporating activities such as self-exploration, high school and major selection, job analysis, role model interviews, key ring making, resume writing, and mock interviews. Evaluation results showed significant improvements in students’ career design competencies (self-understanding, occupational understanding, exploration, planning) and career readiness competencies (optimism, persistence, curiosity, flexibility, initiative, communication). Students reported high satisfaction and practical benefits from the program. This study confirms the effectiveness of home economics career education in enhancing students’ career development competencies and highlights the need for further research and practice in this field.

The objectives of this study were to establish additional content validation data for proposed stomal and peristomal complications interventions and to identify optimal interventions for the specified complications based on experts' clinical judgment. Following pilot testing of the researcher-designed instrument, the survey was mailed to 1000 systematically randomly selected expert WOC nurses via a national mailing to a representative sample of participants who identified in their WOCN Society description as having ostomy certification and/or clinical expertise. Two hundred eighty-one nurses returned the survey, comprising a response rate of 28%. A cross-sectional, quantitative descriptive design with qualitative components was used for this study. Respondents were asked to quantify degree of validity (relevance or appropriateness) of the survey's stated stomal and peristomal complications interventions. They were asked to rank interventions for each stomal and peristomal complication for being first-line (most preferred), second-line, and third-line treatment. Hand-written qualitative comments of the participants were transcribed and analyzed, and themes were derived. On a scale of 1 to 4, the mean score for all interventions was 3.47 ± 0.29 (relevant/very relevant, mean ± SD). The overall survey's Content Validity Index was 0.84 out of 1.00. Some items had lower mean scores and content validity index scores, especially peristomal interventions. Ranking of most preferred treatments revealed clearly preferred approaches in some clinical situations and some less so. Qualitative analysis of participants' comments about each stomal and peristomal complication intervention and about the whole instrument and research process was conducted generating positive and negative themes. The proposed stomal and peristomal interventions were rated as generally valid substantiating results of our earlier study. The ranking of most preferred treatments for stomal and peristomal complications provides, to the authors' knowledge, the world's first research support for prioritized approaches and evidence-based practice in ostomy care.

INTRODUCTION: Conducting a needs assessment is imperative to identify gaps in the current data management practices for visually impaired students. This study aims to evaluate the content validity of a needs assessment questionnaire, a critical precursor to developing a systematic visual attributes profile for this student population. By validating the questionnaire, the challenges and needs of visually impaired students can be accurately identified, enabling targeted interventions and informed policy decisions in special education. Ensuring the precision of the questionnaire establishes a foundation for understanding and addressing these students' needs, ultimately contributing to more effective educational environments. MATERIALS AND METHODS: The instrument underwent two phases, i.e. item development and a comprehensive assessment of item validity by six experts. The experts evaluated the instrument’s relevance and comprehensibility using a four-point Likert scale. Microsoft Excel facilitated the analysis of the Content Validity Index (CVI), Content Validity Ratio (CVR), and modified kappa (K) statistics. RESULTS: The item content validity index (I-CVI) ranged from 0.83-1, with a Scale-level Content Validity Index (S-CVI/Ave) of 0.97, indicating acceptability. The Content Validity Ratios (CVR) for most items surpassed 0.7, indicating strong agreement among experts on their relevance with the interpretation of the K analysis of 70% excellent. However, three items in the second and third domains required revision and clarity enhancement. CONCLUSION: The content validity analysis showed that all items in the questionnaire were deemed appropriate. This suggests that the questionnaire is suitable for assessing the need to develop a systematic visual attribute profiling for students with visual impairment.

The objective of this study was to examine the content validity of commonly used muscle performance tests in military personnel and to investigate the reliability of a proposed test battery. For the content validity investigation, thirty selected tests were those described in the literature and/or commonly used in the Nordic and North Atlantic Treaty Organization (NATO) countries. Nine selected experts rated, on a four-point Likert scale, the relevance of these tests in relation to five different work tasks: lifting, carrying equipment on the body or in the hands, climbing, and digging. Thereafter, a content validity index (CVI) was calculated for each work task. The result showed excellent CVI (≥0.78) for sixteen tests, which comprised of one or more of the military work tasks. Three of the tests; the functional lower-limb loading test (the Ranger test), dead-lift with kettlebells, and back extension, showed excellent content validity for four of the work tasks. For the development of a new muscle strength/endurance test battery, these three tests were further supplemented with two other tests, namely, the chins and side-bridge test. The inter-rater reliability was high (intraclass correlation coefficient, ICC2,1 0.99) for all five tests. The intra-rater reliability was good to high (ICC3,1 0.82–0.96) with an acceptable standard error of mean (SEM), except for the side-bridge test (SEM%>15). Thus, the final suggested test battery for a valid and reliable evaluation of soldiers’ muscle performance comprised the following four tests; the Ranger test, dead-lift with kettlebells, chins, and back extension test. The criterion-related validity of the test battery should be further evaluated for soldiers exposed to varying physical workload.

Patients in intensive care units require comprehensive care. Hence, improving health care quality depends on accurate assessment and documentation. To develop and validate the content of an assessment sheet for critically ill patients. A Delphi design study was conducted between January and March 2020. The content validity index (CVI) was used to calculate the degree of agreement among the experts to analyse the instrument and the entire set of items. Content validity was determined by seven experts (three critical care nursing professionals, two critical care doctors, and two anaesthesiologists) using a four-point Likert scale. They evaluated the items in terms of the following: 1= "irrelevant," 2="somewhat relevant if the phrasing is profoundly adjusted," 3="relevant with some adjustment as to phrasing," and 4= "very relevant." The CVI was applied, and the accepted value was ≥0.50. Three rounds of evaluation were required to achieve the minimum index. The items were reviewed for content and face validity. The instrument was validated with 86 items with a total CVI of 0.90, a face validity of 1, and a scale-level content validity index/universal agreement calculation method (S-CVI/UA) value of 0.813. This instrument can help nurses, doctors, academics, and students assess patients in intensive care units. The daily assessment tool may provide a systematic and consistent approach to critically ill patients' assessment to guide interventions.

IntroductionWith the increasing aging population, the demand for care that fosters independence in older adults is rising. Complications from hospitalization and the preference for aging in place highlight the need for geriatric home care systems. This study aims to develop a comprehensive home-based care model specifically for Iranian seniors and evaluate its feasibility.MethodsThis study employed a multi-phase approach in Iran. It began with a mixed-methods analysis, including a survey on caregiver reliance, followed by qualitative interviews to identify challenges in home care services. Phase 2 involved a scoping review of home care frameworks from various countries. In Phase 3, an initial model was created based on previous findings and relevant documents in Iran. In the fourth phase, feedback was gathered from an expert panel selected through purposive sampling, with discussions recorded and concluding at saturation. The feedback was then integrated into the final model. Additionally, in a Delphi study, experts evaluated the model components using a four-point Likert scale, calculating the content validity index (CVI) for each item. A CVI of 79% or higher indicated validity, and continuous feedback led to iterative refinements.ResultsFollowing the design of the initial model, an expert panel convened with 15 participants to review the framework. The final model comprises seven key components: leadership and governance, legislative framework, financial framework, human resource management system, information management system, and control and monitoring system. Results from the Delphi study indicated that with a CVI exceeding 80%, this model is deemed a valid framework for delivering home-based care.ConclusionThis study presents a comprehensive model that serves as a valuable guide for policymakers seeking to implement integrated home care with professional oversight. By doing so, it aims to enhance the quality of care and improve stakeholder satisfaction.

To date, referral practices based on social determinants of health (SDOH) among primary care providers (PCPs) and clinic staff in rural regions, including Appalachian North Carolina (NC), are not well understood. This study aims to develop and content validate a primary care engagement (PCE) survey to assess (1) engagement and burnout; (2) referral practices; and (3) self-efficacy and confidence in making referrals based on SDOH among PCPs and clinic staff in Appalachian NC. Using the Social-Ecological Model as a theoretical framework, researchers developed a 37-item PCE survey. Content validation was completed by a panel of experts recruited from a convenience sample of faculty at a local university and PCPs and clinic staff practicing in Appalachian NC. Participants rated the degree of relevance of survey questions on a four-point Likert scale and provided additional feedback about the wording/appropriateness for the intended audience. Content validity index (CVI) scores were calculated for each question by averaging the degree of relevance ratings. Ten participants completed the study between August and November 2022 (nurse practitioners, academic researchers, clinical support staff/quality improvement associates, administrative staff supervisor, administrator/practice manager). CVI scores for each item ranged from 3.43 to 4.0. Comments regarding potential improvements were primarily focused on small edits, including grammar-related changes and opportunities for clarity and inclusivity. High CVI ratings for all survey items indicate the overall approach/survey aim resonates with local clinicians and individuals with expertise in SDOH. This study and the final survey lay the foundation for collaborative, collective-impact initiatives that are directly informed by the survey findings.

Social accountability (SA) is an obligation for medical schools in meeting the priority health concerns of the communities they serve. To measure the integration of SA principles into medical curricula, suitable tools are needed. This study developed and validated an inventory to assess SA values within the existing case scenarios used in problem-based learning (PBL) curricula. The Delphi technique was employed to develop and validate the new inventory. The validation used expert opinion and calculated the content validity using content validity indices (CVIs). The initial draft (Draft 0) was formulated with 25 open-ended questions. Following expert evaluation, Draft 1 had 22 closed-ended questions and the mean ratings, according to the experts, were as follows: relevance, 3.33–4.83; importance (3.5–4.8); clarity (3.33–4.83); and simplicity (3:00–4.67). Draft 2 had 19 questions. After a further round of rating and analysis, a final draft was prepared, consisting of 17 items, with CVI scores ≥ 0.8 and 100% overall satisfaction. Using this inventory tool will help health professions schools to translate SA indicators into curricular activities by identifying the gaps in their PBL curricula. Deficiencies can be either in the type of case scenarios used or the triggers embedded in the individual case scenarios, subsequently leading to the development of PBL case scenarios that address real health social needs. A revision and rewriting of the problem case scenarios to incorporate SA will be the next step.

Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.

Student evaluation of university teaching activity is now compulsory in Italy and a research group of the ItalianMinistry of Instruction, University, and Research proposed a questionnaire with items based on the four-point Likert scale and a traditional item-by-item analysis for the evaluation of classrooms, work load, course organization, lectures, and teaching aids. Three split-ballot experiments were carried out to test the differences between the four-point and five-point Likert scale. The traditional analysis is compared with the results of the fuzzy system set up to achieve the same purposes. The fuzzy system yielded scores that proved to be generally higher but sometimes also lower than those obtained using the five- or four-point Likert scale. Furthermore, an extension of standard procedures of the fuzzy system is suggested to obtain a fuzzy item-by-item analysis, thereby increasing the possibility of their use in social sciences.

The COVID-19 pandemic is a challenge for health systems. The absence of prior evidence makes it difficult to disseminate consensual care recommendations. However, lifestyle adaptation is key to controlling the pandemic. In light of this, nursing has its own model and language that allow these recommendations to be combined from global and person-centred perspectives. The purpose of the study is to design a population-oriented care recommendation guide for COVID-19. The methodology uses a group of experts who provide classified recommendations according to Gordon’s functional patterns, after which a technical team unifies them and returns them for validation through the content validity index (CVI). The experts send 1178 records representing 624 recommendations, which are unified into 258. In total, 246 recommendations (95.35%) are validated, 170 (65.89%) obtain high validation with CVI > 0.80, and 12 (4.65%) are not validated by CVI < 0.50. The mean CVI per pattern is 0.84 (0.70–0.93). These recommendations provide a general framework from a nursing care perspective. Each professional can use this guide to adapt the recommendations to each individual or community and thus measure the health impact. In the future, this guideline could be updated as more evidence becomes available.