Table 6 The content validity (CVI) tracking matrix

Steps

Clarity

Relevance

A /B /C**

I: CVI and individual think-aloud

.71 (13/26)

.70 (14/26)

7/12/0

Input of reformulations into more concrete language with reductions of double meanings for some of the items.

II: CVI and focus group interview

.73 (15/26)

.70 (13/26)

5/17/0

Input of reformulations of language, grammar, differentiation of group- and individual outcomes and adding “ethics” to some items. Foremost, items belonging to the domains ‘Improvement on organizational level’ and ‘Concrete results’ were questioned.

III: Mailed CVI

.88 (23/26)

.77 (14/26)

11/9/2

Input of sharper English everyday formulations from the British respondents. The Dutch respondents foremost pointed out overlapping items, but different ones pointed out. The items “Reach answers what the ethical problems are” and “Learn to formulate questions about ethical issues” were discarded, due to low clarity and relevance. Two items were brought back: “Enhances my understanding of ethical theories (ethical principles, values and norms)” and “I understand better what it means to be a good professional”.

IV: CVI and individual think-alouds

.94 (21/26)

.85 (23/26)

0/2/0

In the Swedish translation, there were still ambiguous interpretations of the following items: 15, 20, 22, 23, 25 (Table 4). The critique centred on that policy work does not reach staff working on the floor and also on the interpretation what a “good professional” is. Reformulations followed of number 22 and 23, also in the English version.

V: CVI and focus groups

.91 (24/26)

.87 (20/26)

5/12/0

In the Dutch translation, the participants of the focus groups were positive about the clarity and the relevance of the items, although some thought some were still rather abstract. Furthermore, some thought that some items did not fit within their view on MCD. Some problems of clarity were interpreted to be related to the translation into Dutch. Ambiguous interpretations of item 6 and 15 (Table 4).

VI CVI and focus group

.96

.77

3/6/0

In the French focus group, participants were able to see both the English and French version. Three types of reformulation input: grammatical precision, formal clarity and substantial clarification of terms where relevance was questioned. For example, the item 22 (Table 4) became in French “contribute to the evolution of individual and collective practices”, recognizing the importance of the political dimension included in the care activity. Somewhat ambiguous interpretation of 6, 13, 15, 20 and 23.

VII CVI and individual think-alouds

.95

.95

4/7/0

The Norwegians questioned foremost the clarity of the items 20 and 23, especially the meaning of being a good professional. Revison was conducted after answers from five respondents and after next five, the CVI was improved.