Content Validity of the CHANT's French-Language Translation and Cultural Adaptation: A Modified E-Delphi Study

Background/Objectives: Climate change is a major global health challenge with direct implications for public health. As frontline health professionals and agents of change, nurses must develop competencies to address climate-related health issues and implement sustainable practices. This study aimed to translate and culturally adapt the Climate, Health, and Nursing Tool (CHANT) into French and to assess its content validity using item-level and scale-level content validity indices (I-CVI and S-CVI, respectively). The CHANT evaluates nurses' awareness, motivations, concerns and self-reported behaviours related to climate change. A secondary objective was to examine potential associations between experts' sociodemographic and professional characteristics and their CVI ratings. Methods: A descriptive international study using a three-round modified e-Delphi approach was conducted between January and June 2025 in French-speaking regions of Switzerland, France and Belgium. A multidisciplinary panel of experts in nursing, planetary health and environmental sciences evaluated the relevance, clarity and comprehensiveness of each item and response option, enabling iterative refinement. Results: The original 12-item CHANT was evaluated by 17 experts in Round 1. Following expert recommendations, one additional item was incorporated, resulting in a 13-item version, which was subsequently evaluated by 15 experts in Round 2 and 25 experts in Round 3. Across the three Delphi rounds, 57 completed expert evaluations contributed to the iterative refinement of the instrument. Round 1 I-CVI ranged from 0.79 to 1.0, and S-CVI reached 0.935, with full consensus. Round 2 I-CVI ranged from 0.71 to 1.0, and S-CVI was 0.91 (92% consensus), with one item not meeting the predefined threshold. Round 3 I-CVI ranged from 0.82 to 1.0, and S-CVI returned to 0.935, confirming consensus. A final linguistic, semantic and cultural review conducted by the research team ensured the conceptual consistency and cultural appropriateness of the translated instrument. Conclusions: The French-language version of the CHANT demonstrated satisfactory content validity and provides a culturally adapted instrument to assess climate-related competencies and eco-literacy in nursing education and practice. Further psychometric evaluation is warranted.