will add substantially to readers’ con- fidence in their evaluation of the research, rs Roterences Cousens, 7, Sara, A, BLACKBURN, BSH "van By ScmorDt B Rerwsh, De & ‘onmoe, A’ (198), Aneto for ase ihe quality of a randomized contol ta ote Ctl a 3 Set cone) (1077), Stotstel power analy for the Bhaolratacenes red) New Yak dheademie Pres DenSiwonhn, fey CAARETE, Te, MePERR, Monretisn F-(1982). "Reporting. of tretbods i-lilal tia, New. Englend Journal of Medline, 306: 1938-198T Ditns D. (199) Reseerch nursing race. Philadelphia: J. B. Lippincott, Dumiss, RG, & LEONanD, fC. (1953). The effect of nursing’on the incidence of postop- trative vomiting, Nursing Research, 1211), sty FFeINsTeIy, A. R (1995), Clinical epidemtolo- 4 Philadelphia: Piadtpie: WB Suan- FFREMIAN, Jo, Cuaunens, T., Sveti, HL, & even (1978) The importane of beta, ype, Tt error and sample skin the @ [here nigtcann and any eomanigue point a loan of the instrument must be given to the experts (Kerlinger, 1978). Al- though the persons selected have al ready been determined to have ex- pertise in the content/domain area(s) of the instrument, it is not sufficient to supply them with the instrument and simply ask if it is content valid. ‘They must be given a set of specific instructions by which to determine the domain or content relevance of the items and also of the instrument as a whole (see McCain, 1984). The experts should be provided with ei- ther a delineation of the full content domain for cognitive instruments or dimensions of the affective variable, with specific questions pertaining to the content relevance of each item. The most widely used quantifica- tion of content validity is the index of content validity (CVI), which is de- rived from the rating of the content relevance of the items on an instru- ment using a 4-point ordinal rating scale, where 1 connotes an irrelevant item’ and 4 an extremely relevant item. The actual CVI is the propor- tion of items that received a rating of 8 or 4 by the experts (Waltz & Bau- sell, 1981), Use of the CVI in both steps of the judgment stage of content validity determination necessitates extension of the CVI to item evaluation as well as entire instrument evaluation. The CVI for each item (Step 4) is deter- mined by the proportion of experts who rate it as content valid (a rating of 8 or 4); the CVI for the entire instrument (Step 5) is the proportion of total items judged content valid Waltz and Bausell (1981) posed two limitations to the CVI procedure for the assessment of content validity: The possibility of chance inflation (agreement) of the CVI and the dependence of the CVI on the num- ber of categories used in the rating, in 384 that a four-option scale is not univer sally used in CVI determinations. ‘These limitations can be controlled by using the methods discussed in this article, ‘The first limitation is ad- dressed in the selection of the number of experts and the minimum number that must agree by using a significant combination from Table 2. The sec- ond concern would be controlled by establishment of a 4-option rating scale (1 = not relevant; 2 = unable to assess relevance without item revi- sion or item is in need of such re MOVING? GIVE US YOUR NEW ADDRESS SIX WEEKS AHEAD To ensure prompt service when you change your address or when: fever you write to us about your NURSING RESEARCH subscription, please include your address label from _a recent issue of NURSING RESEARCH. Address your corre ‘spondence to Subscription Depart- ment, NURSING RESEARCH, 555 West 57th St, New York, N.Y. 10019-2061 ‘Af address label here when send: ing address change, Clearly print NEW address, The expiration date of your subscription is toward the tight end of the top line of your address label, followed by month, eg. 86 Sept. Name Aadiess ity State 2p. that it would no longer be relevant; 8 relevant but needs minor alter tion; 4 = very relevant and succinct) for all content validity assessments, The scale should be both mathemati- cally and conceptually meaningful, Although a 8- or 5-point rating scale might be considered, the 4-point cale is preferable because it does not include the ambivalent middle rating common in odd number rating scales. Using a 4-point rating scale should provide the instrument developer with sufficfently delineated informa- tion upon which to calculate a mean- ingful CVI The experts, in addition to judging cach item, should identify any area(s) that have been omitted from the instrument. If omissions are identi- fied although the entire instrument is assessed as content valid, further clar- ification may be necessary. If no omissions are identified and the in- strument is judged content valid by the experts, in conjuction with the knowledge of the magnitude of the VI values, the content validity of the instrument may be asserted, Should an expert identify no areas of ‘omission, evaluate the items positive- ly, and, yet, not assess the instrument as content valid, doubt about the per- son's expertise should lead to consid- ering replacing that person as an expert. Suggestions for item improve- ment may be requested from the experts, however, without interfering with the content validity judgment Ttems that do not achieve the required minimum agreement of the experts (Table 2) should be elimi- nated or further revised. It is certain- ly possible that several items, and, therefore, the entire instrument, need to be evaluated more than once in order to obtain sufficient content va~ lidity. In this case, the instrument developer should determine whether NURSING RESEARCHto use the same experts or obtain new, but equally qualified, replacement experts. Should the same experts be used in repeated assessments of an instrument, a 10- to 14-day period between assessments should be a suf- ficient time interval (see McCain, 1984). This process for content validity determination may also be applied to existing instruments, for the validity of many such instruments either has never been reported or has been ply untested. Given that the instru- ment has been already created, Steps 2and 8 may not be applicable if, by completion of the content validity process, acceptable content validity is determined. In the event that content validity is not sufficiently achieved, with the instrument developer's per- mission, Steps 2 and 3 (item and instrument revision) may also be in- corporated to eventually obtain con- tent validity. Summary: The arbitrary assertion of two or three experts does not estab- lish content validity. Application of a two-stage process that incorporates rigorous instrument development practices and quantifies the aspects of content validity is required. In the first stage of this process, the content domain or dimensions are identified and items are generated to reflect the scope of the content domain of 2 cog- nitive variable or each of the dimen- sions of an affective variable. Once generated, the items are assembled in a usable, testable format. The instru- ment and domain or dimension spec- iffeations are then presented toa pan- elof experts, the size of which is an a priori decision, for their judgment of the items using a 4-point ordinal rat- ing scale, Using the item evaluation, CVI calculations are applied to both the items and the entire instrument. The experts are asked, as a part of the content validity assessment, to identi- fy areas of omission and to suggest areas of item improvement or modifi- cation. ‘Admittedly, there are times when adherence to such rigor may not be feasible. When less stringent methods of determining validity are appl should not be said that content valid- ity has been determined. Opponents of the process described in this article might argue that these specifications and expectations exceed practical ap- plication and that this process is NOVEMBER/DECEMBER 1986 VOL. 35, NO. § THEVERAE BENDER VISITING PROFESSORSHIP ENDOWED CHAIR This fully endowed chair will support distinguished and nationally recognized scholars interested in highly individu- alized, creative and innovative one-year positions, beginning September 1987. The successful candidate will have the opportunity to engage in scholarly acti- vities with faculty of the School of Nurs- ing and the University at large. This in- dividual can develop course(s) and scholarly activity, consistent with his/her qualifications and interests within the context of the doctoral program's goals of theory development and research. In- terested applicants are invited fo send resumes ond a proposal planto: Harriet R. Feldman, Ph.D, RN., Assistant Dean for Academic Administration, ADELPHI UNIVERSITY, MAB School of Nursing, Box 516, Garden City, NY. 11530 rivet ban EAA Employer Adet therefore too rigorous. Content valid- ity, by. its nature and definition, demands rigor in its assessment, and its assessment is, in fact, critical. Such 4 rigorous process for content validity determination is offered because con: tent validity is an inexpendable form of validity which is rapidly losing credibility due to its less than stan- dardized and rigorous assessments. Content validity, different from all other forms of validity, is crucial to the understanding of research find- ings and their practical or theoretical applications. It is worth the rigor. oteronces Brown, F. (1980, Perpectvs on valid NCME Measurement News, 23(3), 3-4. cannes, EG ertan eA: GS) Ra lly and sai assessment. Beverly cnn wet (1970). Essentials of oh onsite ental of meycho nea tesigrde Now Se Meeps aa Roe DownteN ML, & eam, RW (1974 Base State pithods (ath ed} New York i he Guiurono. |. 858) Pectometrc meth New York Mera Jenaey, AR 080) as in ment tating UNIVERSITY. [phi New York: The roe Pres xentincen, F. (1073) Foundations of behae ioral research (2nd ea) New York: Hoh, inebart and Winston MeCaWn, NL (1984) A ist of Cohen's devel. opmental model for profesional soctllea on with Bacalaureote nursing students, Unpublished doctoral dlsentation, The Un ‘erty of Alabama in Birmingham Manens, W. Ay & Lesstanns EJ, (1984) asuterent ind eoaluation tn education chloe ded} New York Hoh, rebar ae 1k, § (1961). Evidence and ethics in the valatian of tests. Educational Researcher, 10(9), 9-20, Mosse: CL (1947) A crtcal examination of ‘he concepts of face validly. Education and Plyshologiea! Measurement, 7, 101-205 Nuswaty J.C. (1978). Poyehometric theory {Gnd ed) New York, Meraw- til warts CW) cat KB, I), Nae ‘ng research: Desig, satstes and comput sronalges Phiadsicha FA, Dave Wien, ¥ MN Research ethedo logy end its application to murlng. New ‘York John Wiley and Sone, Use the handy order card in this issue to subseribe to | NURSING RESEARCH | 5NURSING RESEARCH MANUSCRIPT REVIEW PANEL Faye G, Abdellah, PRD, FAN Gene Cranston Anderson, PhD, FAAN Ruth M. Barnard, PhD, Bd Marjorie V. Bley, PhD, FAAN Jeanne Q. Benolti, DNS, FAAN Andrea U. Bireher, PAD, RN Kathleen N, Bondy, PhD, RN Ann Burgess, DNSe, FAAN Jacqueline 8: Chapman, PAD, RN Noel J. Chrisman, PRD, RN’ Jacqueline F, Clinton, PhD, FAAN Desmond F, 8. Cormack, PRD, BN ‘Mecca Cranley, PhD, RN Linda R. Cronenwet, PhD, RN Mary Cruise, DNS, RN Carol Deets, EdD, RN Donna Diers, MSN, FAAN Molly C. Dougherty, PhD, RN Mary E. Duffy, PhD, RN Mitzi. Dusbury, PhD, FAN Veronica Engle, PAD, RN Jacqueline Faweett, PAD, FAAN Geraldone Felton, EdD, FAN Joyce J. Fitzpatrick, PAD, FAAN Jacquelyn H. Flaskerud, PhD, FAAN Juanita W. Fleming, PhD, FAAN Elizabeth Geden, PLD, RN Carol Germain, EdD, FAAN Barbara Given, PRD, FAAN Susan R. Gortner, PhD, FAAN Effie S. Hanchett, PhD, RN Barbara C. Hansen, PhD, FAAN Shirley M. H. Hanson, PhD, FAAN Kay Hart, EdD, RN Sue T. Hegyvary, PhD, FAAN ‘Ada S. Hinshaw, PhD, FAAN Jacqueline R. Hott, PhD, FAAN Jeanne Howe, PhD, RN Sally Hutchinson, PhD, RN Barbara Jacobsen, MS ‘Ada Jacox, PhD, RN Anne Jalowiec, PhD, RN Jean E, Johnson, PhD, FAAN Susan L, Jones, PhD, RN Beatrice J. Kalisch, PhD, FAAN Shaké Ketefian, EdD, FAAN Karin T, Kirchhoff, PhD, RN ‘Norma J. Kolthoff, PhD, FAAN ‘Marlene Kramer, PhD, FAAN Janelle C. Krueger, PhD, FAAN Linda Lange, EdD, RN Elaine Larson, PhD, FAAN Anna Leach, PhD, RN Regina Lederman, PhD, FAAN Franees M. Lewis, PhD, RN Maxine E. Loomis, PhD, FAAN Barbara Lowery, EdD, FAAN Mary R. Lynn, PhD, RN 1986 American Nurses’ Foundation Research Grant Recipients Named American Nurses’ Foundation research grants for 1986 have been awarded to 27 regs tered nurses. Reeiptents are Donna Lee Algase, MSN, RN, Case Western Reserve University, "Prevalence and Temporal Pattern of Wandering"; Elaine Bagley, PhD, IRN, University of California, San Francisco Hospital, “Bagley Support Inventory: Contin- ‘ued Development and Testing’ Janet L. Blen- net, PhD, RN, San Diego State University, ‘Stimulus Intensity Modulation Seale: Devel ‘opment’; Sharon Ann Brown, MN, RN, Uni versity of Texas, “Effects of Educational Inter ventions on Knowledge, Sell-Care Behaviors, and Metabolic Control in Diabetie Adults: A Meta-Analysis of Findings"; Karen W. Budd, PHD, RN, Case Western Reserve University, Preterm Delivery: Predictors Beyond the So. loeconcmie Status”; Marc-Lee Catanzaro, TRD, RN, University of Washington, “Pole entity and Chronic llvess During Midlife"; Kathleen M. Costa, MSN, TUN, St, Jossph's Hor pital, “A Comparison of Colony Counts of Breast Mik Uullzing Two Methods of Breast Cleansing”; Karen E, Dennis, PRD, BN, Fran: cisScott Key Medical Center, "Control Prefer. ‘and Intervention Congruence” Margaret P. Gagne, MSN, KN, Medical Center Hospital Vermont, “Diabetes and Beast-Feeding: An Exploratory Study.” ‘Marcia M. Grant, MSN, RN, University of California, San Francisco, "Supporting, Oral Intake During Radiation "Therapy"; Deborah ‘Ann Gross, DNS, RN, Pace University, "Ma- ternal Confidence: Comparing Pre-Term/ lI"Term Groups": Pamela Hermansdorfer, RN, University of Florida, "Nursing 308 Administration Research Themes and. Meth- ods; Carol A. Landis, MS, RN, University of California, "Contribution of Pain to Disturbed Sleep in Artrtic Rats"; Jane G, Llewellyn, DNSe, RN, Rush-Presbyterian-St.- Luke's Medical Center, “Outcomes of Same Day Ad- ‘mission Surgery"; Naney K. Lowe, PhD, RN, Northern Ilinos University, “Testing the The: oreticalSiracture of the MeGill Pain Question naire in Parturient Women” Jean A. Massey, PhD, RN, University of South Carolina, “De- velopment of a Psychosomatic Self-Reglation Strategy Inventory"; Arlene C. Miller, MSN, AN, University of Cincinnati Medical Center, “Mluralvision® a5 Distraction for Control of Pain Judith A. Fitzerald Miller, MSN, RN, Marquette University, "Psychometric Evalus- tion of an Instrument to Measure Hope Ellen F. Olsharsky, DNSe, RN, C, Universi ty of Washington, “The Meaning of Infertility toa Marital Relationship"; Theresa Overield, PhD, RN, Brigham Young University, "Life. style and Health"; Constance A. Reid, MS, RN, Balward Hines Jr VA Hospital, "Efficacy of 3 Group Exercise Program in Long-Term Care"; Donna Lynn Rew, EdD, RN University of ‘Teas at Austin, “Intuitive Experiences of ‘Nurses in Clinial Nuesing Practice”; Barbara Sachs, PRD, RN, University of Kentucky, "Ma ternal Health Risks and Neonatal Outcomes"; Sharon L- Seandrett, PAD, RN, University of Tennessee, “Endogenous Healing Process ‘Among Elderly”; Sharon Willams Utz, PAD, INN, Medical College of Ohio, "Health State and Self-Care in Subjects with Mitral Valve Prolapie"; Willam R. Whetstone, PD, RN, University of Misouri—Columbia, “Health Ida Martinson, PhD, FAAN | Frank E. McLaughlin, PhD, FAAN Afaf I. Meleis, PhD, FAN Ramona TT. Mercer, PhD, FAAN Sally R. Miller, PhD, RN Barbara B. Minckley, DNSe, FAAN Margaret A, Newman, PhD, FAAN Jane S. Norbeck, DNSc, FAN. Lucille E. Notter, EdD, FAAN Kathleen O'Connell, PhD, RN Irene S. Palmer, PhD, FAAN Stephanie Pardue, EdD, RN L. Ghaite Parsons, PhD, RN Susan E, Pollock, PhD, RN Marjorie J. Powers, PhD, RN Susanne Rabb, PhD, FAAN Rozella M. Schlotfeldt, PhD, FAAN Elizabeth M. Seo, PhD, RN Dorothy 1, Sexton, EdD, RN ‘Anna M. Shannon, DNSe, FAAN Dorothy Sheahan, ‘PhD, RN Mary Jane Smith, PhD, RN Joanne Stevenson, PhD, FAAN Shirley M. Stinson, EdD, RN Marlene R. Ventura, EdD, FAAN Mary Jane Ward, PhD, FAAN Holly $. Wilson, PhD, FAN. Patricia Winstead-Fry, PhD, RN Naney F, Woods, PhD, FAAN Rosemary Ellis Rosemary Elis, PRD, FAAN, profesor Jemerta of nursing at the Frances Payne Bolton [School of Nursing, Case Western Reserve Uni versity, Cleveland, died October 10, 1986. De Elis was a longtime friend of and con ributor to Nursing Research, She served for ‘many years on the Manuscript Review Panel ‘She reeelved the BS. degree in nursing rom the University of California at San Frar- cisco, and the Ph.D. degree from the Univers ty of ilinols at Chicage. During World War I she was a Ist lieutenant in the Army Nurs Corps. At Case Western Heserve she taughe| pursing administration, education, and re-| search, she retied in July 1986, Dr. Elli received the American Nore Foundation’s Distinguished Contribution o| Nursing Seience Award in 1986, and a Con- gresional citation for her contribution to nus ing was awarded posthumously. Promotion of Older Adults: Pereeived Bate riers"; Naney Margaret Wineman, MSN, RN, University of Rochester, "Correlates of Adap- tation in Mukple Scleresis (Over $82,000 was awarded in 1086. Support for the program came from members of the ANF Century Club and corporate contributes: the Allstate Foundation, American Journal of ‘Nursing Company, American Nurses’ Associ tion, American Organization of Nurse Execu tives, Bristl-Meyers Fund, Burroughs Well- come Fund, C.¥, Mosby Company, Deluxe ‘Check Printers, March of Dimes Birth Defects Foundation, Nursing '86, Phzer Pharmaceuti- cals, and Sterling Drug, Ine NURSING RESEARCH