Currently submitted to: JMIR Medical Informatics
Date Submitted: May 30, 2026
Open Peer Review Period: Jun 17, 2026 - Aug 12, 2026
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Development, Content Validation, and Pilot Testing of a Digital Maturity Assessment Questionnaire for Integrated Healthcare Systems
ABSTRACT
Background:
Digital transformation in the healthcare sector plays a crucial role in improving operational efficiency, patient safety, and the quality of services provided. So, the measurement and assessment of digital transformation is primordial, for the evolution of any health care service. Around the world there are some instruments that already do this, but in Portugal there is none that is suited for the Portuguese context and that will assess the digital maturity of Integrated Healthcare Systems.
Objective:
This study aimed to validate a questionnaire for assessing the digital maturity of Integrated Healthcare Systems, ensuring its reliability and suitability for the Portuguese context.
Methods:
This is a mixed-methods study that was conducted in two phases: The first was content validation. This phase started with two Focus Groups where experts in the field to discussed the construction and global understanding of the questionnaire. Next, still in the first phase, to verify the clarity, relevance, and coherence of the items, a Delphi methodology was used, where experts reviewed the questionnaire. The second phase was a pilot testing. It was conducted with a sample of healthcare professionals from Local Health Units to assess the instrument's internal consistency, feasibility, and preliminary reliability. After data collection, a statistical analysis of the instrument’s structure and reliability was conducted.
Results:
The final instrument includes sixty-five items across four dimensions. Content validation through a two-round Delphi process showed improved experts’ consensus between rounds, with S-CVI/Ave values increasing from 0.69-0.79-0.76 (clarity, relevance, coherence) to 0.93-0.96-0.95, respectively. Pilot testing with twenty-eight respondents demonstrated high internal consistency across all dimensions, with Cronbach’s alpha values ranging from 0.877 to 0.948. No items were removed after reliability analysis.
Conclusions:
The questionnaire presented in this study is demonstrated satisfactory content validity and feasibility for assessing digital maturity in Integrated Healthcare Systems. By supporting the assessment of digital maturity, the instrument may contribute to improvements in service delivery, operational efficiency, patient safety and overall quality of care. Further research is needed to evaluate additional psychometric properties and conrfirm its applicability in different healthcare settingsy. To the author’s knowledge, this is the first instrument designed to assess digital maturity in vertically integrated healthcare systems within a European Union context, offering a potential strategic blueprint for other Member States advancing integrated care models.
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