Clinical Simulation in Nursing (2016) 12, 530-531

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Making Sense of Methods and

Measurement: Lawshe’s Content
Validity Index
Gregory E. Gilbert, EdD, MSPHa,b, Susan Prion, EdD, RN, CNEc,*
a
DMI’s-IRCS, Iselin, NJ 08830, USA
b
Center for Teaching and Learning, Ross University School of Medicine, Roseau, Dominica, West Indies
c
School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA

Calculating Lawshe’s Content Validity Index
Simulation performance evaluation is a complex and
complicated process. To produce valid and reliable assess-
ment data, the instruments used to gather the data must be
empirically grounded. In previous columns, we have
discussed reliability (Adamson & Prion, 2012a) and validity
(Adamson & Prion, 2012b, 2012c). In this column, we
extend our understanding of validity by introducing Law-
she’s Content Validity Ratio (CVR) and Content Validity In-
dex (CVI) used to quantify validity of an assessment
instrument or tool as evaluated by review of clinical experts.
A validity study begins with gathering evidence-based
items for potential inclusion in the instrument or tool. If a
skill is being assessed, locate the best practices for perform-
ing the skill and include all the steps for conducting that
skill listed by all sources. Once the items to be evaluated
have been collected, a Content Evaluation Panel is formed.
The Content Evaluation Panel should be composed of per-
sons who are experts about the domain being studied.
Ideally, there should be a range of experts (also known as
subject matter experts) on this panel at various professional
levels. In content areas where it is difficult to find experts,
the use of three experts is acceptable; normally, a panel of
5-10 experts is preferred. The use of >10 experts is prob-
ably unnecessary (Lynn, 1986). For example, if assessing
the validity of a task trainer used for urinary catheterization,
an investigator could assemble a group of nurses, nurse
* Corresponding author: prions@usfca.edu (S. Prion).
practitioners, and physician assistants. These are experts
representing practitioners who regularly insert urinary
catheters.
Each member of the panel is supplied the list of
evidence-based items chosen by the researcher to represent
the construct or skill (Figure 1). Independent of the other
panelists, each panelist is asked to rate each of the items
as ‘‘essential,’’ ‘‘useful,’’ or ‘‘not necessary.’’ A weighted
value is assigned to each rating.
Responses from all panelists are pooled, and the number
indicating ‘‘essential’’ for each item is determined.
Calculating the Content Validity Ratio
The CVR is an item statistic useful in rejection or
retention of individual items and is internationally
recognized as the method for establishing content
validity (Wilson, Pan, & Schumsky, 2012). The CVI is
the mean CVR for all the items included in the final in-
strument (DeVon et al., 2007). When all panelists say
that the tested knowledge or skill is ‘‘essential,’’ or
when none say that it is ‘‘essential,’’ we are confident
to include or delete the item. It is when there is not
consensus that item issues arise. Two assumptions are
made, each of which is consistent with established psy-
chophysical principles:
 Any item, performance on which is perceived to be
‘‘essential’’ by more than half of the panelists, has
some degree of content validity.

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Making Sense of Methods and Measurement: Lawshe’s Content Validity Index
Is the skill (or knowledge) measured by this item
o Essential?
o Useful but not essential? Why?
o Not necessary? Why?
Figure 1 Lawshe’s method for assessing content validity.
 The more panelists (beyond 50%), perceiving an item
as ‘‘essential’’, the greater the extent or degree of its
content validity.
The CVR is calculated using the shown in Figure 2:
where:
ne is the number of panelists identifying an item as “essential” and
N is the total number of panelists (N/2 is half the total number of panelists).
Figure 2 Equation to calculate Lawshe’s Content Validity Ratio
(CVR).
When all panelists agree an item is ‘‘essential,’’ the CVR
is 1.00 (adjusted to 0.99 for ease of manipulation according
to Lawshe [1975]). When the number of panelists rating an
item ‘‘essential’’ is more than half, but less than all, the
CVR is somewhere between 0 and 0.99. If none of the
raters marks the item as ‘‘essential,’’ the CVR would be 0.
Item Selection
A CVR is calculated for each item. Items are eliminated
possibly occurring due to chance using a table of critical
values found in Ayre and Scally (2014). Alternatively, Polit,
Beck, and Owen (2007) suggest items with a CVR of 0.78
or higher with three or more experts could be considered
evidence of good content validity. If an item does not reach
this threshold, it would normally be deleted from the final
instrument.
Content Validity Index
The CVR tells us about the validity of individual items. If
we want to know the content validity of the entire instrument
pp 530-531  Clinical Simulation in Nursing  Volume 12  Issue 12
531
or tool, we can calculate a CVI. The CVI is simply the mean
of the CVR values for all items meeting the CVR threshold
of 0.78 and retained for the final instrument. Tilden, Nelson,
and May (1990) suggest CVI values exceed 0.70; however,
Davis (1992) suggests a CVI exceeding 0.80 is preferred. In
many situations, it is more efficient to report the overall CVI
score than each individual item CVR.
The CVR is a useful statistical technique to determine
the validity of individual instrument items, as rated by a
panel of content experts. The CVI provides a numeric value
for the overall mean CVRs of all items included in the
instrument. Both the CVR and CVI can provide researchers
and consumers with a quantitative measure of the validity
of a simulation evaluation instrument.
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