Development of an instrument to measure the attitudes and skills of undergraduate nursing students in caring for family caregivers: An international multi-method study

The increasing demands on family caregivers due to the shortage of healthcare professionals and the rising prevalence of chronic conditions underscore the need for adequate nursing support to enhance family caregivers' abilities and reduce their burden. No instrument exists to measure undergraduate nursing students' attitudes and skills in involving family caregivers. This study aimed to develop a questionnaire to evaluate undergraduate nursing students' attitudes and skills in caring for family caregivers. A three-phase multi-method study was conducted involving a consortium of five universities in Italy, Denmark, India, Spain, and Sweden. Theoretical models and literature analysis and review informed initial item generation. Then, a Delphi process with purposefully selected international experts across three rounds refined the item list based on clarity, essentiality, and relevance, achieving consensus on a final set of items. Finally, pilot testing with purposefully selected 25 students assessed face validity and clarity. The preliminary phase led to 130 items. Delphi rounds reduced the initial 130 items to a refined set of 39 (13 items on attitudes, 26 on skills). Content Validity Index (CVI) scores for clarity and relevance were high (S-CVI/Ave = 0.93 for clarity, 1.0 for relevance). From the pilot test among 25 students, items scored an average clarity of 0.84 (I-CVI). Two items were removed, resulting in a final 37-item questionnaire (12 attitudes, 25 skills). The developed questionnaire bridges a gap in nursing education assessment. Emphasizing attitudes and skills, it addresses key areas such as understanding family dynamics, emotional support, and collaborative planning with caregivers, aligning with nursing education needs across diverse cultural contexts. The use of this instrument will support educational programs in enhancing family-centered care competencies of undergraduate nursing students, ultimately improving support for family caregivers in healthcare settings.