Cultural adaptation and validation of health literacy instrument for school-age children in Iranian adolescents.

Introduction: This study explores the integration of local wisdom from the Coastal Riau community, Indonesia, into chemistry education through an ethnochemistry approach focused on traditional fermentation practices. Locally produced fermented foods such as dadih (fermented buffalo milk), durian acid (fermented durian), rebung acid (fermented bamboo shoots), jeruk maman (fermented Cleome leaves), and bekasam (fermented fish) embody valuable biochemical processes rarely addressed in formal curricula. Incorporating these cultural contexts into chemistry learning aims to make abstract concepts more meaningful and foster students’ creativity and scientific literacy.Methods: The research employed a Mixed Methods Sequential Explanatory Design. The qualitative phase involved interviews and participatory observations with traditional food producers in three regencies—Meranti, Pelalawan, and Rokan Hilir—to identify fermentation-based products and analyze their chemical principles. The quantitative phase involved expert validation (N=16) of the developed ethnochemistry-based learning media using the Content Validity Ratio (CVR) and Content Validity Index (CVI), followed by classroom implementation with 45 chemistry education students.Results: Five traditional fermentation products were identified, each illustrating chemical processes such as acid–base reactions, enzymatic catalysis, and microbial metabolism. The developed learning media achieved a CVI and CVR validity score of 91%, confirming scientific accuracy and pedagogical suitability. Student creativity scores averaged 80, categorized as high, indicating that contextualized ethnochemistry learning effectively enhances creative performance.Conclusion: Ethnochemistry-based learning media grounded in local fermentation practices effectively bridge cultural experience and scientific theory, fostering creativity, scientific competence, and appreciation for Indonesia’s cultural heritage.

Development and validation of prescription quality assessment tool in geriatrics.

The Manchester driving behavior questionnaire (DBQ) integrating health and technology factors: The DBQ 2025 update with translations in 11 languages.

To develop and validate a grading system for assessing the periradicular region of primary teeth on intraoral periapical radiographs. A mixed-methods approach was employed, comprising three phases: (1) Development of the grading system through a systematic literature review and analysis of 300 radiographs, (2) Delphi exercise with 20 expert pediatric dentists assessed face and content validity, and statistical measures such as Content Validity Index (CVI) and Content Validity Ratio (CVR) were calculated, and (3) Initial user feedback (n = 50) for acceptability, time taken, and accuracy of grading were assessed after grading 10 radiographs. A pool of 41 items was devised after phase 1. Two rounds of deliberations by the Delphi group resulted in 49 items for inclusion, with ≥ 85% expert agreement and high content validity (CVR ranging from 0.7-1.0). The majority (60%) of the feedback group found the developed index to be acceptable. The correct response rate was 29.6% while it was 43% for the retest. The mean time taken for grading 10 radiographs was 51.12 ± 7.84 min, which decreased to 44.2 ± 4.47 min during the retest. A novel grading system with high face and content validity was developed. Further evaluation of the feasibility and reliability is required prior to regular use.

The success of disease registry systems (DRSs) depends on developing software that aligns with the registry's specific needs. This study focuses on localising the Checklist with Items for Patient Registry sOftware Systems (CIPROS) to facilitate the DRS assessment. This applied and cross-sectional study was carried out in 2023 in six phases. The first phase involved translating the CIPROS checklist. In the second phase, experts validated the face validity of the checklist. The third phase focused on calculating the content validity ratio (CVR) and content validity index (CVI) for each item. In the fourth phase, the items removed earlier were reassessed. In the fifth phase, definitions for each item were proposed. The sixth phase encompassed calculating the reliability of the localised checklist. For the data analysis, descriptive statistics were computed using SPSS software. The original checklist included 12 aspects and 72 items. After evaluating the CVR and CVI indicators, 40 items were validated. By reassessing the deleted items, the localised checklist was created, composed of 56 items categorised into 11 aspects. The localised tool would support the authorities responsible for DRSs when making software purchasing decisions. Additionally, it would be advantageous for policymakers by helping them establish the criteria for DRS assessment.Implications for health information management practice:Localising the registry assessment tool will facilitate its use; providing descriptions of assessment tool items leads to a uniform understanding and ease of use of the tool.

A survey to understand the knowledge and perception on climate change: a Delphi study on health professionals.

The nozzle tester teaching aid commonly used in the automotive engineering program at SMK N 1 Kedungwuni was leaking, making it unable to support learning optimally and affecting student learning outcomes. This was the main reason for conducting research on the development of a nozzle tester teaching aid using a used jack, which was implemented in the teaching of conventional diesel engine systems. This study employs a Research and Development (R&D) approach using the ADDIE model. The research methodology involves pretest and posttest groups. The findings of the study include: (1) the developed teaching aid was deemed suitable by media experts and subject matter experts based on content validity ratio (CVR), content validity index (CVI), and percentage of agreement (PA) analysis; (2) the product trial results showed a high level of effectiveness, as demonstrated by the Independent Sample t-Test on N Gain Score yielding a significance value (Sig. 2-tailed); and (3) the reproducibility coefficient (Kr) and scalability coefficient (Ks) each indicate that the application of the nozzle tester teaching aid in conventional diesel engine system learning is highly practical. The conclusion of this study is that the nozzle tester teaching aid can enhance learning outcomes in conventional diesel engine system education.

Background — Protecting patient privacy is a key principle in relationships between healthcare professionals. A validated and reliable instrument for assessing patient privacy during surgical procedures in the operating room (OR) is lacking. Objective — The goal of this study is to develop a psychometric instrument for assessing patient privacy protection from the perspective of OR staff. Methods — This is a methodological study. Initially, items were developed based on qualitative research, a comprehensive literature review, and input from experts in the field of gerontology and questionnaire development. The validity and reliability of the developed instrument were then assessed using face validity, content validity, construct validity using exploratory factor analysis (EFA), and reliability based on Cronbach’s alpha, and internal consistency coefficient. Results — A total of 27 items were generated. During development, 9 items were excluded, resulting in a preliminary version of the questionnaire containing 18 items that underwent psychometric evaluation. The content validity index (CVI) value for most items was above 0.9, and the content validity ratio (CVR) was above 0.79. Finally, the instrument, which included 18 items across four dimensions (physical, informational, psychological, and environmental), was examined using EFA. The Cronbach's alpha coefficient for this instrument was 0.91. Conclusion — The developed Patient Privacy Questionnaire for Operating Room Staff has acceptable validity and reliability. This instrument can be used as a simple, convenient, valid, and reliable tool for assessing patient privacy protection from the perspective of OR staff.

Objective: The Malpractice Tendency Scale for Physiotherapists (MTSP) was developed to assess physiotherapists’ malpractice tendencies, addressing a gap in patient safety and professional standards. This pioneering tool provides avalid and reliable way to measure malpractice risks specific to physiotherapy. The MTSP aims to improve professional conduct and patient outcomes by enabling physiotherapists to systematically evaluate and enhance their practice. Thisstudy aimed to develop a valid and reliable scale to measure the malpractice tendencies of physiotherapists, ultimately enhancing patient safety and elevating professional standards. Methods: This methodological scale-development study was conducted among 351 physiotherapists working acrossdiverse healthcare settings in Türkiye between 2023 and 2024. Data were collected online using a snowball sampling approach. The development process proceeded through sequential phases, including an extensive literature review, creation of an item pool, expert evaluation, calculation of the content validity ratio, pilot administration, andlarge-sample psychometric testing. Construct validity was examined through exploratory factor analysis (EFA) with 217 participants and confirmatory factor analysis (CFA) with 134 participants. Reliability analyses included Cronbach’s alpha, item-total correlations, and subscale consistency assessments. Results: The MTSP demonstrated high reliability (Cronbach’s α = 0.89). The EFA identified a 3-factor structure (institutional, patient-related, and personal) with 15 items. At the sub-factor level, the Cronbach’s α values were 0.68 forfactor 1, 0.72 for factor 2, and 0.87 for factor 3. The CFA confirmed the construct validity with excellent fit indices (χ2/df,standardized root mean square residual, comparative fit index, and incremental fit index). Conclusion: A valid and reliable scale was developed to enable physiotherapists to objectively evaluate malpractice tendencies and gain insight into their causes, thereby improving their professional performance. It is thought that MTSP will increase patient safety in physiotherapy by contributing to educational programs and professional develop ment activities. Cite this article as: Deniz G, Sönmez M, Akaras E, Eymir M. Malpractice tendency scale for physiotherapists, scale development study. Arch Health Sci Res. 12, 0071, doi:10.5152/ArcHealthSciRes.2025.25071.

The rapid development of digital-based learning highlights the need for innovative media that supports students’ understanding. At the same time, learning tools grounded in local wisdom remain scarce, especially those linking medicinal plant knowledge with food and digestive system content. The objective of this study is to assess the feasibility of a digital pocket book as a learning tool that focuses on food and the digestive system based on an inventory of medicinal plants for lengkauk disease. This research and development include potential and problems identification, data collection, product design, design validation, and design revision. The digital pocket book’s feasibility was assessed through validity testing by five validators using a validation sheet. The validated aspects included format, content, and language. The validation data were analyzed using Content Validity Ratio (CVR) and Content Validity Index (CVI). The digital pocket book validation results for food and digestive system material obtained a CVR value of 1.00 for each criterion in each aspect, with a valid category, and a CVI value of 1.00 with a valid category. Therefore, the digital pocket book developed in this study is suitable for use as a learning medium.

Occupational Safety and Health (OSH) represents a core element of the social dimension of sustainability, working in tandem with environmental performance to support sustainable development. Resilience Engineering complements this perspective by focusing on organisational adaptability and the ability to maintain safety in dynamic, uncertain environments. The objective of this study is to develop an integrated framework for sustainable supplier selection that incorporates both resilience and Health, Safety, and Environment (HSE) performance as strategic evaluation criteria. This approach aims to guide organisations in aligning procurement practices with broader sustainability and safety goals. To construct and validate the proposed framework, expert input was gathered and synthesised using the Delphi method, ensuring consensus on critical evaluation factors. The Content Validity Ratio (CVR) was applied to assess the clarity and relevance of the selected criteria. For prioritisation, the Best-Worst Method (BWM) was used to determine the weight of each criterion. The multi-attributive Border Approximation Area Comparison (MABAC) method was then employed to rank supplier performance across the established criteria. The resulting framework consists of seven main categories and 26 sub-criteria, representing a holistic view of supplier sustainability, resilience, and HSE performance. The model was applied to assess four suppliers, demonstrating its effectiveness in identifying variances in safety practices, adaptability, and environmental responsibility. It provided clear, actionable insights into the comparative strengths and weaknesses of each supplier. The integrated framework offers a practical and strategic tool for enhancing supplier selection decisions. By embedding resilience and HSE into evaluation processes, organizations can support long-term goals related to safety, adaptability, and sustainability. This structured approach facilitates the development of robust and adaptive supply chains, reinforcing the alignment between operational practices and sustainable development principles.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-30055-9.

Acceptance and Commitment Therapy (ACT) has been widely applied in clinical contexts; however, its systematic adaptation to elite sports, particularly precision-based disciplines such as shooting, remains underexplored. The present study aimed to develop and preliminarily validate an ACT-based psychological training program—the Acceptance and Commitment Performance Training for Shooters (ACPT-S)—by reframing ACT from a therapeutic intervention into a performance-oriented training framework. Using a multiphase formative evaluation design, a needs assessment was first conducted with 28 elite and collegiate shooters to identify sport-specific psychological demands. Based on these findings, a ten-session ACPT-S program was developed by integrating the six core ACT processes with shooter-specific routines, embodied exercises, and performance-relevant metaphors. The program was subsequently examined through two pilot studies: Phase 1 with four collegiate/corporate athletes and Phase 2 with 15 national-level shooters. Data were collected via session reflections, focus group interviews, and expert panel evaluations, and the Content Validity Ratio (CVR) analysis was used to assess conceptual clarity and implementation feasibility. The results indicated that ACPT-S was perceived as both feasible and contextually appropriate, with athletes reporting improvements in attentional focus, emotional acceptance, value-based motivation, and reduced anxiety. Qualitative analyses demonstrated strong engagement with ACT principles and their functional integration into shooting performance contexts, while all program components achieved CVR scores of ≥0.80, indicating a strong expert consensus. Program refinements were guided by feedback related to activity sequencing, metaphor resonance and personalization strategies. Overall, this study reconceptualizes ACT as a performance-enhancement framework rather than a purely clinical approach and introduces the ACPT-S as a novel, theory-driven, and scalable psychological training model for precision sports, providing a robust foundation for future longitudinal and comparative research.

Introduction: Ensuring livable environments that support independence and well-being in later life has become a critical task. However, few approaches comprehensively capture the interplay between personal, environmental, and occupational factors. This study aimed to develop and content-validate preliminary items of livability to support continued residence in familiar homes and communities. Methods: A modified Delphi technique was employed with 17 experts in health, welfare, architecture, and residential environments. Over two survey rounds, experts evaluated and refined item relevance and importance to achieve consensus. Results: The Delphi process produced 70 preliminary items across four domains: person, environment, daily activities, and performance. In the second round, strong expert agreement was reached (content validity ratio = 0.92; convergence = 0.38; consensus = 0.78; stability = 0.15). A validity–importance matrix identified 35 core items exceeding the mean, representing key indicators of livability. Conclusion: The content-validated items provide a practical framework for assessing livability among older adults. By capturing the dynamic interaction between individual abilities and environmental support, it informs interventions and policies aimed at promoting aging in place and improving quality of life in community settings.

Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health challenges in low- and middle-income countries, including Nepal. This study aimed to develop and validate a tool to assess children’s knowledge of ARF and RHD. A 14-item multiple-choice questionnaire was developed through expert consultation and a systematic translation and back-translation process. Content validity was evaluated by 10 experts using item-level and scale-level content validity indices (I-CVI and S-CVI) and the Content Validity Ratio (CVR). A cross-sectional survey of 207 students aged 11 to 16 years was conducted in public schools. Item difficulty and discrimination indices were calculated, and internal consistency was assessed using the Kuder-Richardson Formula 20 (KR-20). Known-groups validity was tested by comparing scores across grades and prior exposure to RHD screening programs. The scale demonstrated excellent content validity (S-CVI/Ave = 0.91) and good internal consistency (KR-20 = 0.772). Item difficulty indices ranged from 0.32 to 0.61, and discrimination indices from 0.23 to 0.36, both within ideal ranges. The mean knowledge score was 6.05 ± 3.43. Higher knowledge scores were observed among older students, those in higher grades, and those previously screened for RHD (P < .05). The RHD Knowledge Scale is a valid and reliable instrument for assessing children’s understanding of ARF and RHD. Although this study was limited to a single municipality and did not include test–retest reliability, the tool shows strong potential for adaptation and validation across different cultural, linguistic, and geographical contexts. Beyond research settings, this tool can serve as a practical means to integrate ARF and RHD education into school health programs and to monitor the effectiveness of nationwide prevention initiatives.

IntroductionIn medical education systems, the clinical internship phase is critical for clinical laboratory knowledge training. Insufficient clinical laboratory knowledge among clinicians directly leads to diagnostic errors or suboptimal treatment decisions. This study aimed to develop and validate a questionnaire evaluating laboratory medicine knowledge and attitudes among clinical medical undergraduates during their internships.MethodsBased on a comprehensive literature review and focus group discussions, our research team designed the “Questionnaire on Laboratory Medicine Knowledge and Attitudes Among Undergraduate Clinical Medical Interns.” The questionnaire comprises four sections: demographic information, knowledge assessment, attitudes evaluation, and suggestions for improvement. Internal consistency was analyzed using Cronbach’s α and intraclass correlation coefficients (ICC). Content validity was assessed via Content Validity Index (CVI) and Content Validity Ratio (CVR). Structural validity was examined using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and model fit indices (e.g., GFI, CFI, RMSEA).ResultsA total of 303 valid questionnaires were collected from interns across 11 general hospitals in the Yangtze River Delta region. The Cronbach’s α coefficients were 0.905 (knowledge subscale) and 0.803 (attitudes subscale), respectively, with ICC values of 0.705 and 0.576. The CVR was 0.923, and all item-level CVIs exceeded 0.78. EFA revealed a two-factor structure (KMO = 0.783, Bartlett’s test p < 0.001), accounting for 79.357% of the total variance. CFA confirmed satisfactory model fit (χ2/df = 2.214, RMSEA = 0.063, GFI = 0.988, NFI = 0.992, CFI = 0.995, TLI = 0.984).ConclusionThis validated questionnaire demonstrates preliminary reliability and validity for assessing laboratory medicine knowledge and attitudes among clinical interns in specific healthcare contexts (e.g., urban tertiary hospitals). Further validation in diverse healthcare contexts is required before broader implementation.

This study aimed to develop and validate the Artificial Intelligence and Academic Writing Questionnaire (AI-AWQ) to assess participants' perceptions with AI. The primary focus was to explore the factors that influence attitudes toward AI in educational settings. This study utilized a mixed-methods approach to develop and validate the psychometric properties of the AI-AWQ. The questionnaire, consisting of 30 items rated on a 5-point Likert scale (1 = Never, 5 = Always), was administered to a sample of 252 medical and dental students at Shiraz University of Medical Sciences, Iran, who had taken the academic writing course during the 2023-2024 academic year. Data were analyzed using Exploratory Factor Analysis (EFA), with Varimax rotation employed to clarify the underlying factors. A total of 252 completed questionnaires were analyzed, of which 59.5% were from Iranian students and the remaining respondents were international students. The results of the exploratory factor analysis demonstrated satisfactory sampling adequacy (KMO = 0.930) and a significant Bartlett's test of sphericity (P < 0.001), confirming the suitability of the data for factor analysis. Construct validity testing led to the extraction of five distinct factors-Perceived Effectiveness of AI, Ethical and Authenticity Concerns, AI-Supported Writing Process, AI Feedback and Writing Enhancement, and Affective and Motivational Impact-which together accounted for 77.99% of the total variance. The questionnaire demonstrated strong validity and reliability, with a Content Validity Index (CVI) of 0.903, a Content Validity Ratio (CVR) of 0.882, and an overall internal consistency confirmed by a Cronbach's alpha of 0.883. The findings suggest that the AI-AWQ provides preliminary evidence of reliability and validity for measuring perceptions of AI, offering insights into the multi-faceted nature of AI and academic writing. This study contributes to understanding the factors shaping individuals' views on AI in educational contexts and provides a foundation for further research.

This study presents the expert review and face validation of a survey instrument specifically designed to assess Halal Business Responsibility Practices (HBRP) among industry practitioners and academic experts in Halal-related fields. Given the increasing significance of integrity, sustainability, and strategic compliance in Halal food business practices, it is crucial to establish the content validity of the instrument before distributing the survey on a larger scale. The validation process was conducted in two stages. First, face validity is performed with small group of target respondents to check clarity, wording, layout, and readability of the instrument items. In the second stage, the instrument was distributed to Halal industry experts and academicians to evaluate the relevance and clarity of the survey items. This evaluation utilized the Item-Level Content Validity Index (I-CVI) and the Scale-Level Content Validity Index (S-CVI/Ave), aiming for acceptable indices (I-CVI ≥ 0.78; S-CVI/Ave ≥ 0.80). The findings also show a high Item-Level Content Validity Index (I-CVI = 0.98) and Content Validity Ratio (CVR = 0.96), indicating excellent expert agreement on item relevance and essentiality Further discussion is provided to ensure the relevancy and appropriateness of the research instrument are in place, as the reliable assessment tool for measuring the Halal Business Responsibility practices in the Halal food industry context.

Asthma remission has recently emerged as an aspirational treatment goal, yet its definition remains inconsistent across studies and expert groups. The absence of a standardized framework hampers its application in clinical practice and research, particularly in Korea where biologics use is rapidly increasing. This study aimed to establish a consensus definition of clinical remission in severe asthma among Korean experts. A two-round modified Delphi survey, followed by a focused third round, was conducted among 28 board-certified pulmonologists from the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD). The questionnaire consisted of 6 domains and 27 items. Responses were analyzed using agreement rates, interquartile ranges, and content validity ratios to determine consensus levels. Consensus was reached on defining clinical remission as a composite of no exacerbations, no systemic corticosteroid use, sustained symptom control (ACT ≥20 on at least three occasions over 12 months), and stabilization and optimization of pulmonary function while on maintenance treatment. Experts agreed that pulmonary function should be assessed based on clinical judgment rather than absolute thresholds. Complete remission was additionally defined as fulfilling all clinical remission criteria with normalization of type 2 inflammation (blood eosinophils <300/μL and FeNO <25 ppb). This Delphi consensus provides a regionally relevant and pragmatic framework for defining remission in severe asthma. These statements may help guide clinical practice, inform guideline development, and support future research on remission as a treatment goal.

BackgroundToday, the growing need for efficient medical leaders has been highlighted due to the complexity of health care systems, rising costs, and attention to patient-centered care. Therefore, it is essential to design and implement curricula related to the development of the leadership skills of medical students. This study aims to investigate the effect of clinical leadership and management courses on residents’ knowledge of clinical leadership competencies in the Departments of Internal Medicine and General Surgery.MethodsThis pre-experimental study with a one-group pretest and posttest that is conducted on residents of the Departments of Internal Medicine and General Surgery of Iran University of Medical Sciences. The Dick and Carey nine-step instructional design model was used to design, implement, and evaluate the effectiveness of the course. After translating and verifying validity and reliability, the self-assessment of clinical leadership competencies questionnaire of the NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges was used as a data collection Tool in this study. The results were analyzed using the Kolmogorov–Smirnov statistical test, parametric independent t test, and paired-sample t test.ResultsIn the present study, the content validity index and content validity ratio of the self-assessment questionnaire of clinical leadership competencies of the residents were confirmed. The reliability of the questionnaire was also verified by Cronbach’s alpha of 0.956. Moreover, after instruction, the mean scores of each dimension of clinical leadership competencies increased significantly so that the mean scores of “clinical leadership competencies” of 43 participants increased from 131/14 in the pretest to 151/186 in the posttest, and the significant value of the paired t test was less than 0.001, which implies that the instructional intervention had a significant impact on improving the scores of “clinical leadership competencies” of residents.ConclusionConsidering the effect of holding leadership courses on promoting clinical leadership competencies and responding to the instructional needs of individuals in this field, it is necessary that curriculum planners specifically address strengthening the curriculum of residents concerning the subject matter of leadership.