Content Validity Research Articles

Confirmatory factor analyses of the Mandarin Chinese version of the perceived stressors in intensive care units among healthcare professionals

BackgroundThe Perceived Stressors in Intensive Care Units (PS-ICU) scale was designed to assess both general and occupational stressors experienced by healthcare professionals (HCPs) under normal circumstances. It has demonstrated good psychometric properties in three languages: French, Spanish, and Italian. The aim of the present study was to translate the scale into Mandarin Chinese and to examine its construct validity and reliability.MethodsThis study was conducted from April 2022 to October 2023. In phase I, the scale was translated into Mandarin Chinese following the Cross-cultural adaptation guidelines and reviewed by expert panels. In phase II, the reliability and validation were tested by 530 HCPs working in tertiary grade A hospitals from two provinces (Shandong and Sichuan) in China. Fifty participants were contacted to evaluate the test–retest reliability and underwent a follow-up investigation 2 weeks after completing the initial online survey.ResultsThe content validity ratio for the 50 questions varied between 0.8 and 1, with every item having S-CVI values exceeding 0.92. After removing 4 items, the Exploratory Factor Analysis (EFA) results revealed six factors. Confirmatory Factor Analysis (CFA) affirmed construct homogeneity, comprising of (1) lack of fit with families and the organizational functioning, (2) emotional load associated with patient and family, (3) difficulties associated with teamwork, (4) issues associated with workload and human resource management, (5) issues associated with complex/at-risk situations and skill, (6) and suboptimal care situations. The comprehensive scale displayed strong internal consistency (the total Cronbach’s α = 0.96) and showed high 2-week test–retest reliability (Person’s r = 0.95). The Job Content Questionnaire (JCQ) was employed to assess the criterion-related validity, alongside with the Maslach Burnout Inventory-Hunman Services Survey (MBI-HSS), which revealed either positive or negative associations between PS-ICU and these measures.ConclusionThe final 46-item Mandarin Chinese version of the PS-ICU scale is reliable and valid for evaluating perceived stressors among HCPs under normal ICU conditions. It may significantly identify perceived stressors in the ICU providing a foundation for focused intervention research.

Development and Validation of a Teaching Module for Prescription Writing for Dental Students: A Randomized Controlled Trial.

Dentists commonly encounter patients with complex medical comorbidities that require an advanced level of competence in the art of prescription writing. However, the current structure of dental education often places limited emphasis on this critical skill. This study aimed to develop and validate an innovative teaching module designed to enhance prescription-writing skills for dental students, with a specific focus on patients with medical comorbid conditions. This study was completed in two phases. In phase 1, an interprofessional education (IPE) designed comprehensive teaching module was created. The topics included in this teaching module were medical comorbidities, drug interactions, and best prescription practices. The developed teaching module's face and content were validated, and the item- content validity index (I-CVI) was computed. In phase 2, the teaching module was tested among 48 dental students as part of a randomized controlled trial. A pool of eight items addressing different aspects related to prescription writing were validated in dental students. All the eight items reached an I-CVI for relevance and structure of ≥0.8. In phase 2, the intervention group, exposed to the teaching module on skill development of prescription writing, showed a statistically significant increase in their prescription-writing skill than the control group. The introduction of a teaching module aimed at developing prescriptions for medical co-morbidities could substantially improve the prescription writing abilities of dental students.

Re-Examining Measurement Invariance of School Climate Surveys Across Race/Ethnicity

Educators commonly use school climate survey scores to inform and evaluate interventions for equitably improving learning and reducing educational disparities. Unfortunately, validity evidence to support these (and other) score uses often falls short. In response, Whitehouse et al. proposed a collaborative, two-part validity testing framework for research-practice teams to gather evidence on school climate instruments to substantiate score interpretations and uses to promote equitable school environments. This study extends their work by including approaches to gather evidence on content and predictive validity of obtained scores, beyond an instrument’s internal structure, and using the alignment method to assess measurement invariance across student racial/ethnic groups. We demonstrate the procedure on a school climate survey developed by a large, urban U.S. public school district using data obtained on a sample of 6,423 Black and White middle school students. Results suggest that our expanded framework offers a more extensive, empirically based approach to gathering validity evidence on locally developed school climate measures. We discuss implications, limitations, and future directions for the development and use of school climate measures for decision-making.

Model of cost management for the Jakarta–Bandung high-speed railway project

The completion of the Jakarta–Bandung high-speed railway project in 2023 marks a significant milestone for Indonesia, showcasing enhanced connectivity between two cities of Jakarta and Bandung. Despite facing challenges, particularly in cost management, this study employs content validity ratio, factor analysis and structural equation modelling to address these issues. Surveying 404 stakeholders, it highlights the crucial role of cost planning in project success, aligning with existing literature on similar endeavours. The final model refines 108 cost management attributes as per Project Management Body of Knowledge guidelines, namely cost management process involves planning, estimation, budget determination and cost control. The outcomes of the final structural equation model underscore the significance of cost control in enhancing both cost efficiency and project success, aligning with findings from literature on similar projects. The novelty of this study lies in its application of content validity ratio, factor analysis and structural equation modelling within the context of high-speed railway projects, adding to the existing literature on infrastructure development in Indonesia. This research offers valuable insights for practitioners and policymakers involved in the planning and execution of large-scale infrastructure projects, potentially leading to enhanced cost efficiency and project success in similar projects in the future.

The 24-Hour Activity Checklist for Cerebral Palsy: Translation, Content Validity and Test-Retest Reliability of Portuguese Versions.

The importance of 24-h movement behaviour, including sleep, physical activity (PA) and sedentary behaviour (SB), has gained prominence due to its significant impact on the health and development of children, including those with cerebral palsy (CP). The 24-h activity checklist for CP, a tool developed in the Netherlands to monitor the activity in CP paediatric population, requires translation and cultural adaptation to Portuguese for use in Brazil and Portugal. This cross-sectional methodological study involved translating and culturally adapting the 24-h activity checklist for CP into Brazilian Portuguese (BP) and European Portuguese (EP) languages. The process included forward translation, synthesis and backward translation, expert panel evaluation and pretesting. Brazilian and Portuguese experts appraised content validity, assessed by the individual item (I-CVI) and scale level content validity index scores (S-CVI/Ave). Sixty parents of children with CP participated in the test-retest analysis, reported with the Intraclass Correlation Coefficients (ICCs). I-CVI scores were higher than 0.78 for both versions. S-CVI/Ave scores were considered excellent for BP (0.91) and EP version (1.0). Expert's appraisal results in the inclusion of a question about sleep-related time indicators and the split of sleep, PA, and screen time questions for weekdays and weekends. Brazilian and Portuguese parents of children with CP reported understanding on instructions, questions, and answer options. The ICC values range from 0.81 to 0.99 and 0.6 to 0.98, for BP and EP, respectively. The BP and EP versions of 24-h activity checklist for CP demonstrated good content validity and test-retest reliability, supporting its use in Brazil and Portugal. This tool can contribute to improving communication between families and healthcare professionals to monitor and develop tailored interventions for healthy movement behaviours in children with CP.

Return-to-Play With R2Play: Protocol for Evaluating Cross-Site Feasibility, Face Validity, and Content Validity of a Multidomain Concussion Assessment Tool for Youth.

Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport. To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data. Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total nc = 25) and 10 youth sport participants (ages 10-25y) with a history of concussion in the previous year (total ny = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1)changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2)youth-perceived physical and cognitive exertion for each level, and (3)overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity. This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.

Psychometric Properties of Dysphagia Handicap Index Scale for Older Adults with Oropharyngeal Dysphagia in China.

The impact of oropharyngeal dysphagia (OD) on older adults is recognized in Western countries but has not received sufficient attention in China. The dysphagia handicap index (DHI) scale is an OD quality-of-life evaluation instrument. This study evaluated the psychometric properties of the Chinese version of DHI scale in older Chinese adults. A total of 600 older adults were recruited from five nursing homes in one city to complete the 25-item scale. The reliability and validity of the scale were evaluated: internal consistency was investigated using Cronbach's alpha; test-retest reliability was evaluated using the intraclass correlation coefficient; the content validity of the scale was evaluated using content validity ratio; and the factor structure was examined using an exploratory factor analysis, principal component analysis, and confirmatory factor analysis. The scale was divided into three subscales: physical, functional, and emotional. Cronbach's alpha was 0.97 for the entire scale and between 0.89 and 0.94 for the three subscales. The item-to-total correlation coefficients for the three subscales were between 0.63 and 0.92, and the test-retest correlation coefficient was 0.87. The content validity was 0.93. In the factor analysis, these three factors accounted for 75.3% variance of 25 items. The confirmatory factor analysis was significant (p < 0.0001). The Chinese version of dysphagia index scale had good reliability and validity. Thus, it can provide a subjective evaluation of older adults with OD and can be used by clinicians to improve the outcomes of older adults with OD.

Development, content validation and feasibility of a decision aid tool for the treatment of women with menopausal symptoms.

Development, content validation and feasibility of a decision aid tool for the treatment of women with menopausal symptoms.

The Persian Version of the "Participation Measure-3 Domains, 4 Dimensions": Translation, Cultural Adaptation, Face and Content Validity

The Persian Version of the "Participation Measure-3 Domains, 4 Dimensions": Translation, Cultural Adaptation, Face and Content Validity

Nurses' Readiness to Implement the Critical-Care Pain Observation Tool in the Intensive Care Unit-Instrument Adaptation and Psychometric Analysis.

Ensuring effective pain assessment and management in intensive care units (ICUs) is crucial for promoting the well-being of patients. To develop and investigate the psychometric properties of an instrument designed to measure nurses' readiness for implementing the Critical-Care Pain Observation Tool in ICUs in Saudi Arabia. This study involved instrument adaptation and psychometric testing. A convenience sample of 160 ICU nurses, head nurses, in-charge nurses, and nurse educators. This study comprised two phases. Phase 1 focused on modifying the Acceptability to Intervention (AIM) Intervention Appropriateness Measure (Williams et al.), and Feasibility Intervention Measure (FIM), measuring the content validity and pilot testing the modified tool. Phase 2 involved the psychometric testing of the modified tool and assessing the nurses' readiness for implementing pain assessment in the ICU. The modified instrument was termed the Acceptability and Feasibility tool (mAFt). Academic and clinical expert panel feedback indicated satisfactory content validity. Exploratory factor analysis of the tool resulted in two factors: acceptability (10 items) and feasibility (5 items). The tool demonstrated high internal consistency with Cronbach's alpha values of 0.986 for acceptability and 0.951 for feasibility. The construct validity of the mAFt was supported as ICU nurses with higher education levels exhibited higher readiness scores. The results offer empirical support for the tool's credibility in gauging its readiness for implementation. However, further, psychometric assessments should be conducted with different nurse groups to validate the tool's effectiveness in diverse contexts.

Development and Validation of a Shortened Severity Measurement Tool for Tinnitus.

There is a need to develop and validate a brief questionnaire to measure tinnitus severity that can meet the needs of clinicians and researchers. The objective of this study is to demonstrate the validity and reliability of the 9-item Tinnitus Severity Short Form (TS-SF). A cohort study of online survey respondents recruited in October 2020 from the American Tinnitus Association electronic mailing list with a 2-week follow-up time interval. Online. Face and content validity, factor analysis, internal consistency, convergent validity, reliability, and minimal clinically important difference (MCID) were analyzed. Of 1121 participants that started the survey, 325 (29%) completed the baseline TS-SF. Through confirmatory factor analysis, the 9-item survey demonstrated a bifactor model with a substantive distress factor and a method factor. The instrument had high internal consistency with Cronbach's α of .96. Convergent validity determined the TS-SF score to be a predictor of tinnitus severity. Of 261 follow-up respondents, the test-retest reliability of r = 0.69 (95% confidence interval, 0.62-0.75) was determined. The MCID was determined using a distribution approach to be a 12-point change. The TS-SF demonstrates good internal consistency, validity, and reliability. This patient-reported outcome measure for tinnitus can be used in tinnitus treatment trials and clinical practice. The 9-item survey is less likely to result in respondent survey fatigue than longer surveys, and the 2-week reference interval allows for monitoring of tinnitus severity change in an appropriate timeframe.

Points of contention in measure evaluation can arise from the use of divergent validity frameworks: A reply to Conway et al. (2025).

This reply to Conway et al. (2025) illustrates how points of contention in the evaluation of mindreading (or theory of mind) measures can arise from the use of divergent validity concepts. The construct validity model used in Wendt et al.'s (2024) empirical study contrasts with the perspective implicit in Conway and colleagues' commentary, which is more consistent with Lennon's (1956) content validity model. This is reflected in the authors' conception of the nature of what is to be measured (i.e., the measurand), the criterion for what makes a measure superior (i.e., validity), and the proposed methods for judging this (i.e., validation). The mismatch between the validity concepts adopted by the respective authors has three major implications: First, Conway and colleagues' critique does not fully address the specific goals, assumptions, and intricacies of construct validation methodology. Second, their approach to measuring mindreading should not be confused with, or considered as an alternative to, construct validation but is valuable in its own right. Third, the two validity frameworks mentioned offer unique opportunities for different phases of the research process. While a content validity approach can be valuable for describing an empirical phenomenon that seems worthy of explanation (e.g., real-world mindreading), a construct validity approach can identify the theoretical constructs that might help explain it (e.g., mindreading ability). (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Validity and reliability of &lt;i&gt;SmartShield&lt;/i&gt; questionnaire for sexual abuse prevention among primary school children

Child sexual abuse is a critical public health issue, affecting one in eight children worldwide. This study evaluates the validity and reliability of the &lt;i&gt;SmartShield&lt;/i&gt; questionnaires, designed to assess knowledge, attitudes, and skills related to sexual education and abuse prevention among primary school children. The &lt;i&gt;SmartShield&lt;/i&gt; 1 and &lt;i&gt;SmartShield&lt;/i&gt; 2 questionnaires underwent validation processes, including expert content validation, face validation with teachers, and internal structure assessment involving 167 children in Kota Bharu, Kelantan. The results indicated strong content validity index averages of 0.90 and 0.91, and face validity index averages of 0.87 and 0.89, both exceeding established cut-offs. Additionally, the internal consistency, measured by Cronbach’s alpha, showed acceptable values for both questionnaires. Overall, the &lt;i&gt;SmartShield&lt;/i&gt; questionnaires are validated tools for assessing children’s knowledge, attitudes, and skills regarding sexual education and abuse prevention. These instruments are valuable for future research aimed at evaluating the effectiveness of sexual abuse prevention programs.

Knee osteoarthritis emotional meaning scale development study.

Knee osteoarthritis (OA) is a chronic, long-term disease with both physical and psychosocial consequences. In determining the treatment programs of patients diagnosed with knee OA and ensuring compliance with treatment, it is important to understand the emotional attitudes and experiences of patients regarding the physical and psychosocial effects of the disease. This study aimed to create a scale for evaluating the emotional attitudes of patients with knee OA as they manage and cope with the condition. The research was a validity and reliability study designed using methodological methods. Study data were collected from the Department of Physical Therapy and Rehabilitation at a university hospital in Turkey between November and December 2024. The study sample included 90 patients diagnosed with knee OA. To establish the validity of the scale, content validity and construct validity were assessed. Internal consistency was determined using Cronbach's alpha reliability coefficient, item-total score correlations, and the Hotelling T2 test. The test-retest method was applied to determine the scale's stability over time. The content validity index (CVI) values for the draft form of the scale ranged between 0.91 and 1.00. The exploratory factor analysis indicated that the scale consisted of a single factor, which explained 41.62% of the total variance. The scale demonstrated strong reliability, with a Cronbach's alpha coefficient of 0.86, item-total correlations ranging from 0.36 to 0.73, and a significant Hotelling T2 value (P < 0.001). Test-retest analysis indicated a positive and highly significant correlation for the overall scale (r = 0.964, P < 0.001). The knee osteoarthritis emotional meaning scale (KOEMS) was demonstrated to be a valid and reliable instrument for this patient sample.

Language Assistant Programs and CLIL: Developing and Validating Questionnaires to Determine Program Training Needs

Research on language assistants in content and language integrated learning (CLIL) classrooms in the context of Spain has been scarce. Given the unique, demanding nature of CLIL instruction, more investigation into the implementation of language assistant programs in CLIL using validated research tools is essential. Therefore, this paper outlines the process for developing and validating questionnaires created to analyze the perceptions and training needs of language assistants, CLIL teachers, and bilingual program coordinators in relation to effectively implementing language assistant programs in CLIL. In this study, three questionnaires were created for three specific cohorts (i.e., language assistants, CLIL teachers, and bilingual program coordinators). The first step of the double-fold pilot process used to validate the questionnaires entailed an expert rating approach, where the experts rated each item’s clarity, precision, and relevance, followed by rating the entire questionnaire’s logical order, number of items, and content validity. The second step involved a pilot study conducted among all three cohorts. Next, Cronbach’s alpha was calculated for each section of the three questionnaires, except for demographic information, and for each questionnaire as a whole. The results show that all sections and questionnaires are internally consistent and thus could be used in a wide array of studies analyzing the implementation of language assistant programs in CLIL. The questionnaires allow the use of data source triangulation to determine the training needs of three cohorts in both their CLIL pedagogical knowledge and language assistant program implementation skills, specifically in a secondary school classroom setting.

Tele-patient-reported outcome measures (telePROM) in follow-up of endometriosis: a validity and test-retest reliability study of an endometriosis-specific questionnaire (EQ)

Objective Patient-Reported Outcome (PRO) measures supported by a severity algorithm may serve as a decision aid for triage and consultation in follow-up of patients with endometriosis. In a new follow-up regime, patients filled out an endometriosis-specific questionnaire (EQ) at home before outpatient consultation (tele-Patient-Reported Outcome Measures; telePROM). A severity algorithm was assigned patients’ answers using a color code thereby reflecting the need of clinical attention. Our study aimed to assess the test-retest reliability of the severity algorithm and of the single items as well as to evaluate the face- and content validity of the EQ. Methods The study was carried out in a referral endometriosis clinic at a Danish University Hospital. The validation was based on an initial version of the EQ, which was adjusted simultaneously with its severity algorithm, to meet the purpose of this study. Reliability was assessed by a test-retest setting of the questionnaire including patients with endometriosis, ≥ 18 years and Danish speaking. Kappa statistics and interclass correlation analyses were applied to assess test-retest reliability. Face- and content validity was explored by focus group interviewing of patients. Results In total, 14 patients answered the questionnaire twice. Results indicate that the EQ demonstrated substantial reliability in three out of five domain indicators in the severity algorithm and 65% of items with kappa values above 0.60. Further, focus-group interview of five patients resulted in adding an open-ended question regarding important issues to discuss at the consultation. Conclusion TelePROM in outpatient follow-up of endometriosis is feasible as patients viewed the questionnaire relevant for their clinical follow-up. Yet, due to the small sample size results should be interpreted with caution. Further validation of the EQ is recommended.

A protocol for validation of the Handover Evaluation Scale in multicultural ICUs.

Effective handover communication by nurses is essential to ensuring care continuity, care quality and patient safety and minimizing the risk of adverse events. Notably, the increasing globalization of the nursing profession and the resulting rise of multicultural workplaces in health care can affect handover communication. However, no tools have yet been developed to evaluate the current practices and factors contributing to effective handover in multicultural care settings, even though such instruments are deemed necessary to identify communication challenges and opportunities for improvement. This paper describes the protocol that will be used in a proposed study that aims to adapt and validate an existing instrument for measuring handover quality-namely the Handover Evaluation Scale. The proposed study will also examine the factors contributing to effective handovers in a multicultural critical care context using a sequential exploratory mixed-method and will involve a qualitative and a quantitative phase. The first phase will explore Saudi Arabian ICU nurses' perceptions of effective shift handovers and the factors influencing handover quality. Data will be collected by recruiting 20 nurses through purposive sampling for semi-structured interviews. Interpretive description will be used to analyse the data to identify items useful for modifying the tool. Next, the tool will be modified based on the qualitative findings. Lastly, a quantitative study will be conducted based on the results of the first phase to assess the instrument's reliability and content validity and determine its internal dimensional structure. This paper describes the study protocol that will be applied to adapt and validate an existing tool to measure the quality of handover in multicultural ICUs, using an exploratory sequential mixed-methods design. The protocol described in this paper provides a framework for an adaptation of the Handover Evaluation Scale to measure handover effectiveness and to identify current challenges and factors affecting handover effectiveness in the multicultural critical care context. This version of the scale can be applied in clinical practice to determine best practices for improving handover.

Investigation the Psychometric Properties of the Persian Version of Nursing Student Satisfaction Scale for Nursing Program

Abstract Background: Evaluating the efficacy of educational programs is a good way to assess the current situation, which requires the use of valid tools in this area. Therefore, the purpose of this study was to translate and evaluate the psychometric properties of the Persian version of the Nursing Student Satisfaction Scale (NSSS). Materials and Methods: The NSSS was translated from English to Persian using the standard forward-backward method. After face validity, content validity was performed with qualitative method and quantitative method with CVR and CVI calculation for each item. Using convenience sampling, 297 nursing students were selected and completed the questionnaire. Exploratory factor analysis (EFA) and Confirmatory Factor Analysis (CFA) in SPSS and AMOS software were used to evaluate the construct validity of the scale. Results: In face validity, some items were modified based on the opinion of the target group. Item impact score for each item was at least 1.7 to 2.5. Moreover, S-CVI/Ave = 0.966, S-CVI/UA = 0.706, and the content validity ratio for each of the items was 0.87-1. According to the results of factor analysis, the three factors introduced in the main tool were approved with acceptable values. All indices of CFI = 0.906, χ2/df = 1.572, and RMSEA = 0.0609 confirmed the fit of the final model. In addition, the reliability of the instrument obtained using the internal matching method (Cronbach’s alpha) for the whole instrument was 0.90. Conclusions: The Persian version of the NSSS has acceptable psychometric indicators in the population of Iranian nursing students.

Qualitative research and literature review support the integrated Alzheimer's Disease Rating Scale (iADRS) content validity in early symptomatic AD.

The integrated Alzheimer's Disease Rating Scale (iADRS) is a measure of cognition and daily function used to evaluate treatment effects in Alzheimer's disease (AD) clinical trials. This study aimed to assess the content validity of the iADRS in early symptomatic AD, and to determine whether integrating assessment of cognition and function into a single measure of global disease severity is supported by the patients' experience. A targeted literature review of qualitative research in AD and qualitative interviews with 25 care partners of individuals with early symptomatic AD were conducted. Interviews started with open-ended concept elicitation exploring the patient experience of AD from the care partner perspective, including how cognitive changes affect daily functioning. This was followed by cognitive debriefing of the ADCS-iADL items. Interview transcripts were analyzed thematically. Concepts extracted from the literature review and interviews were categorized into a conceptual model of patient experience of AD. A concept-to-item mapping exercise was conducted to assess the conceptual coverage of the iADRS. The literature review comprised sixty articles. Interviews were conducted with care partners of 7 individuals with Mild Cognitive Impairment (MCI)-AD and care partners of 18 individuals with dementia due to AD. The resulting conceptual model incorporated 75 concepts related to AD experience categorized into three overarching domains: Cognition, Daily Function and Other Symptoms/Impacts. Interview findings endorsed the close link between cognition and daily function. Concept-to-item mapping demonstrated all Cognition and Daily function sub-domains within the model were assessed by at least one iADRS item, except Work/Professional, providing supportive evidence that the iADRS covers concepts that reflect the patient experience of early symptomatic AD. This study offers a comprehensive conceptualisation of the patient experience of early symptomatic AD and highlights the intrinsic connection between cognition and daily function. The findings endorse the relevance of an integrated assessment of cognition and function and provide strong evidence for the content validity of the iADRS, highlighting its utility as a meaningful clinical outcome assessment (COA) for use as an endpoint in AD.

Preparation for the Implementation of the International Classification of Diseases 11th Revision: A Survey on Clinical Coders' Knowledge of the International Classification of Diseases 11th Revision, Educational Needs, and Readiness to Accept New Roles: A Cross-Sectional Study.

Studies have shown that the knowledge and skills of clinical coders impact the quality of clinical coding, and professional training for clinical coders is essential to ensure coding quality. Like other countries, Iran should establish the required infrastructure to promptly implement ICD-11. One of the essential infrastructures is clinical coders' familiarity with and skills in utilizing ICD-11. The purpose of this study was to investigate clinical coders' knowledge of ICD-11, their educational requirements, and their willingness to assume new responsibilities following the implementation of ICD-11. This was a survey conducted during 2021-2022. A researcher-made questionnaire including five parts was applied as an instrument. Ten experts confirmed the content validity of the questionnaire, and CVR and CVI were applied to measure content validity. In addition, test retest was used to assess the reliability. A Likert scoring scale was used to measure the responses. The research population consisted of all clinical coders working in Iranian health facilities. Data were analyzed using descriptive statistics, Pearson's χ 2, and Independent Samples t-test. Totally, 453 people responded to the questionnaire. Twenty-nine percent of the participants were familiar with the ICD-11. The relationship between the level of familiarity with ICD-11 and age, gender, ICD-10 coding skills, and work experience was not statistically significant. Moreover, the lack of training courses was the main reason for not being familiar with ICD-11. In addition, the participants believed that skill in using ICD-11 tools had more priority than other educational axes. According to the majority of clinical coders, they may not be ready to accept new roles if ICD-11 is implemented. This study revealed that familiarity with ICD-11 was low. Therefore, a training program is necessary to meet the needs of the target groups for nationwide ICD-11 education.