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

Climate change is recognized as the most significant health threat to humanity, with healthcare systems contributing substantially to greenhouse gas (GHG) emissions. Operating theatres, as the most energy-intensive areas in hospitals, are a critical focus for reducing environmental impacts. Despite the evident need for action, knowledge gaps and limited education on climate change within healthcare persist. The aim of this study was to reach consensus on appropriate survey items for evaluating healthcare professionals' knowledge and perceptions about climate change in operating theatre settings. Using the Delphi method, a consensus study was conducted with eight experts, including nurses and doctors, from Italian healthcare settings. The study involved two rounds of surveys, achieving a consensus of ≥75 % on 28 questions categorized into seven modules: sustainable practices, understanding climate change fundamentals, its impacts on healthcare, climate-smart actions, implementation likelihood, and barriers to change. A total of 28 survey items across seven thematic modules were validated. All items achieved full consensus (≥87.5 %) with high Content Validity Ratios (0.75-1.0). Expert feedback led to improved clarity, contextual relevance, and practical examples. This study provides a shared and valid survey to measure healthcare professionals' knowledge and perceptions about climate change in operating theatres. Future research should test this instrument in larger samples and different contexts to guide interventions that help the nursing workforce advance sustainable healthcare and align with global climate goals.