Assessing the content validity of the migrant health country profile tools in Tunisia: A mixed methods study protocol

Human migration is a historical constant, yet integrating migrant populations into health policy and systems remains a challenge. As highlighted by UN agencies and The Lancet Migration Commission, a key issue exacerbating inequities is the lack of data on disease indicators and healthcare access for migrants, with existing datasets often fragmented. Our transdisciplinary consortium co-developed the Migrant Health Country Profile tools (MHCP-t) - an innovative package of three survey tools that nationally map migrant health data sources (MHCP-t: Data tool), document migrant health policies and the integration of migrants in policies (MHCP-t: Policy tool), and the integration of migrants into healthcare provision (MHCP-t: Provision tool) for key diseases. This protocol describes a mixed-methods validation study investigating the content validity, feasibility, and acceptability of the MHCP-t in Tunisia.

We will recruit a purposive sample of 40-50 national experts in migration health to complete one of the three MHCP-t according to their expertise. Two subsequent surveys will evaluate: 1) item-level content validity (relevance, comprehensiveness, and comprehensibility for individual items) for the MHCP-t: Policy and MHCP-t: Provision, where items function as indicators of the extent to which migrants are integrated into health policies and service provision and therefore require direct assessment at the item level, and 2) tool-level validity, feasibility, and acceptability for all three tools, including the MHCP-t: Data tool, where the primary objective is to assess the comprehensiveness and relevance of the inventory as a whole rather than the validity of individual items as indicators. This will be followed by focus group discussions with a nested sub-sample of approximately 10-15 participants from the initial survey to provide qualitative depth of participants' perspectives. Item-level content validity will be analysed using the Item/Scale Content Validity Indices and Krippendorff's Alpha (α). To assess the level of agreement, the interquartile range will be calculated for each item based on Likert scale ratings (1-5). The second survey will be analysed using descriptive statistics while qualitative data will undergo thematic analysis.

Findings will be disseminated via peer-reviewed publications, conferences, and other formats relevant to different stakeholders. By integrating these findings, the study will determine the tools' appropriateness for mapping migrant health data sources, policies, and service provision, informing their potential for wider national rollout across the MENA region and other contexts.