CONTENT VALIDITY OF TECHNOLOGY INFORMATICS GUIDING EDUCATION REFORM (TIGER) ASSESSMENT INSTRUMENT FOR INFORMATICS COMPETENCIES OF GRADUATING NURSING STUDENT. OF ADVANCED

1. College of Health Sciences, Mindanao State University, Marawi City, Philippines. 2. San Pedro College, Davao City, Philippines. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 09 September 2018 Final Accepted: 11 October 2018 Published: November 2018

Informatics competencies assessment instrument developed by Technology Informatics Guiding Education Reform (TIGER) is an essential tool for appraising the graduating student nurses' competencies in nursing informatics. The TIGER recommended informatics competencies developed through collaborative effort of expert health care professionals abroad, validation of its content was not appraised in the Philippine setting. A need for further validation supports universal practical application of the tool despite variations in the age of technology country-by-country. Hence, this paper aims to examine the content validity of TIGER assessment instrument for informatics competencies in the context of graduating student nurses. Methods employed are literature review and 4-point scale content validity questionnaire rating each item for relevance, ambiguity, clarity, and simplicity. The assessment tool as divided into three domaincomputer competencies with eleven main items and 211 sub-items, information literacy competencies with five main items and 39 subitems, and information management competencies with five main items and 70sub-items has been evaluated through Content Validity Ratio (CVR), Content Validity Index (CVI) and Modified Kappa Coefficient (K*). The result for CVR scores revealed that 308 out of320 items are considered critical by the content experts. Then, CVI and K* revealed that still 308items under the three domains of informatics competencies are appropriate and excellent while the remaining 12 were reasonably deleted. Thus, the instrument is a valid and excellent instrument to address informatics competencies of graduating student nurses in the country.

Methodology: -
The research technique employed in this inquiry is quantitative through itemized questionnaire with four-point rating scale based on the literature suggested criteria for measuring content validity [5]. It has been circulated to pooled content experts. The purpose was to identify the content validity of NI competencies assessment instrument to facilitate construct validity and reliability for actual administration to a large number of populations in the context of graduating student nurses. Results has been assessed through Content Validity Ratio (CVR), Content Validity Index (CVI) two approaches (i.e. Item Level Content Validity Index [I-CVI's] and Scale Level Content Validity Index [S-CVI's]) with Modified Kappa Coefficient (K*) discussed below.

Literature Review
The researcher primarily conducted literature review of NI competencies [1,2,3,4] in order to explore important components of NI competencies in the context of graduating student nurses. This is to develop a standard NI competencies instrument in the form of a checklist type questionnaire. Review on different content validity studies has conducted to determine appropriate methods of validating an instrument [5,6,7].

Questionnaire survey
The NI competencies assessment instrument developed and recommended by TIGER was the subject of this research after appraisal of literature [1] from reputable databases. Based on review of other sources showed that items or statements deemed important for identifying NI competencies are reflected in the TIGER NI competencies assessment instrument [1][2][3][4]. It is composed of three dimensions or constructs -basic computer competency with 18items and 211-sub-items; information literacy competency with 5-items and 39-sub-items; and information management competency having 9-items and 70-sub-items.

Classification of respondents.
There were fifteen respondents as context expert validators considered by the researcher but only nine returned the instrument after giving ample time. They were approached and contacted by the researcher based on their available time physically and virtually to discuss the purpose and aim of the study. The decision in choosing the number of 684 experts were based on literature in consideration to use both the Content Validity Ratio (CVR) and the Item Level Content Validity Index (I-CVI) [6,8]. Other authors have suggested at least five number of experts for validation [6,[9][10]. But in this study, it deduced to nine number of experts who participated which deemed to be acceptable compared to the set norms [12]. Table 1 shows the number of respondents, expertise, area of designation and length of experience in years. Notably, all of the nine respondents have more than 10 years of experience in which postulated by Benner's as experts in her Novice to Expert Theory.

Content Validity Ratio (CVR).
According to Yaghmaie [5], content validity is not highly regarded as important process by researchers may not actually measures what it intends to measure. CVR is employed in this study through expert's proportional level of agreement in evaluating an item as essential. A 3-point scale has been applied in rating each item; (3) essential; (2) useful but not essential; and (1) not necessary [7,11]. The CVR mean score of each item were then compared to CVR critical table of Ayre and Scally [12] in deducing item as very important. Table 2 shows the CVR critical table [12].
(ne − (N / 2)) Content Validity Ratio (CVR)= [11] (N / 2) where, ne: number of expert's panel members indicating an item 'essential' N: number of expert's panel members  (1) irrelevant. CVI has been applied to take the mean of all retained or remaining items. The Item Level Content Validity Index (I-CVI's) and Scale Level Content Validity Index (S-CVI's) as two approaches suggested by Polit and Beck [6] has been considered in this research. The former deals with computing the relevancy of an items based on the number of experts who gave a relevance rating of 3 or 4 over the total number of experts. While the latter then deals with the proportion of total items on an instrument that had achieved a rating of 3 or 4.

Modified Kappa Coefficient (K*).
Modified Kappa Coefficient is used in this study to address possible inflated values as a result of chance agreement. The combination of CVI and K* are used to provide computable methods for appraising the level of agreement between content experts. Formula below shows that Probability of Chane agreement (Pc) has been computed first using the value of I-CVI followed by computing the K*

Findings and Discussion: -
The presentation and discussion of findings were arranged based on the analysis of CVR, CVI, and K*. Table 3shows the name and the number of constructs (i.e., Basic Computer Competency; Information Literacy Competencies; and Information Management Competencies) together with the title of items and the number of subitems. The NI competencies comprised of 320 items rooted from the three constructs. The items with the number of sub-items under Basic Computer Competency are hardware-13, software-5, networks-9, ICT in everyday life-19, security-8, law-7, operating system-17, file management-26, utilities-6, print management-5, using the application-5, the internet-5, using the browser-19, using the web-6, web outputs-6, electronic communication-14, using e-mail-19, and e-mail management-10. Then Information Literacy competencies is comprised of items namely as knowledge-3, access-9, evaluates information and its sources critically-11, use information effectively to accomplish a specific purpose-8, and evaluate outcomes of the use of information-8. Lastly, information management competencies have demographic/ patient info-9, consents and authorizations-3, medications management-7, planning care-6, order/results management-6, care documentation-4, decision support-21, notifications-8, and facilitating communications-6.

Analysis of the Content Validity
Thus, the developed content of NI competencies questionnaire after careful content validation infers qualification to construct validity through Exploratory Factor Analysis (EFA) complemented with Confirmatory Factor Analysis (CFA). Reliability test may also follow to finally arrive into conclusion that NI competencies instrument is valid and reliable.

Content Validity Ratio (CVR)
The data responses of the respondents' content experts were encoded in the IBM-SPSS application to compute for the CVR. Table 4 shows that the utmost critical items were 308 out of 320 based on the judgment of content experts. The 308 items deemed critical (210 items in computer literacy competencies; 33 in information literacy competencies; and 65 in information management competencies) based on comparison with CVR critical table which requires that for an item to be critical with panel size of 9 (N=9) is 8 (Ncritical), 0.889 (proportion agreeing essential), and 0.788 (CVR critical) [12]. Moreover, these 308 items were deemed critical to be retained and included in NI competencies instrument as a probable tool to be used in the context of graduating student nurses. The remaining 12 items has been considered for further content evaluation using CVI and K* testing.

Content Validity Index (CVI) and Modified Kappa Coefficient (K*)
687 Table 5 below shows that Item Content Validity Index (I-CVI), number of items, score together with range value of K*, number of items, and score. Based on the scores in the I-CVI, 308 items ranged from 0.899 to 1.000 are classified as appropriate (greater than 0.79 I-CVI); 4 items need revision (within range of 0.70 -0.79 I-CVI); and 8 items are reasonable to be eliminated (less than 0.70 I-CVI).  [14], Cicchetti and Sparrow [15] and Polit&Beck [6] Moreover, apart from I-CVI, all items (320) has been evaluated based on K* scores. It shows that 308 items are excellent (greater than 0.74 K*), 0good (within range of 0.60 -0.74 K*), 4fair (within range of 0.40 -0.59 K*), and 8 poor (less than 0.40 K*). Hence, it is also reasonable to eliminate the 12 items. This means that the total no of items based on the combination of I-CVI and K* is 308 items.

Conclusion: -
After CVR appraisal by content experts to theNI competencies instrument revealed that only 308 out of 320 items are regarded as the most critical based on comparison in the table of CVR critical table. Items of each construct has trimmed down as follows: basic computer competency -210 items; information literacy competencies -33 items; and information management competencies -65 items. Nonetheless, the remaining 12 items were tested for CVI and K* revealed that these items are reasonable to eliminate (I-CVI = < 0.70) because is either fair (K* = 0.40-0.59) or poor (K* = < 0.40).
The process of content validity in this research is considered robust as the method applied is systematic and subjected to three stages: CVR, CVI, and K*. Thus, this research has better basis and foundation of content validity particularly the NI competencies instrument. It means it could be administered for actual data gathering among graduating nursing students and be further validated using EFA and CFA which in the long end result to a very valid instrument.