Development and application of a quality evaluation scale for ERAS health education in gynecologic malignancies

To develop a quality evaluation scale for ERAS health education in gynecologic malignancies and examine its reliability and validity, providing a dedicated assessment tool for clinical health education quality management that complements-rather than replaces-ERAS clinical compliance audits.

Guided by the Donabedian structure-process-outcome model, an initial item pool was established through literature review and semi-structured interviews. Two rounds of Delphi consultation with 18 experts were conducted to screen items. A supporting implementation and evaluation protocol was developed simultaneously, specifying delivery agents, timing, formats, evaluation methods, and feedback-improvement mechanisms. A total of 116 perioperative patients with gynecologic malignancies were enrolled for reliability/validity testing and clinical application.

The final scale comprises 4 primary dimensions, 22 secondary indicators, and 36 tertiary items, corresponding to admission, preoperative, postoperative, and discharge education stages, with a total score of 100. Response rates for both Delphi rounds were 100%, with authority coefficients (Cr) of 0.897-0.914. I-CVI ranged from 0.833 to 1.000 and S-CVI/Ave was 0.946. KMO was 0.821; four factors were extracted with a cumulative variance of 51.60%. Cronbach's α for the total scale was 0.890, and test-retest ICC was 0.925. Clinical application showed a total score of 86.7 ± 8.4. Discharge education emerged as the weakest domain (scoring rate 84.3%), with all four items scoring <70% concentrated in this dimension: psychological counseling and peer support (60.0%), sexual life resumption guidance (63.0%), home medication guidance (65.9%), and home activity/nutrition/wound care (68.1%).

The scale demonstrates good reliability and validity. As a dedicated tool for evaluating ERAS health education quality, it complements rather than replaces comprehensive ERAS compliance audits, enabling identification of weak links and continuous quality improvement. Its association with core ERAS outcomes warrants further validation through multicenter prospective studies.