Validation of the Persian Triage Decision-Making Inventory (TDMI): a cross-cultural adaptation study

BACKGROUND: Effective triage decision-making is crucial in emergency care, requiring healthcare personnel to possess strong cognitive abilities, experience, and intuition. The Triage Decision Making Inventory (TDMI) is a standardized tool designed to assess these competencies. However, cultural and linguistic differences necessitate the adaptation and validation of such tools for specific populations. This study aimed to translate, adapt, and validate the Persian version of the TDMI to ensure its applicability in Iran and other Persian-speaking countries. METHODS: In 2024, a cross-cultural psychometric evaluation was conducted on 217 emergency nurses and technicians in hospital and prehospital settings in Tehran, Iran, following ethical approval. The translation process followed the Bullinger Method, involving forward and backward translation, expert panel review, and cognitive debriefing. The psychometric evaluation assessed the following: face validity, content validity (Content Validity Ratio [CVR] and Content Validity Index [CVI]), construct validity (exploratory and confirmatory factor analysis), convergent and discriminant validity, and reliability (Cronbach’s alpha, McDonald’s omega, and test-retest reliability). RESULTS: The Persian TDMI demonstrated excellent face and content validity, with all retained items exceeding the minimum CVR (0.61) and I-CVI (0.78) thresholds. Exploratory factor analysis (EFA) identified three factors explaining 66.68% of the total variance, with five items removed due to low factor loadings or cross-loading. Confirmatory factor analysis (CFA) supported the three-factor structure, achieving satisfactory fit indices (CFI > 0.9, RMSEA < 0.08). The instrument exhibited high internal consistency (Cronbach’s alpha = 0.91) and strong test-retest reliability (ICC = 0.88). CONCLUSION: The Persian version of the TDMI is a valid and reliable tool for assessing triage decision-making competencies among Persian-speaking emergency personnel. Its application in research and training can enhance triage accuracy, optimize resource allocation, and improve emergency care outcomes in Iran and other Persian-speaking regions. The Persian version of the TDMI can be used for training, professional development, and performance evaluation, ultimately promoting more consistent and evidence-based triage decisions, particularly in Iran and other Persian-speaking countries. TRIAL REGISTRATION: Not applicable.