Content validity of digital health competence measures for nursing in South Africa

The increasing use of digital technology to improve healthcare outcomes for patients and institutions requires that nurses have adequate levels of digital competence, measured by psychometrically sound measures. However, most measures are developed in high-income countries and have not been adapted to other settings. Therefore, this study aimed to determine the content validity of two measures, developed in Finland, that measure digital competence (DigiHealthCom) and influences on digital competence (DigiComInf), for their application in South Africa.

Participants were predominantly nurses from private and public facilities in South Africa who completed an online content validity rating scale (n = 12) South Africa by rating the relevance and clarity of each item and subscale of competence (DigiHealthCom) and influence (DigiComInf). Of these, ten participated in an online focus group discussion. Ratings were analysed by calculating individual item content validity indices (I-CVI) and scale and subscale average content validity indices (S-CVI/Ave).

I-CVI values for relevance and clarity were mostly >.78, except for some items in the "human-centred remote counselling competence" subscale (DigiHealthCom) and one item in DigiComInf. S-CVIs were sufficient for DigiHealthCom (S-CVI_relevance/Ave = 0.86, S-CVI_clarity/Ave = 0.87) and DigiComInf (S-CVI_relevance/Ave = 0.95, S-CVI_clarity/Ave = 0.89). The focus group discussion highlighted several concerns, such as the absence of discerning, contextually relevant definitions for the constructs measured, lack of clarity about the target population, and applicability of certain items to different healthcare contexts.

Adaptations included adding relevant definitions, clarifying the target population or management level, adding a "not applicable" option to the rating scale and clarifying the meaning or context using appropriate alternative words. The final measure was approved by the participants and the original authors of the measures.